COLLABORATE UNIFY HEAL
Every Team Needs a Captain
by Jeffrey Goldberg, MD
At last winter’ s Kentucky Medical Association Physicians’ Day at the Capitol, I probably spent more time in conversations with legislators about scope of practice legislation than anything else. Prior authorization reform was( appropriately) the top legislative priority this year, but none of the legislators I spoke with seemed to need much convincing. They had all experienced the negative consequences of the abuses of prior authorization by commercial insurance companies, either personally or through a friend, family member or constituent – and usually all of the above. I wasn’ t at all surprised that prior authorization reform legislation passed both chambers easily.
But the legislators I spoke with had also all been bombarded by constituents advocating for greater practice autonomy for our healthcare colleagues, ranging from audiologists to physician assistants( or physician associates, as their professional organization would now like their members to be addressed). And the nurse practitioner lobbyists were back with their perennial request to remove all prescribing restrictions on scheduled drugs. As one of the legislators put it,“ I just don’ t see what the problem is with allowing them to do what they claim they can do, so please explain to me why you have a concern.”
And yet I’ m not sure how this got framed as an“ us vs. them” conversation when the reality could not be further from the truth. The physician assistants and nurse practitioners whom I have worked with throughout decades of practice have been golden to me. My patients love them and appreciate me for having NPs and PAs as a part of the team. They have allowed me to be in two places at once, enabling a patient with an urgent problem to get seen in the office even when I’ m in surgery, or getting an acutely ill inpatient evaluated promptly
even though I’ m busy in the office. I wish I had a nickel for every time someone else on my team picked up on something important I missed, particularly psychosocial cues. I couldn’ t be more appreciative of the fact that they are legally permitted to write prescriptions, remove sutures, perform endometrial biopsies, see patients for cancer surveillance exams and a myriad of other tasks that historically required the services of a highly trained physician. I’ m quite certain that I simply could not function without the team of highly skilled non-physician professionals all around me. While technically I have the skill set to do everything that they do, in reality I would quickly burn out, and then patient care would come to a grinding halt. They are invaluable, indispensable and incredibly appreciated.
Similarly, I know that they appreciate being able to exercise their professional skills with me around to assist. They have never hesitated to ask me if I think a lesion warrants a biopsy, or ask me to repeat a patient’ s pelvic exam when they’ re not quite sure whether they are feeling something that’ s abnormal. They know the limits of their training and expertise, and if anything, they err on the side of caution when exercising their legal authority to deliver healthcare without me being statutorily required to directly supervise their every move.
I know that my cancer patients with lymphedema will benefit greatly from the skills and expertise of a physical therapist. I know my patients need lymphatic massage that I do not perform, nor could I teach to a patient’ s partner. I know that my patients need to be measured for high compression stockings that fit properly, but I have no idea how to be certain they receive the correct size. It is an intrusion upon my time, and a distraction from caring for others, for me to have to sign the
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