Team Models Could Provide Care for Increased Patient Loads

While patient studies show that cancer survivors don't even want to use a primary care physician for anything more elaborate than shining a light in their ear, service surveys show that doctors are already trying to see too many patients - a problem that will only get worse when the Afforadable Care Act mandates go into force.

Primary care is facing the dilemma of excessive patient pool sizes, authors claim — the average primary care physician's panel size of 2,300 is too large for delivering good care under the traditional practice model — and we are about to witness an environment of primary care workforce shortage, which means patient panel size will only increase.

Solution: let someone besides doctors handle a lot of stuff that some patients don't even want their general practitioner handling.

A delegated team model of primary care whereby an interdisciplinary mix of team members is responsible for patient care could provide preventive, chronic and acute care, say researchers from the University of California at San Francisco, who offer estimates of what panel sizes might be reasonable if portions of these services were delegated to non-physician team members.

They conclude that depending on the degree of task delegation, a primary care team could reasonably care for panel sizes achievable with the available primary care workforce.

Specifically, using three assumptions about the degree of task delegation that could be achieved (77 percent, 60 percent, and 50 percent of preventive care, and 47 percent, 30 percent and 25 percent of chronic care), they estimate a primary care team could care for a panel of 1,947, 1,523, or 1,397 patients.

The authors conclude the replacement of physician-only care with team-based care will require a significant change in the culture and structure of primary care practice, but high-functioning primary care teams have the potential to both ensure access and quality for the nation's population and provide a reasonable work life for physicians and other team members.

Paper: 'Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation' by Justin Altschuler, MD, et al, September/October 2012 Annals of Family Medicine