Study: Diversifying medical staffing patterns could improve productivity

Continuously challenged by complex reform policies and the goal of ensuring high quality care at low costs while still maintaining profitability, healthcare providers must also continuously look for ways to improve productivity.

The U.S. is experiencing a physician "mal-distribution," or an inadequate supply of primary care physicians in many non-metropolitan regions. One way health experts have recommended addressing this issue and to improve the quality of care delivered is for medical practices to transform and embrace "team-based" care, in which a broad range of medical staff work together.

A new study published in Health Affairs identified and analyzed different types of medical staffing patterns and the contributions of different types of staff to productivity at community health centers across the U.S.

Using data from a sample of 1,191 community health centers, representing 8,900 clinical sites in 2012, researchers classified medical staff into four categories: (1) physicians, (2) advanced-practice staff (nurse practitioners, physician assistants and certified nurse-midwives), (3) nurses (registered, licensed vocational and practical nurses) and (4) other medical staff (including medical assistants, nurse aides and lab or radiology staff). Productivity was defined as the number of weighted medical visits per center in 2012 (weighted to account for the complexity of care required, which could also influence the type of staff involved in care).

The study found physicians contribute to productivity the most, but other medical staff members make significant contributions and ultimately increase the amount of care that can be delivered. Engaging in team-based care could help ease the strain on a limited number of physicians in underserved areas and ensure more patients are seen.

The study found that productivity levels were relatively similar across all configurations and there did not appear to be an optimal pattern. Medical practices can be productive with various staffing patterns of physicians, advanced-practice staff, nurses and other medical staff.

According to the study, nurses and other medical staff complement physicians and advanced-practice staff's diagnostic work by assisting in tasks that require less-specialized skills, like administrative tasks, patient education and quality assurance.

Expanding the role of non-physician providers can increase productivity and the quality of care delivery. According to another report cited in the study, the use of medical assistants as health coaches was associated with improved patient outcomes.

The study also said that in some cases, advanced-practice staff can serve in similar functions as physicians, such as making diagnoses or issuing prescriptions, and therefore these non-physician providers can help fill in where physicians are lacking. With a physician's authorization, advanced-practice staff can diagnose and prescribe, even in states with restrictive scope-of-practice laws.

Data from the National Ambulatory Medical Care Survey found that advanced practice staff were more involved in providing preventive and follow-up care to patients than physicians, though physicians still saw patients with more complex conditions.

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