Solve Primary Care Shortage With Physician-Led, Team-Based Care

The US health care system can meet the need for primary care providers by fully implementing physician-led patient-centered medical homes (PCMHs), according to an American Academy of Family Physicians (AAFP) report. “Primary Care for the 21st Century” described the research that supports team-based care and its ability to transform primary care in the United States and focused on the need for this approach to improve quality and cost efficiency in the American health care system.

In the report, the AAFP cautioned against substituting nurse practitioners for physicians as a stopgap answer to the primary care physician shortage. Such a solution contradicts multiple studies that demonstrate that the best, most efficient care is provided by teams of health professionals in a PCMH led by physicians, not independent practice by a single nonphysician health professional, it was noted.

The PCMH model improves the quality of care because it capitalizes on the unique expertise of each member of the patient’s health care team and expands access to services while ensuring that each patient is under the care of a physician, according to the AAFP. The use of teams of health professionals in the PCMH not only improves quality but also reduces unnecessary tests, procedures, and hospitalizations and results in lower patient care costs, research has shown. This approach offers patients access to their primary care physician as well as their nurse practitioner, physician assistant, or any other professional involved in their care.

Patients understand and care about disparities in training between physicians and nurse practitioners, according to an American Medical Association (AMA) survey. More than 9 of 10 respondents said that a physician’s years of education and training are vital to the best patient care, especially in emergency and complicated situations, and 3 of 4 patients said that they prefer to be treated by a physician.

The education and training of physicians and advance practice registered nurses are substantially different, and physicians and nurses are not interchangeable, according to the AAFP. Family physicians bring breadth and depth to the diagnosis and treatment of all health problems, from strep throat and chronic obstructive pulmonary disease to stress headaches and refractory multiple sclerosis, the AAFP report stated. Nurse practitioners’ training gives them expertise in epidemiology and community health, as well as treating patients who require basic preventive care or treatment of straightforward acute illness or uncomplicated, previously diagnosed chronic conditions. Together, their expertise supports and complements each other in the PCMH.