By Salomon Maya, MD
A new kind of physician-only team is bringing added value—and safety—to the OR
Traditionally, the physician-only model has cost more because doctors have limited their scope of work. But times are definitely changing. Granted, a physician’s time costs more, so certain elements of care, such as starting IVs, labeling syringes, drawing medications or monitoring a patient’s blood pressure, ought to be delegated to other staff. But today’s physician-only teams are taking a new approach to care, adding extreme value by delving into new areas, while continuing to deliver the good, old-fashioned value of expertise.
So, What Do Physician-Only Teams Do?
A lot more than you know. The physician-only team I work with is a perfect example. If you’re imagining a group of anesthesiologists who “do their thing,” then retreat to the office until the next case, think again.
Every one of our doctors is highly involved outside the OR in projects to improve efficiency and patient experience and outcomes. We do things like accountable care organization (ACO) management, and we design and implement perioperative surgical home projects.
The perioperative approach is a huge part of the added value that teams like ours bring. We don’t just take a few quick pre-op notes five minutes before the scheduled surgery. By the time surgery day arrives, more often than not, we’ve already met with the patient and have become a familiar face. And, in every case, we’ve fully reviewed the patient’s charts and medical history prior to meeting them. We do patient satisfaction follow-up evals, as well—and it’s all in the name of better outcomes (which, in the end, save money and, sometimes, lives).
Our team also has pain management specialists who can design treatment courses and manage patients along those courses, and we provide staff education services. Not to mention that we use advanced health care IT that frees us to spend our time taking care of patients rather than chasing down information and constantly changing codes and policies. And we do all that and more without ever leaving a patient’s side during surgery.
The Value of Expertise
The twelve or so years of blood, sweat and tears you put into your medical education is worth it. Because it gives you the level of experience—and requires the level of dedication—that patients deserve. Many people are unaware that when a case is done by an anesthesiologist, that anesthesiologist doesn’t leave the patient’s side until the patient is in the recovery room, showing stable vital signs. In a care team model, this duty is often delegated to a nurse anesthetist who cares for the patient without the anesthesiologist physically present.
That was the case three years ago when 45-year-old Michelle Hunt was admitted for a quick outpatient EGD test in preparation for the next day’s surgery. Unfortunately, the supervising anesthesiologist wasn’t in the OR when Michelle stopped breathing, and, by the time the doctor was called in, it was too late.
The same year, Eli Tella, a 33-year-old father of three, was scheduled for exploratory surgery to check the status of a previous operation. At a critical point in Eli’s surgery, only a nurse anesthetist and other RNs were in the operating room. Eli, like Michelle, stopped breathing, but, by the time the care team called the anesthesiologist to the OR, Eli had suffered irreversible brain damage. Sadly, as it turns out, his trouble was caused by a simple mucous plug blocking his airway—a complication his anesthesiologist—would’ve quickly identified and treated.
In the OR, where a life-threatening complication can emerge in an instant, the training and experience a good physician brings to the table can mean the difference between a great and a tragic outcome.
I’m a businessperson. I recognize that the medical industry is plagued with high cost, and I appreciate the importance of cost-reduction programs. And that’s exactly why I’m part of a physician-only team that fights to curb those costs. Yep, the doctor’s role is changing. And physician-only models like ours balance cost effectiveness with lowered liability. The problem is, no one knows it, yet.