Frequently we hear the phrase “work to the top of your license.” Additionally, operational efficiencies focus on this point. Furthermore, segregating activities by function is a proven methodology for improving throughput and standardization. But when we consider these in tandem with the physician role, we often throw this logic out the window. When practicing full time, I vividly recall all the letters, phone calls and internal directives I was given that had very little impact on patient care and how I kept asking myself, “Why are they requesting that I do that function? Isn’t there someone more appropriate to do that task and allow me to do my job?”
As a physician, what is my scope of duties and functions? Is it to do data entry into the EHR? Should I be doing my own EKGs so my assistant can work on something else? Am I the best person to discuss dietary changes with my patients or fill out request forms? How proficient am I at demonstrating back exercises? Of course, I understand how to do all of these tasks, but am I optimizing the desired outcomes?
By illuminating the results that others doing charting in the EHR improved predetermined outcomes, a recently published trial, The Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial by Risha Gidwani, DrPH1 , Cathina Nguyen, MPH, Alexis Kofoed, MPH, Catherine Carragee, BA, Tracy Rydel, MD, Ian Nelligan, MD, MPH, Amelia Sattler, MD, Megan Mahoney, MD and Steven Lin, MD, solidified this viewpoint.
Optimization of our medical profession occurs when the focus is on diagnosing and treating conditions that inflict those we serve. Empowerment, engagement and activation of those that have entrusted their care to us drive preferable outcomes. Therefore, focusing on successful results has greater importance than centering on who does the job. Accordingly, team-based care exemplifies a model that elevates the strengths of all for the betterment of those served. Therefore, our models must aim to distribute functions based on ability, not a title.
Discernment of role and functional responsibilities will become significantly more important as we study the value of interventions. How and who implements a new model of care will be just as important as the paradigm itself. Further studies on activation and engagement as a means of success will continue to illustrate the importance of skills that are deeper rather than broad.
Physicians must have a considerable depth of knowledge and breadth of understanding. Accepting the difference between the two will allow us to create value-based models of care that accomplish our goals. Consequently, optimizing the skills of all will be paramount to our success. Being the jack-of-all-trades sounds great in theory, but is not being shown to drive better outcomes.
One could argue that the separation of functional-based tasks will lead to a more fragmented approach to care. This polarity requires management, but we must begin with the end in mind, what works best for those we serve. Let us focus on the actual problem we are trying to solve and work our way to a delivery model that empowers all to fulfill their vocations in a manner that improves the health and well-being of individuals and communities.