Taking doctors out of health care doesn’t work

It’s no secret that our country has serious health care challenges. From rising care costs to a shortage of medical professionals, there are a lot of ideas and opinions out there on how to solve these challenges.

One such solution approved by the Florida Legislature in March 2020 was a scope of practice expansion, allowing advanced practice registered nurses (APRNs) to practice medicine autonomously. The argument among APRN associations is that enabling the non-physicians to practice medicine without the supervision of a physician will provide additional patients with access to health care and may even help reduce costs.

While it may make sense in theory, cutting the physician out of the care process can lead to dangerous outcomes and even higher medical care costs for the patient.

Over the years, the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP) have studied states where independent practice is allowed in various capacities to examine how this scope of practice expansion impacts health care costs, access to health care and the quality of care that patients receive, versus states that require physician oversight.

When looking at patient access to care, an examination by AAFP of Washington’s health care provider shortage, a state which allows nurse practitioners to work independently, revealed a continued health professional shortage in nearly 70% of Washington’s counties.

And an AMA study showed that care provided by non-physicians is more expensive than care delivered by physicians, is more likely to result in unnecessary prescriptions and diagnostic imaging and results in unnecessary referrals.

In contrast, care delivered by a physician-led team — with the entire care team working together to care for the patient — results in a more effective delivery of high-quality, efficient care to give the patient the best outcome.

When we look at why physician-led care teams are so effective, it comes down to the physician’s extensive medical education and clinical training, as required by rigorous national standards set by the Accreditation Council for Graduate Medical Education.

After undergraduate school, medical students spend four years learning concepts regarding the entire human body before undertaking residency training in their specialty to understand further and treat a patient’s full range of medical conditions. We learn how to work collaboratively with medical assistants, nurses, technicians and physician consultants to maximize the value added to patient care. At a minimum, physicians complete at least seven years of training after earning their bachelor’s degree, totaling more than 15,000 hours of medical clinical training.

In comparison, an APRN must complete an additional two to three years of training after nursing school, followed by 500-720 total hours of medical clinical training. In Florida, an APRN is then technically qualified to enter independent practice.

Looking at the education and training requirements for a physician versus an APRN, an APRN undertakes just 6% of the training, education and experience required of a physician.

After understanding the differences in medical professional training and education, we can examine the most appropriate, safe and affordable care setting for patients — a physician-led, team-based approach to care.

At Baptist Health, we started an arthritis clinic that follows this approach. Arthritis pain affects millions of Americans. That many people dealing with one problem can cause an access issue if we’re not proactive enough.

In our arthritis clinic, we trained a physician assistant (PA) to see patients for an initial visit to evaluate the patient. The PA gathers the patient’s history, does an exam, arranges x-ray imaging and beginn a treatment plan. Behind the scenes, the PA is consulting with our physicians. We review charts together and discuss the treatment plan. If the patient needs treatment beyond what the PA can do or if the initial treatment plan fails, the patient will follow up with a physician.

This team-based approach works well to free our physicians to address more complex patient cases while allowing the PA to work to the fullest extent of their training and education. Patients also benefit from quick scheduling with an appropriate medical professional qualified to treat their unique conditions and can rest assured that their care is not being managed in a vacuum. They benefit from a comprehensive care team behind them, led by a physician.

The next time you need medical attention, ask who leads your care team. Insist on a physician-led team.

Dr. Michael Swartzon is a physician at Baptist Health and serves as the team physician for the Miami Dolphins, InterMiami CF and Florida Panthers. He is an associate professor for Florida International University, an affiliate professor for Nova Southeastern University, program director for Baptist Health’s primary care sports medicine fellowship program and a board member of the Florida Academy of Family Physicians.