“Team-based care” May Increase Stress on Physicians

Note from the Editor:  This blog post was submitted by a physician who wanted to convey personal opinions about team-based care.

I am a hospitalist physician. On a typical shift,I work with 4-5 physicians and am required to “collaborate” with two nurse practitioners (NPs). Frankly, it is exhausting.

As part of my job, I am constantly cleaning up problems created by nurse practitioners. I could elaborate on the many times nurse practitioners have mismanaged patients, but that is not the point of this particular post. Instead, I wish to explain the impact that these errors have on me, the full-time practicing and “collaborating” physician.

I have identified many patient management errors by Nurse Practitioners. Thankfully, I was able to intervene and correct those errors before a patient was harmed.

During these efforts, I have discovered the core problem in working with non-physician practitioners: their skill set is limited.

Nurse practitioners do not do things the way I would do them as a physician. They are not as meticulous. I find myself constantly thinking, if only I had another physician here instead of these NPs.

Combined, the two NPs see about the same number of patients as one physician. If there were another physician in their place, I would not need to run around double-checking everything they did, and they would not be operating under my license.

What I have learned is that team-based care is garbage.

Team-based care and delegation of responsibility to non-physicians could work in extremely limited circumstances. NPs are often touted as a way increase access to care in rural communities. Others endorse NPs and Physician Assistants (PAs) as resources to unburden busy surgeons from repetitive tasks and simple procedures. While this may be true in some cases, there are opportunities to incentivize physicians to practice in rural environments and to offer more surgical training to physicians.

The increase in non-physician practitioners is a result of greed.

The proliferation of NPPs (Non-Physician Practitioners) has nothing to do with teamwork, being a good “team-player,” or anything else the midlevel lobbies push. Why, in an era of a physician shortage, are we allowing the proliferation of interlopers? I am growing more misaligned with the idea “physician-led” care.

Rather than advocating for physician-led care, we should be advocating for more PHYSICIANS.

After working as a hospitalist, I realize that I am practicing “physician-led care,” and it is exhausting.

As a physician, I am more likely to burn out fixing the errors NPs make or explaining myself when I stop one of their discharges than I am in the actual performance of my duties as a physician to my patients. I would rather I not be forced to work with midlevels, but I am given no choice. There is no physician group that is advocating for me not to be in this position, especially if I want to continue to work as a hospitalist.  (Editor’s note: PPP does advocate that physicians should not be forced to supervise or collaborate with NPPs as a condition of employment.)

I just do not believe that team-based care is best, unless that team is comprised of physicians and nurses, not physicians, midlevels, nurses, and everything in between, from pharmacists that prescribe to respiratory therapists that intubate. Is this truly “the best” that we can provide for our patients or ourselves as physicians?