One way to help lower the cost of health care delivery is for doctors to work less. The WSJ has a trend story on the increasing prominence of “team-based” care. In this model, nurse practitioners, physician assistants, and clinical pharmacists do more of the day-to-day basic care under doctor supervision. The doctor is called in for higher-level decisions or procedures.We’d like to believe that doctors are delegating more of their routine work to other professionals. It’s cheaper for all of us when they do (how care is delivered does ultimately affect how much insurers pay for it). But there is very stiff resistance to this trend:
A 2012 survey of more than 1,000 low-income people in California by the Blue Shield of California Foundation found that the majority preferred to be seen by doctors. About 1 in 4 of the respondents already had team-based care, and 94% of them said they liked it. Among those who didn’t have team-based care, 81% said they were willing to try it.Doctors may resist being part of a team and ceding care of their patients, studies have found. Experts in health-care delivery also caution that team members must coordinate care and delegate clearly to avoid anything falling through the cracks.
This resistance persists even though many individual doctors think team-based models will free them up to do the kind of care they got into medicine to do in the first place. One test for whether doctors are delegating more care is the success of scope-of-practice bills. These bills allow nurse practitioners to perform more medical tasks autonomously—for example, prescribing drugs. One bill of this kind just passed in Kentucky, and two are pending in Florida and West Virginia. Doctor’s groups have staunchly opposed the Florida bill. It is up for vote today, and the result will help us understand just how much momentum models like team-based care will have.