Editorial: Are You Working Collaboratively or Competitively?

Most healthcare workforce projection models agree that the shortage of providers will worsen in years to come. These shortages will likely make our complex healthcare system even more difficult for patients to navigate. Wherever you practice, this is more of a problem than you think.

Workforce shortages are worsened by rules that regulate which provider must do what task. These scopes were initially based upon skills provided by educational models, but few regulations have kept up with actual practice. Reimbursement for services provided has become both the driving force and the boundaries defended. In addition, providers are often left working against each other for job protection instead of collectively for the patient’s best interests.

I initially trained as an emergency medical technician (EMT) in high school. After becoming certified, I worked on an ambulance and as a medical technician in a hospital. There were many low-skill technical procedures I performed that helped free the nurses and physicians so they could provide more advanced clinical care. These procedures were definitely below their education and scope. By utilizing me in this role, they could be more effective in their roles.

I also observed paramedics. I was amazed to see what they were doing in the field, but somehow something magical happened when they crossed the threshold of the hospital doors. Those same skills became “out of their scope” once they entered a medical facility.

Upon entering nursing school I was saddened to learn of the “turf wars” that existed between emergency medical services (EMS) and nursing. The argument was usually based on licensure versus certification and education, but I quickly realized the divide went deeper than that. There are inconsistencies between hospital policies, personal perceptions, state laws and reality.

It is true that an argument can be made on education and scope of practice. While I agree there are things I did on an ambulance that weren’t covered in my educational program, there were also things I did in nursing that weren’t covered in my nursing education.

There are states today that require a paramedic to limit responses to emergencies and patient transports to the emergency department. Can you imagine what a nurse, paramedic, pharmacist or a social worker could do to help navigate patients to the healthcare they need, instead of just transporting them to a hospital? The reality is that up to 30% of emergency 9-1-1 responses in this country aren’t true emergencies. In fact, a large percentage of those patients receive treatment at home and are never transported, even though the EMS providers are not reimbursed for their time or supplies. Against the rules? Maybe, but it’s definitely reality.

I work as an attending physician in a large county emergency department that has an emergency medicine residency program. That same department utilizes physician assistants, nurse practitioners and paramedics in addition to the usual staff. It is a great example of utilizing every provider to the top of their scope. There are examples of mutidisciplinary teams across healthcare systems in this country. If we truly want to improve population health and patient experiences for less money, we must look at who does what. If we are going to be successful, we have to start working with each other, not against.

Most providers think they know about the roles of other healthcare practices. They often don’t. While nurse practitioners are requesting independent practice without a supervising physician in some states, at the same time nurses are opposing the concept of paramedics doing something other than responding to emergency calls and taking patients to EDs. Physicians oppose advanced scopes for interdisciplinary providers when we can barely keep our own heads of above water.

Healthcare delivery is changing. It has to change if we want make it better for each and every patient. We must look introspectively at what we are doing for our patients, not to our patients. It isn’t about us, but who needs us.

Every care provider should have representation at the table, but first we must leave the self-serving agendas behind. We must work collaboratively to improve our delivery system. We have to start integrating our healthcare delivery, not only at our table but at every table.

Jeff Beeson, DO, is medical director for the Emergency Physicians Advisory Board in Ft. Worth, TX.