ACP: Physicians must remain team leaders in patient care

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Doctors must remain the leaders of clinical teams caring for patients, according to the American College of Physicians (ACP).

The college’s Committees for Health and Public Policy and for Medical Practice and Quality published a position paper affirming physician leadership and policies to support it with a goal of best possible patient care.

“These principles represent a renewed call on policymakers to ensure that all patients – including those residing in rural and other medically underserved areas – have access to a personal physician with leadership of a highly skilled clinical care team trained to deliver whole-person, comprehensive, and longitudinal care,” the position paper said.

The paper includes recommendations about professionalism, licensure, payment and research.

Professionalism

ACP called for internal medicine or other primary care doctors to have leadership responsibilities among the multidisciplinary team members caring for patients.

“The leaders of the clinical care team should be the health care professional with the most education and training,” said the position paper’s appendix with explanations for each recommendation. “Physicians have the depth and breadth of training necessary to lead the team.”

They are not interchangeable with nonphysician health care professionals, ACP said. The college continues to oppose granting independent practice ability to nurse practitioners (NPs), physician assistants or physician associates (PAs), or other allied health care professionals.

Teamwork requires interprofessional training in communication, collaboration, and recognition of professional boundaries, and ACP supports that.

Licensure

State legislatures and licensing boards must recognize that doctors, nurses and other medical professionals have different skills that are not interchangeable. Lawmakers should review their licensure laws to reflect that.

Patients may be endangered if health care professionals practice beyond their professional capabilities. However, ACP noted physician burnout declines when team members are practicing at the top of their skill levels.

Payment

Payment models should be structured to ensure access and address disparities and inequities in health care. Payment models should be redesigned to support physician-led care, such as the Patient-Centered Medical Home and Patient-Center Medical Home Neighbor practices.

Research

Additional study is needed to devise the best form, function and coordination of team-based care. Among potential research areas:

• Optimizing team-based care to alleviate physician and other clinician shortages in medically underserved areas.
• Organizational theory.
• Communication strategies to help patients and their families understand the roles of physicians and other clinicians.

ACP noted consolidation and private equity investment could have potential effects on patient care.

“Profit-driven entities may seek to cut costs by replacing physicians with nonphysician health care professionals with less training,” the appendix said. “Research is necessary to determine appropriate oversight so that patient safety is not compromised.”

“Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care: A Position Paper From the American College of Physicians,” was published Dec. 26, 2023, in Annals of Internal Medicine.