AAFP Cautions Against Stop-Gap Efforts to Solve Primary Care Shortage

Physician-Led, Team-Based Care is Key to Better Outcomes, Access and Cost Savings

Tuesday, September 18, 2012


LEAWOOD, Kan. — The U.S. health care system can meet the nation’s need for primary care providers by fully implementing physician-led patient-centered medical homes, according to a new report released today by the American Academy of Family Physicians. The report, “Primary Care for the 21st Century,” lays out the research that supports team-based care and its ability to transform primary care in the United States. It focuses on the need for this team-based approach to improve quality and cost efficiency in the American health care system.

In the report, the AAFP cautions against substituting nurse practitioners for physicians as a stop-gap answer to the primary care physician shortage. Such a solution flies in the face of multiple studies that demonstrate the best, most efficient care is provided by teams of health professionals in the patient-centered medical home led by physicians, not independent practice by a single non-physician health professional.

The PCMH model improves the quality of care because it capitalizes on the unique expertise of each member of the patient’s health care team, according to Roland Goertz, MD, chair of the AAFP Board of Directors. In doing so, it expands access to services while ensuring each patient is under the care of a physician. Research has demonstrated that teams of health professionals in the PCMH improve quality; reduce unnecessary tests, procedures and hospitalizations; and result in lower patient-care costs.

The answer lies in the team-based care that gives patients access to their primary care physician as well as their nurse practitioner, physician assistant or any other professional involved in their care, according to Goertz.

“Wholesale substitution of non-physician health care providers for physicians is not the solution, especially at a time when primary care practices are being called upon to take on more complex care,” he said. “Patients need access to every member of their health care team — starting with a primary care physician, nurse practitioners, physician assistants, and all the other professionals who provide health care. Creating a system in which some patients have access to only a nurse practitioner is endorsing two-tiered care. That doesn’t happen in the physician-led patient-centered medical home, and we believe all Americans should have access to this quality of care.”

Patients understand and care about the disparities in training. According to the American Medical Association, more than nine out of ten respondents to a recent survey said a physician’s years of education and training are vital to the best patient care, especially in emergency and complicated situations. And three out of four patients said they prefer to be treated by a physician.

Education and training of physicians and advance practice registered nurses are substantially different, and physicians and nurses are not interchangeable, according to Goertz, who added, “Their levels of knowledge and skills are complementary, but they are not equivalent.”

The report notes that primary care physicians complete 21,700 hours of education and clinical training during 11 years, compared to nurse practitioners’ 5,350 hours of education and clinical training during five to seven years. All family physicians complete a four-year undergraduate degree and a four-year medical school program. They must pass two tests given by U.S. Medical Licensing Examinations to earn their medical degree before beginning their three-year primary care physician residency training. The result is a health professional who “brings breadth and depth to the diagnosis and treatment of all health problems, from strep throat to chronic obstructive pulmonary disease, from stress headaches to refractory multiple sclerosis,” the AAFP report says.

Although 11 states and the District of Columbia don’t require a master’s degree to be a nurse practitioner, most NPs are registered nurses who have completed their nursing education through a one-and-a-half- to three-year degree program that confers a Master of Science in Nursing degree. Their training gives them expertise in epidemiology and community health, as well as treating patients who require basic preventive care or treatment of straightforward acute illness or uncomplicated, previously diagnosed chronic conditions.

“Together, the physician and nurse practitioner comprise an extraordinary team of professionals whose expertise supports and complements each other in the patient-centered medical home,” said Goertz.

The report has garnered support from the American Academy of Pediatrics, the Medical Association and the American Osteopathic Organization, which have joined the AAFP in advocating for the PCMH.

“The American Academy of Pediatrics believes that the optimal care of infants, children, adolescents, and young adults is delivered within the patient-centered medical home model by a physician-led team composed of appropriately documented and trained clinicians,” said AAP President Robert W. Block, MD, FAAP.

Jeremy A. Lazarus, MD, president of the American Medical Association, agreed. “The AMA commends the AAFP for their outstanding work on this timely subject,” he said. “The AMA and AAFP recognize that the physician-led team approach to care is key to ensuring patients receive high-quality, cost effective care, and most Americans agree. According to a recent AMA survey, 86 percent of respondents said that patients benefit when a physician leads the primary care team. Physicians and other health professionals have long worked together to meet patient needs for a reason — the physician-led team approach to care works. Patients win when each member of their health care team plays the role they are educated and trained to play.”

AOA Executive Director John B. Crosby, JD, concurred. “As the professional organization representing more than 100,000 DOs and osteopathic medical students, the American Osteopathic Association recognizes the important role of a team approach to health care for our patients,” he said. “While there is an unarguable need for more primary care providers in this country, this report underscores our belief that a team led by a fully licensed physician — DO or MD — is the best way to ensure that patients receive the highest level of care.”

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Founded in 1947, the American Academy of Family Physicians represents 134,600 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

To learn more about the AAFP and family medicine, visit www.aafp.org/media. Follow us on Twitter,(twitter.com) and like us on Facebook. For information about health care, health conditions and wellness, visit the AAFP’s award-winning consumer website, www.familydoctor.org(familydoctor.org).