With a physician leading your team, you’re getting the best quality healthcare | Opinion

The world of healthcare and medicine can be complicated. From APRNs, NPs and PAs to MDs and DOs, how is a patient to understand the differences between the many medical professionals they see?

You likely recognize the titles nurse practitioner (NP) and physician assistant (PA), and you’ve probably been treated by them many times. The ecosystem of each of these highly trained medical professionals is a valuable one when all are working together to achieve a common goal: providing patients the highest quality care in the most efficient manner.

In Florida, however, advanced practice registered nurses (APRNs) can practice medicine independently, without the supervision of a physician, within certain parameters, under the Board of Nursing.

Prior to legislation passing, only a medical doctor (MD) or a doctor of osteopathic medicine (DO) was permitted to practice medicine independently by the Board of Medicine. That’s because of the rigorous education and clinical training requirements that medical students undertake — properly equipping them to diagnose and treat patient conditions.

Medical students spend four years learning concepts regarding the entire human body before undertaking residency training in their specialty to further understand and treat a patient’s full range of medical conditions. At a minimum, physicians complete at least seven years of training after their bachelor’s degree, totaling more than 15,000 hours of medical clinical training.

On the other hand, an APRN must complete an additional two to three years of training after nursing school, with 500-720 total hours of medical clinical training required. In Florida, an APRN is then technically qualified to enter independent practice.

In looking at the differences in clinical training and education, we can examine the most appropriate, safe and affordable care setting for patients — and that’s a physician-led, team-based approach to care.

How does a physician-led care team lead to more affordable patient care?

When non-physician medical associations lobbied to expand their scope of practice, a central argument was that allowing independent practice would bring patients increased access to healthcare at a time when our country is experiencing a physician shortage. The American Medical Association (AMA) and American Academy of Family Physicians (AAFP) carefully examined this claim.

The AMA reported in a recent study of healthcare in Mississippi, a state that allows certain non-physicians to practice independently, that cost data revealed that care provided by non-physicians was more expensive than care delivered by physicians.

Another study by the AAFP examined the impact of scope expansion on the health-professional shortage in Washington, another state that allows nurse practitioners to work independently. The study revealed a continued health-professional shortage in nearly 70% of Washington’s counties.

On the affordability side, these studies also found care led by a physician resulted in fewer emergency-room visits, fewer hospital admissions and readmissions, shorter hospital stays and lower healthcare costs overall for the patient.

When a physician is the lead of the patient-care team and the entire team works together, the team can more effectively deliver high-quality, efficient care to give the patient the best outcome.

What does that look like in practice?

As the physician for Baptist Health and a team physician for three local professional teams and two local universities, I have seen the power of the team-based healthcare approach. Without the contributions and care of mid-level practitioners, it would be difficult to treat patients.

For example, osteoporosis and fragility fractures are common issues for patients in the South Florida area. When we identify a fracture, we will prescribe the appropriate medication to avoid a second fracture. The pharmacist on our team helps with ordering the medicines, monitors the labs that we need to order and reminds us when it is time for a refill. The nurse practitioner sees these patients and helps manage a patient’s osteoporosis. We work through a collaborative relationship.

Another big issue for our patients is arthritis. At Baptist Health, we trained a physician assistant to see patients for an initial visit. The PA evaluates the patient and begins proper treatment. Most patients need a history review, examination, X-ray and education on several treatment options. The PA sees the patient and begins the appropriate treatment plan, consulting with a physician along the way. The PA is in the same office space, which allows for open communication.

Working in a collaborative, team-based environment gives me confidence that our patients walk away with the best quality of care after every visit. The next time you need medical attention, make sure to ask who is leading your care team.

Michael Swartzon, M.D., is a physician at Baptist Health and also serves as the team physician for the Miami Dolphins, InterMiami CF and the Florida Panthers.

This story was originally published April 18, 2022 at 5:47 PM.