Is Team-Based Care Good for Primary Care?

The numbers are somewhat staggering. By 2026, 21% of family medicine, pediatric, and OB/GYN physicians, which comprise about 32,000 doctors, will be 65 or older. It is estimated that 23,000 of those physicians will leave the profession permanently. The Association of American Medical Colleges projects a shortage of 124,000 physicians by 2034. At the same time, demand for primary care providers is expected to grow by 4%.

PAs and NPs, also known as Advanced Practice Providers (APPs), are expected to be part of the solution. Roughly 40,000 PAs and NPs join the medical workforce annually. PAs are master's or doctorate-educated providers that are trained in the generalist medical model, often side by side with their physician counterparts. PAs are required to pass a national certifying exam and recertify every ten years. Nurse Practitioners (NPs) are also trained at the master's or doctorate level after completing nursing education and are required to pass a national NP board certification in the specialty field of their choice.

It takes approximately 11 years of post-graduate education to begin practice as a physician. Advanced Practice Providers can begin their careers in 6 to 8 years. Though not a requirement to practice, many PAs and NPs are adding to their training with a 1-year Fellowship in the specialty of their choice. The estimated cost of medical education for physicians is approximately $150,000-$300,000, in addition to costs of undergraduate studies, while the costs of PA graduate education range from $25,000-$100,00 in addition to an undergraduate degree. NP education can cost roughly $25,000-$50,000 after nursing school. Physicians can sometimes accrue education debt as high as $500,000 when including undergraduate and medical school loans. With the excessive costs of medical education, many physicians are choosing specialty care instead of primary care due to the increased earning potential with specialty care.

Medical and nursing practice regulations for PAs and NPs are currently made at the state level and vary greatly throughout the nation. Depending on the state in which you practice, there may be cumbersome administrative restrictions that are placed on the advanced practice provider. During the recent Covid-19 pandemic, short-term state legislative changes were passed in many states to temporarily remove these restrictions. These changes allowed much more flexibility for the APPs to pivot and be used where the needs were the greatest. 

The American Academy of Physician Associates, which is the PA national professional organization, is promoting Optimal Team Practice (OTP). OTP will allow PAs to practice under their medical license without additional administrative burden when working in a team setting. The national nursing associations are promoting Full Practice Authority (FPA) to remove their administrative burdens. Nurses have passed some form of FPA in 32 states and the District of Columbia.

As the statistics show, access to primary care is increasingly becoming more difficult. Is it time to think differently about how that care is delivered? Team-based care is defined by the National Academy of Medicine (formerly known as the Institute of Medicine) as “…the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care.”  Team-Based Care allows each member of a team to work at the top of their license and training to offer the best and most cost-effective care to their patients. This applies not only to medical providers but also to ancillary staff. High-functioning teams are more efficient than the sum of their parts. The future of healthcare delivery will require teams of healthcare professionals working together to provide patient-centered care. Physicians and APPs working in primary care share a commitment to providing the most innovative and highest-quality care. This type of interdependent care will become increasingly critical to any healthcare system of the future. Is it time to fully embrace Team-Based Healthcare in Primary Care? Absolutely! It is past time to remove any restrictive barriers to practice and to fully embrace the Team concept. We owe it to our patients, and it is crucial to preserve the future of primary care.