Physician-Led Care Team Key to Effective Care

Asim Jaffer, MD, MBA


August 03, 2023

Three nurses with doctoral degrees are suing California to overturn a state law that prevents them from calling themselves doctor on the ground that the provision unfairly restrains their right to freedom of speech.

Asim Jaffer, MD, MBA

I'm a family physician, not a constitutional lawyer, so I won't weigh in on the legal merits of the case. What I can say with confidence after 15 years of practice in Illinois is that medicine is a team sport. On that team are physicians, nurses (including those with a DNP degree), nurse practitioners, physician assistants (or associates, if you prefer), and many others who help in the care of patients. I can also say with confidence that the training and experience physicians receive makes them uniquely well positioned to captain those teams.

The pandemic reinforced many things for physicians, from incorporating telehealth services into our everyday practices to how to be trusted messengers and leaders in our communities. Most important, the pandemic reminded me of two things: Providing equitable access to comprehensive care is more critical than ever, and physicians cannot do it alone. That said, neither can nonphysician clinicians.

As we recover from the pandemic, it's fair to recognize that the public health crisis wreaked havoc on all corners of the healthcare workforce. Nearly 334,000 healthcare providers left the field in 2021. According to the American Association of Medical Colleges, we face an estimated shortage of 48,000 physicians by 2034.

Primary care physicians have a particular skillset stemming from years of extensive education and training. We are also, first and foremost, advocates and partners in care for our patients and families. We walk them through medical decisions. We serve as allies in managing chronic health conditions. We help them navigate new medical challenges. These roles are reinforced by our long-term relationships with patients and our ability to provide proactive preventive care that prioritizes wellness over the long-term.

Certified nurse practitioners and physician assistants play an essential part in providing care to patients and are valuable members of a care team. In addition to being the associate medical director at a family medicine residency program, I am the medical director for a palliative care and hospice program. In this role, I work closely with nurse practitioners and offer close oversight and support. I value my relationship with them; I trust them to ask for help when needed, and their support allows me to explore ways to expand access to the palliative care program when I am not directly seeing patients.

States are working to address the real and growing problem of a primary care physician shortage, which is due to long-term systemic underinvestment in primary care coupled with overwhelming burdens on the specialty from administrative tasks like prior authorization and quality measurements. As lawmakers tackle these shortages, it's important to recognize that legislation allowing more nonphysicians without complete training to provide patient care under limited supervision could risk quality of care and safety instead of leaning into the capabilities of well-trained physicians to lead primary care teams. The primary care workforce shortage won't be and cannot be solved by allowing nonphysicians to diagnose and treat patients independently.

The education and training for physicians and nonphysician clinicians is not equivalent. The 12,000-16,000 hours of supervised clinical training physicians are required to have prepares them for the autonomy to make clinical decisions. Many allied health professionals have significantly fewer education requirements, no required residency, and less hands-on training without supervised training to practice independently.

I worry that in my community, some advanced-practice clinicians who provide primary care give patients the impression that they are fully trained physicians. They are not, despite what the three nurses in California are claiming.

The bottom line is that we cannot trade access for quality.

I've seen cases in my community of patients incorrectly diagnosed when physicians weren't consulted, which can exacerbate illnesses and lead to worse health outcomes. Any law or policy that expands scope of practice for nonphysicians could lead to an inappropriate and potentially dangerous lower standard of care in rural and urban underserved areas where the primary care physician shortage is most severe. To that end, policymakers must clarify the roles of physicians and nonphysician clinicians.

We must protect family and other primary care physicians' ability to practice to the full extent of their training and work side by side with their care teams, not by replaced by them. We need more physicians providing primary care, not fewer. At the end of the day, all health professionals have the same goal: to keep our patients healthy. It takes all members of the care team to facilitate healthy communities and safeguard access to care, but it cannot be done without physician leadership.

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