“A visit to the doctor may mean seeing someone else instead.
An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising doctor still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions. These include adjusting medication dosage, ensuring that patients receive tests and helping them to manage chronic diseases.
“I can’t possibly do everything that needs to be done for our patients as a single human being,” says Kirsten Meisinger, supervising physician for a team of between nine and 11 medical professionals at the Union Square Family Health Center in Somerville, Mass., one of 15 primary-care centers run by Harvard Medical School-affiliated Cambridge Health Alliance. For example, Dr. Meisinger says she may see a diabetic patient once every three months. But nurses on her team generally see the patient more frequently and for longer visits. And patients are likely to feel more comfortable telling a nurse than a doctor if, for instance, they haven’t been taking their medication, she says.
The new approach, called team-based care, comes amid a shortage in many parts of the U.S. of primary-care physicians, a situation expected to worsen as the number of new patients obtaining insurance under the federal Affordable Care Act rises. Pervasive chronic diseases such as diabetes also are straining the health-care system.
“In many primary-care practices today, physicians are doing a great deal of work that could be done by others on the team,” says Don Goldmann, chief medical officer of the Institute for Healthcare Improvement, in Cambridge, Mass., a nonprofit that works with medical practices to improve delivery of health care. Dr. Goldmann expects that within 10 years team-based care “will be the norm.”