Primary care providers are responding to the need in health care to increase quality and improve access as part of health care reform. They are moving away from a doctor-centered medical model to a patient-centered medical model. As a result, medical offices today are far more complex and are run by teams of health care professionals.
Who’s On First?
Patients now talk to their medical team rather than just their physician, and all of the members of a medical team work together to create seamless health care. Who’s who in medicine? And what they can take care of?
Besides doctors, there are associate staff (mid-level providers) who also practice medicine. They can evaluate and treat patients, prescribe medications and assess need for further care. Mid-level providers include:
- Nurse practitioners - advanced trained nurses who are licensed and can practice independently.
- Physician assistants – partner with a supervising physician but can see patients on independently own as well.
Nursing and other clinical staff:
- Registered nurses – nurses with highly-trained clinical skills. Typically, they are in direct contact with patients and respond to many of the phone calls a medical office receives daily.
- Licensed practical nurses and medical assistants – specialize on actual patient visits to the office. They take vital signs and review symptoms and medications, perform medical interventions and treatments, follow up on tests done, as well as respond to any other patient needs.
All nurses help run special programs to improve quality in medical offices – these projects include following up after hospital admissions, transitioning to and from nursing homes, and referring to community services.
- Practice supervisor – typically runs the office and is also involved with improving business systems and the process of providing care.
The remainder of the staff do field most of the phone calls, make appointments and referrals, clear medications, tests or equipment through ‘prior authorizations,’ as well as check-in and check-out patients with appointments.
Putting You at the Center of Care
This coming year, many medical offices in Vermont will have been, or will become, recognized as Patient-Centered Medical Homes, through working with the Vermont Blueprint for Health. As of January 2012, eight of Fletcher Allen’s Family Medicine and Primary Care sites are formally recognized as patient-centered medical homes.
This is a special designation acknowledging that an office has met criteria for handling and tracking chronic health conditions. This extra work and care are supported and funded by both the state and insurance companies. When an office becomes a medical home, then there are even more support staff helping to keep patients healthy. Some of the new staff will be members of Community Health Teams (CHTs) which work to improve patients’ and the community’s general wellness and better treat chronic health conditions. Look for them in your community!
Alicia Jacobs, MD is the medical director of Colchester Family Practice, which is a certified medical home, and a clinical assistant professor of Family Medicine at the University of Vermont College of Medicine.
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