Correspondence

Trends in Care by Nonphysician Clinicians

N Engl J Med 2003; 348:1603-1604April 17, 2003

Article

To the Editor:

It comes as no surprise that a greater proportion of patients are being treated by nonphysician health care providers or that physicians are increasingly using physician assistants and other clinicians to extend care to patients, as discussed by Druss et al. (Jan. 9 issue).1 What is unusual in this report is the authors' comment that the productive use of nonphysicians hinges on the successful integration of services.

In addition to more and better access to care, the public is seeking high-quality care. Greater integration of services is essential to addressing the issue of quality. In the physician-assistant community, we call it team practice. The health care system long ago moved beyond the model of the solo practitioner as the ideal way to deliver health care. Today, all practitioners, including physicians, are integrated through an intricate network of referrals, review systems, and shared information systems.

The question of whether greater use of nonphysicians results in a growing coordination or fragmentation of care can be answered by studying the team practice of physicians and physician assistants. It is increasingly necessary that we evaluate the role, function, and effects of team practice, rather than focus on the contributions of individual clinicians who are presumably acting alone.

The article by Druss et al. answers the question of who provides health care. Research is still needed to answer the question of how medical care, provided by a team of clinicians under the leadership of a physician, is coordinated in actual practice and how society can use this method to ensure appropriate access to high-quality care.

Stephen C. Crane, Ph.D., M.P.H.
American Academy of Physician Assistants, Alexandria, VA 22314-1552

1 References

1. 1

   Druss BG, Marcus SC, Olfson M, Tanielian T, Pincus HA. Trends in care by nonphysician clinicians in the United States. N Engl J Med 2003;348:130-137
   Full Text | Web of Science | Medline

Author/Editor Response

I appreciate both the content and the spirit of Dr. Crane's letter. I agree that the study points to a need for a better understanding of how medical care is and, more important, should be coordinated among the many groups of clinicians that provide it. It is essential that these efforts themselves be both multidisciplinary and collaborative.

Benjamin Druss, M.D., M.P.H.
Emory University, Atlanta, GA 30322
bdruss@sph.emory.edu