The new practitioner: 3 health system leaders on how teams are changing the value of care

The conventional role of the provider is changing. Where physicians once stood alone, a team of practitioners is emerging to more efficiently provide high-value care across patient populations.

This content is sponsored by Integrated Healthcare Strategies.

These changes mean new skill sets are needed — in health education, disease management and teamwork. Understanding and addressing this workforce change and the skills required to survive it will be essential for the success of hospitals today and tomorrow. The following health system leaders provided some perspective on how this change is playing out at their hospitals and what they are doing to stay abreast of the transformation.

  • Scott Nygaard, MD, CMO of Lee Memorial Health System (Fort Myers, Fla.)
  • Diane Postler-Slattery, PhD, President and CEO of MidMichigan Health (Midland)
  • Tim Rice, President and CEO of Lakewood Health System (Staples, Minn.)

Editor's note: Responses have been edited lightly for length and style.

Question: How has the role of the physician or practitioner evolved over the past decade?

Dr. Diane Postler-Slattery: Physicians have had to learn to work with other caregivers such as nurse practitioners, physician assistants and registered nurses. They have had to learn to delegate and function at a high level with other members of the team. Physicians have also had to become versed in the business aspect of their practices as reimbursement models and regulations have changed the practice environment. 

Dr. Scott Nygaard: Really the challenge for physicians is learning that this transformation is much more managing a team of people to provide care as opposed to thinking, 'All the burden falls on me and I have to be everything to everybody.' They are becoming the leaders of teams, particularly on the primary care side.

Tim Rice: One of the key changes to practitioners' roles is increased accountability — all the accountability expectations to be compliant, and meet quality and cost standards. The interesting thing is how this increased accountability has impacted the time with patients and quality of life. It includes a lot more EHR documentation, collecting and reviewing data. Entering everything electronically takes a lot more time, so physicians are getting out of work two to three hours later. Their quality of life and time with family is declining.

Q: What skill sets are essential for practitioners today that were not as pressing 10 years ago?

SN: We used to think we were the masters of knowledge. Now we are trying to help people navigate the avenues of access to information they have. We are helping patients discern the information they have collected before a visit — often, patients have in hand so much information they are more studied than the physician. The practitioner's job is to partner with patients and help them navigate decision making based on their values, wants and needs.

DPS: Clearly, strong clinical skills are still absolutely critical. Because of the emerging team environment, skills like communication, trust, delegation, collaboration and networking with patients and colleagues are now more important than 10 years ago.

TR: Having a high EQ, or emotional quotient, is one essential skill for practitioners today. It basically is the ability to understand people. Now every provider who comes here [to Lakewood] has to take an EQ test. This helps us get to the next skill, which is the ability to work as a team. It's such an important skill set today to be effective in all that is changing. Lastly, providers need to have the ability to know how to adapt to change.

Q: How has technology specifically shaped the role of today's caregiver team?

SN: We are finally getting into an area of analytics where a lot of data fragments are getting organized in a manner that leads to better insights about patient care. Demographic, clinical, socioeconomic information and bio-surveillance information on infection — all kinds of information can now better the patient and their care.

Even though 'population heath' is a buzzword among providers, from the patient perspective healthcare is still one patient at a time. It used to be if physicians had a patient in front of them, and it took 15 to 20 minutes to find information, they might reorder tests — adding more costs — because it was easier than finding the information. Now this information is organized in a way that practitioners can bring up a screen and see gaps in care or the need for certain tests. It makes them more efficient and effective as a team.

DPS: The EHR has brought so many changes; not only in practitioners' daily tasks, but also in the way they do them. They have access to so much data to help manage patient care. They can take a look at a patient's record and see trending information, vital stats or lab data. The fact they can see all of that has helped practitioners today make better decisions regarding interventions and future care. It has also helped staff, working as a collaborative team, look at trends in their own practice and develop specific care protocols based on patterns they see in their own practice.

TR: Technology has definitely helped practitioners. We have satellite locations access and transfer data with our EHR. It's all about working together, but technology only allows it to a certain degree. The rest has to be teams of people, externally and internally, who work together to determine how we can use technology to make sure our patients are safe.

Q: How do you think advanced practice clinicians will impact patients' views of practitioners and the perceived value of care?

SN: That's complex. Most people like seeing an advanced practitioner — they have more time and availability to sit down with patients, communicate care plans and coordinate care — but it's somewhat generational. It also depends how advanced practitioners work in a practice — some do sick visits, others do well care or overflow care. In general, people are becoming more accustomed to advanced practitioners and find them helpful in terms of rendering care.

DPS: Physicians are increasingly working in team environments, and my perception is patients will be seeing more of this team approach. Patients may not distinguish between the work a physician, NP or PA is doing, because if it's a well-orchestrated collaboration, everybody will be interacting with the patient at the right time. At times, the physician should conduct the visit because of the diagnosis, or it may be the exact right time for the PA and NP to have that interaction with the patient. My hope is that patients value the right team member at the right moment.

TR: We are putting a care coordination model in place that pairs an advanced practice clinician with a primary care physician and develops them as a team. Basically, it allows both practitioners to work at the top of their licenses, work as a cohesive team and support each other. It helps the patient's view of both. APCs will play a key role in the future of healthcare, and when paired with physicians, they both provide a much greater value of care. The model has been working really well for us.

Q: How does your organization encourage and support coordination among members of the care team?

SN: [Lee Memorial] uses a patient-centered medical home model. All care team members contribute to the overall wellbeing and outcomes of the patient. We are still in the early phases of the broader work — how to reach out to home health agencies, skilled nursing facilities and other members of the community. What it really means to be clinically integrated and have a community-based health system is not as well organized yet.

DPS: One way is safety rounding. All members of the team participate and focus on patient safety — making sure we have the best environment for patients. We do hospital rounding with an orchestrated team of practitioners, sometimes including pharmacists, nutritionists and social workers, who all meet to make sure patients are getting the exact treatment and interventions they need. In the clinic setting, we use a dyad leadership model, where a physician and an administrator manage the practices. And systemwide, we are creating a model called relationship-based care as a fundamental model for care delivery. There are a number of tenets, but it's really all about building the relationship with the patient from all caregivers' perspectives.

TR: We are in the process of putting in place a new care coordination model. We put a resiliency officer in place to work with providers, leaders and other employees. The specific concept is to focus on helping them with quality of life and work. We also use a dyad leadership model throughout the system with an administrative person and a clinical leader. It's really helpful, because you have the medical and business perspective and end up with better decisions. Lastly, we try to have fun. We try to have regular social gatherings — because how can you support each other if you don't know each other?


More articles on integration and physician issues:

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Saint Louis University receives $1.9M grant to train medical residents, therapy students

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