Deepening the Bench of the Care Team

Josephine Young, MD, MPH, MBA

When I think back on my medical-school education from over 30 years ago, I am struck by how much the training process was focused on developing my autonomy as a solitary physician. Able to work within a team, I was also expected to function independently and be ready for any clinical setting. Three decades and several generations of residents later, the emphasis on teamwork has increased our options for colleagues who can help us survive the long days together.

At Allegro Pediatrics, a physicianowned private pediatric practice of 52 years, we have expanded our provider staff over the past several years to include a number of nurse practitioners (NPs) and physician assistants (PAs). We believe that by including provider-level support for out-of-office tasks and cross-coverage patient appointments, we are able to enhance the continuity of care when a patient’s primary provider is out of office. The teamwork provided by these clinicians, with complementary emphasis on clinical training, offers our patients a range of experiences that can meet their needs more specifically.

As our local community has grown to demand services outside of typical office hours, our NPs and PAs have risen to the occasion to staff our evening urgent-care clinics. While some patient families unfamiliar with NP and PA staff are sometimes initially hesitant to see these clinicians, they readily seek their care at subsequent appointments.

The initial transition in incorporating NP and PA staff into an existing physician-only practice can be challenging if there is insufficient understanding of the academic rigor involved in each type of training program. Trust across multiple disciplines can only be developed through open-minded curiosity, exercised with respect and humility. As Patrick Lencioni has said, “Remember, teamwork begins by building trust. And the only way to do that is to overcome our need for invulnerability.”