“Teamwork makes the dream work.” “Many hands make light work.” “None of us is as smart as all of us.”
Choose your bromide. All point to the universal truth that two or more people working toward a common goal will always get a better outcome than an individual. It’s especially true in medicine – the discipline for which the phrase “Get a second opinion” may have been invented.
So, it makes sense that healthcare providers working as a team can offer more comprehensive care than either one on his or her own. That’s the idea behind teaming an advanced practice provider (APP) – either a physician assistant (PA) or nurse practitioner (NP) – with a doctor. (See footnote for further details.)
The concept is becoming more and more common in medical practices – both primary and specialty care – and everyone benefits from this patient-centered, collaborative approach.
“Each member of the care team has complementary skills that ensure all aspects of the patient’s needs are met,” said Lauren Decker Todd, a Novant Health project manager. “The physician and APP are in constant communication about what’s happening with all their patients.”
Dr. Timothy Ewald of Novant Health Orthopedics & Sports Medicine – Denver and his PA, Brianna McShea, have been working as a team for more than two years. Here, they describe how their partnership benefits patients.
McShea: PAs can do nearly everything physicians can except perform surgery. We can prescribe medicine, give injections, do certain things in the emergency department, such as laceration repairs. (The same is true of nurse practitioners.)
Ewald: The way we see patients in clinic just depends on the day. We might see patients together, but we’ll also see them individually. I want Brianna to see all our new patients, because they take a little bit more time and sometimes more TLC. She'll also see people getting ready to have surgery. And there are certain things she does for our patients that I don't. She does a lot of pain management, a lot of wound care management.
I can tell patients all the details about risks and benefits of surgery, how their recovery might go – the technical standpoint. Brianna will actually be able to give them more context.
Pairing a physician with a PA is how we run our clinic. Every doc has his or her own PA in our ortho practice. Having Brianna allows our patients complete care. She makes the patient's experience much better, I think. If I'm on call or otherwise not in the office, I have Brianna, who’s like my right hand. She’s going to step in, and I feel confident about that. I trust her.
If I’m not in the office, she will certainly see her own patients. But then I review and co-sign all those charts. If there's something she's concerned about, we'll discuss it. So, there are some patients I don't meet, but they tend to be those who don't need surgery – and that’s about 80% of our practice.
McShea: I help Dr. Ewald make the best use of his time. He’s a surgeon and has a very particular skill set. With triage patients who need to see him, we make sure that happens. But I can manage the other conservative care and treatment that patients get.
And, we're still a growing practice in Denver. We hope to get to the point where I’ll see some patients on my own.
Ewald: Any new patients coming to clinic will definitely see Brianna. She can give them the time and attention I may not have.
McShea: On surgery days, I go into the OR with Dr. Ewald. I’ll assist in surgery, and I generally put the dressing on the patient, which allows Dr. Ewald to talk with the patient’s family right away. Being a team helps us be more efficient, and it helps us provide better and more efficient care to the patient.
When someone comes to an orthopedist, it’s to get to the bottom of why they’re having pain. We want that to happen as quickly as possible.
Ewald: Our interest is in getting to the bottom of what’s causing the pain in order to fix it. We try not to rely too heavily on pain medicine; our job is to figure out what's going on and fix the issue.
Surgery is the only reason a patient would need me and not Brianna. Anything short of surgery, Brianna can do. Because we work as a team, patients can get the service they need at different levels.
Note: Nurse practitioners are registered nurses and approach care through a holistic lens, helping patients meet wellness goals and preventing disease in addition to treating disease. Physician assistants are trained in medical schools and approach care through a medical lens, helping patients recover from illness and injury.