AAFP Statement 'Undermines' the Foundation of Team-Based Care

I have to say that along with many of my colleagues in healthcare, I was extremely disappointed with a recent news release from the American Academy of Family Physicians (AAFP). The release, "Americans Overwhelmingly Prefer Physicians for Their Medical Care," undermines the foundation of team-based care and demeans the importance of physician assistants (PAs) to patients and providers alike.

Based on an online survey of just over 1,300 people, the AAFP claims that an overwhelming majority of Americans prefer to receive their medical care from a physician. This is like asking people if they would like lower taxes, without also discussing the consequences and tradeoffs involved.

Yet, this inference goes against a growing body of evidence that shows both patients and providers value the care provided by PAs:

• An independent review of research concluded that people hold consistently positive views about PAs as healthcare providers and are satisfied with the care provided by PAs.
• Most consumers would choose to see a PA or nurse practitioner (NP) if they were available before a physician.
• PAs were named as one of three primary-care providers in the Affordable Care Act alongside physicians and NPs.

I understand the genesis of surveys such as this; family physicians want to reaffirm their “brand” and demonstrate their value as heads of the patient-centered healthcare team. I agree that my physician colleagues have a vast amount of knowledge and training, but there is no need to create fences between and among the members of the physician-led healthcare team to demonstrate this point.

As individuals, no provider can serve all of the ever-increasing demands of the healthcare system in the United States. As a team, we are infinitely stronger than the sum of the parts, and patients benefit from this evolution of the healthcare team. This is what should be pointed out and celebrated by our physician colleagues.

The AAFP survey does nothing to address the larger health human resource issues confronting the healthcare system in the United States in the face of continued healthcare reform.

If the “overwhelming” majority of Americans prefer to see physicians for their healthcare, what is the AAFP’s plan to address the shortage of family physicians, and to also address the geographic disparities of the distribution of physicians? A team-based approach to providing care is the best way to ensure that those who need our skills and expertise receive it.

A survey from Health Affairs in 2013 shows that patients are recognizing the value of a team of medical providers, especially in primary care.

Patients are seeing the value of team-based care, but there are other advantages to physicians as well. A policy monograph jointly published by the American Academy of Physician Assistants with the American College of Physicians from 2010 states that physicians who employed PAs were on average able to work one less week each year while simultaneously supplying more hours in office visits and patient care and increasing net income by 18 percent.

In that monograph, you’ll also see that PAs provide care during office visits, rounds, and calls, and allow physicians to manage the most complex cases. Basically, PAs allow practices to see more patients faster, reducing wait times and increasing patient satisfaction, while holding down cost.

Just another reason why a team-based approach to patient-centered care - where each provider can practice medicine or nursing to the top of their license - is critical to ensuring delivery of quality care.

Ensuring access to quality care is especially important in primary care and medically underserved areas, where a PA may be the only provider. According to the 2013 AAPA annual survey, research indicates that 33 percent of PAs practice in primary care and 37 percent of PAs work in medically underserved counties of the U.S. Yet PAs are not just found in primary care, as they increase access to care in every medical and surgical setting.

According to the AAFP survey, patients value providers who are knowledgeable (37 percent), up to date on the latest medical advances (29 percent), experienced (27 percent) and someone they trust (27 percent).  I completely agree with these findings, as it describes PAs and all other healthcare providers.

A PA is a graduate of an accredited PA educational program. They are nationally certified and state-licensed to practice medicine. PA master’s degree programs take about two and a half years to complete and are modeled on the medical school curriculum, a combination of classroom education, and a minimum of 2,000 hours of clinical rotations.
All 50 states and the District of Columbia authorize PAs to practice and prescribe medicine. 

There are more than 93,000 PAs now actively practicing in the United States, and the time has come to embrace this valuable workforce, and enable PAs to practice at the level of their training in every jurisdiction.

The contributions PAs make to the healthcare team are invaluable and cannot be overlooked. PAs and physicians cannot meet America’s healthcare needs unless every member of the team can provide care to the fullest extent of their training and license.

Quite simply, the American healthcare system needs PAs.