In 2013 we started our journey to team-based care at Childhood Health. In essence, we divided our clinical staff (physicians, mid-levels, nurses, case managers, and medical assistants) into four teams. We didn’t do this just because it’s a popular, catchy new concept in primary care offices (which it is) but for some specific reasons.
Here at Childhood Health we have about 16,000 active patients. We are open long hours: twelve hours a day Monday through Friday, plus short days on Saturdays and Sunday. No one PCP can work all those hours! Also, we do let our clinical staff take vacations from time to time. In the past a patient whose PCP was out for the day or already finished with his/her shift would see any other provider at the office if an urgent appointment was needed. That meant you weren’t likely to see the same person the next time the same kind of situation came up, and it meant that we would be less familiar with your child when that happened. That worked all right when there were just a few of us, but not so well as we got bigger.
With the team system, if your child’s PCP isn’t available for a given appointment then we try our hardest to schedule them with someone else on their team. This should result in better continuity of care for your child. Our teams also include the nurses who give you phone advice (so you are now more likely to talk to the same two or three nurses when you call) and the medical assistants who room your children and give them shots. You can look forward to seeing the same faces more often. In essence, it’s almost like four separate little practices in one clinic... except that of course each team still helps out the other when resources are short. Of course, it’s still best for your child to see his or her PCP whenever possible, especially for care of ongoing problems.
Each of our teams includes mid-level providers. Some of these are Pediatric Nurse Practitioners or PNPs, who first get a nursing degree and then go on for more advanced training in diagnosis and treatment of children, both well and sick. In Oregon, nurse practitioners may practice independently, but ours work directly under our supervision. We also have pediatric Physician Assistants. PAs attend a PA training program after first obtaining an undergraduate degree in any pertinent subject, much like medical students. Their training program is shorter than medical students, though, and focused very much on practical skills and direct patient care. Our PAs are better at some of the physicians when it comes to putting on casts or stitching up wounds! They also work under our direct supervision.
All of our mid-levels receive regular teaching and yearly performance reviews, and always have a physician available for consultation. They not only help out the physicians with their patient overflow but have their own panels of patients for whom they are the PCP. They tend to have longer appointment times and a more leisurely pace, and many of our families appreciate that approach.
So, we hope you will enjoy getting to know the members of your child’s health care team here at Childhood Health! Next time you see your child’s PCP, you might ask about the other team members. And to really get into the spirit of things, ask about the team name. :)