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It's time to involve everyone, including nonphysician providers, in the healthcare team. That requires not falling back on the ways we have always done things.
It seems that the past year has been a real turning point in the increased importance of the team practice of medicine. The Affordable Care Act, along with other things like quality standards in medicine tied to reimbursement, has elevated scrutiny of how to assist healthcare teams and organizations perform better. Physician assistants have been uniquely positioned and trained as high-level providers in physician-led team practice for decades.
I work in an inpatient setting, and over the past 18 months there has been an explosion of the number of providers other than physicians working at our hospital. There are higher numbers of PAs, nurse practitioners, and certified registered nurse anesthetists working at our community hospital than ever before, and more are being hired every month.
They are a critical part of the outpatient, inpatient, and surgical teams at our facility; although we could not deliver the volume of high quality care that we do at our hospital without the dedicated physicians and other providers who are credentialed to practice medicine.
As I began to work in medical staff leadership over the past three years, I quickly realized that there was a major impediment to team practice at our hospital - and that was that PAs, NPs, and CRNAs, although credentialed by the medical staff in the same manner as physicians, were not allowed membership in the medical staff. We have due process, and the ability to be assigned to committee (without a vote), but no real voice in the governance of our hospital.
That didn’t sit right with me or the other nonphysician providers, nor did it sit right with my practice partner, who currently serves as chief of surgery. We formed an exploratory group to look at the issue of our medical staff bylaws, and to come up with some suggestions as to how to better integrate and involve nonphysicians in the healthcare team.
There are a lot of good reasons to include all direct care providers in hospital governance and leadership. PAs, NPs, and CRNAs should be medical staff members to ensure:
• Rapid exchange of critical information on clinical issues
• Sharing of important information on medical staff policies
• Timely input on policies affecting their practice
• Participation in quality review programs
• Full participation on medical care and administrative committees as appropriate
• High-quality patient care by all medical providers
While I can only speak with authority about PAs, we believe in the practice of medicine on physician-led teams. This makes sense in private practice, as well as within an organization the size of our hospital. However, PAs, NPs, and CRNAs have a lot of expertise and experience that is invaluable to the collective governance of our hospital. Up until this point, all officers on medical staff are required to be physicians.
While this makes sense for chief of staff, vice chief of staff, and the medical department chairs, do the chairs of the quality, CME, and clinical practice improvement committees (all largely administrative committees) really always require physician leadership? Are we failing in our healthcare organizations to effectively use all the talents at our disposal to better govern the practice of medicine, and ultimately better serve the patients who rely on us for their care? We hope to change this also at our facility and allow PAs, NPs, and CRNAs a role in medical staff leadership.
While I’m a traditionalist in a lot of ways, I also want to find ways to better involve the healthcare team at my facility, and at every facility in the healthcare system. That requires that we don’t fall back on the way in which we have always done it, and look to develop better, more cohesive teams in medicine. Everyone benefits when we maximize the contributions of all members of the healthcare team.
I’m a realist when it comes to this sort of stuff, having been a veteran of many policy and legislative struggles over my long career. Although our team has the support of the chief of staff, as well as all the major department heads, we will see how this shakes out in the coming months.
This blog was provided in partnership with the American Academy of Physician Assistants.