Dr. Anthony J. Billittier

By Anthony J. Billittier IV, MD, FACEP

Physicians have heard about the benefits of “team-based care” for some time now. We’ve been told that it will improve our job satisfaction, improve efficiency of patient care, reduce our workloads, and enhance patient outcomes. Why then has it not yet been fully embraced by all primary care providers?

As physicians, we’re complicated creatures. We’ve been trained to preserve wellness, prevent disease, improve health and save lives. And, we’ve viewed that burden as ours (and ours alone) since we graduated from medical school and our residencies. Bringing others into our circle of trust is not an easy lift, nor is it natural for many of us.

However, we are now faced with the monumental task of transforming our organizations into Medical Homes; becoming accountable for care coordination outside office visits; and, offering customized, relationship-based care to our patients. We have two basic choices: working longer hours and charting until midnight; or finding a way to work more efficiently and effectively. Letting others in our office help with these important tasks can go a long way to accomplish the latter. Easy choice, right? Maybe.

Ok, so you’ve made the decision to choose team-based care over professional burnout. Now what? Primary care practices are at the center of this conundrum. How do they make a true shift to a team based environment in which all staff are performing tasks to their maximum abilities and scopes of practice?

I don’t want to downplay the task at hand. This requires a fundamental cultural shift in an organization, which includes a serious commitment in collaborative planning and strong communication across all levels of staff.

Perhaps most importantly, physician buy-in and championship are vital. You can expedite this process, and advocate for change. However, it’s important to acknowledge that change is hard, and will not happen overnight. Think about all the steps needed to implement sustainable change:

  • Securing buy in.
  • Re-engineering current operations and workflows.
  • Evaluating existing staff for necessary skill sets.
  • Designing and delivering training and education, and…
  • PDSA over, and over, and over again until new workflows become consistent.

As the quarterback of the primary care team, your leadership will be critical. Change can happen, but should start with you!


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