The Diversity of Providers on the Family Medicine Team

• Behavioral Medicine
• Career Choice
• Family Practice
• Health Policy
• Patient-centered Care

Transforming primary care practices to better serve the nation's triple aim—improved patient experience, improved population health, and reduced costs—requires reorienting care delivery around teams of providers.¹ Studies have shown that increasing percentages of family physicians work with nurse practitioners (NPs) and physician assistants (PAs),² but much less is known about the prevalence of other health care providers in primary care practice, the nation's largest health care delivery platform. Our objective was to characterize the types of providers working with family physicians.

We used data from the American Board of Family Medicine examination application questionnaire in 2014. In each year family physicians were asked whether other health care providers worked at their primary practice site. If physicians applied for the examination multiple times, we kept their most recent response. We used descriptive statistics to characterize the data. Ethical approval was granted by the American Academy of Family Physicians Institutional Review Board.

Among a sample of 11,220 family physicians, over half (52%) reported working with NPs and 39% with PAs. However, despite the oft-cited importance of behavioral health–primary care integration to achieving the triple aim, the reported prevalence of behavioral specialists (21%) and psychiatrists (12%) in family practice teams was far less. Pharmacists, social workers, midwives, and physical or occupational therapists were present in fewer than 20% of family physician practice teams (Figure 1).

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Figure 1.

Family physicians recertifying in 2014 who reported working alongside a given profession. OT, occupational therapist; PT, physical therapist.

Family physicians seem to be heeding calls to broaden primary care teams to better meet patient needs, though behavioral health integration remains limited in family medicine and other disciplines. The high percentages reporting work with NPs and PAs may be related to these providers' ability to more readily bill for clinical services. The presence of NPs and PAs in a majority of practices validates previously reported trends. Not surprisingly, physicians in small practices reported smaller teams; they will likely face additional hurdles to achieving team-based primary care. While these findings are encouraging and likely represent improved access and care for patients, the optimal balance of care teams for a given patient population remains unknown. Adapting lessons from pioneering and high-functioning teams, and taking advantage of broad federal investment in primary care extension and practice transformation, are critical to providing quality individual care while also improving population health and reducing costs.^3⇓–5

• Received for publication July 22, 2015.
• Revision received October 21, 2015.
• Accepted for publication October 23, 2015.