Working With APCs, Pharmacists, and Care Coaches: What Makes Team-Based Care Work

You can learn a lot about a physician’s job by looking at the people around the physician. Some clinics run with an advanced practice clinician (APC) managing half the patient panel while the physician sticks to more complex cases and new consults. Others have a pharmacist on staff to complete medication reviews the physician would never have time for. Some have neither, and the physician is doing everything solo.  

A JAMA Internal Medicine study sheds light on how this plays out for physician well-being. Out of 970 physicians, about half worked with an understaffed team more than a quarter of the time. Unsurprisingly, burnout in that group hit 61%. For physicians who weren’t dealing with staffing gaps as often, it was around 35%.  

For physicians, solid collaboration (or the lack thereof) can make or break your experience. Knowing who owns each part of the patient’s care, having faith in the people you’re working with, and agreeing on when the physician needs to be pulled back in can determine whether or not you’re still on the job in five years. 

Get clear on what your APC colleagues own 

There are two arrangements that tend to work out well. In the first, the APC has their own panel of stable patients and handles routine chronic disease management, medication refills, and follow-ups, while the physician takes complicated cases and anything new. In the second model, the physician stays involved in every patient, but the APC manages most of the intra-visit work along with same-day sick visits. Whatever the model, it works better when expectations are clear before the schedule gets crowded. 

If a nurse practitioner or physician assistant is managing a patient with hypertension, for example, everyone should know when a medication adjustment can happen independently, when a quick discussion with the physician makes sense, and what kind of change warrants a physician visit. The same applies to abnormal results, worsening symptoms, and patients whose condition is becoming more complicated.  

That clarity helps prevent frustration on the physician’s end, while also giving APCs room to practice at the level of their training and experience.  

Make the pharmacist part of the clinical conversation 

A patient walks in on eight medications from three different prescribers, half of which they may or may not still be taking. Reconciling that in a 15-minute visit is not really possible. A clinical pharmacist can take a much deeper pass at untangling the issue than most physicians have time for during a packed clinic day. It may entail reviewing a complicated medication list, identifying interactions, helping a patient understand a regimen, or working through barriers to adherence.  

Evidence shows this kind of physician-pharmacist collaboration can improve outcomes. A study of patients with uncontrolled type 2 diabetes found that 19% of those receiving pharmacist-physician collaborative care reached an A1C below 7%, compared with 11% receiving standard care. Blood pressure control was also higher in the collaborative care group, at almost 75% compared with 67%.  

Physicians still need visibility into substantive changes. What they don’t need is every step of the process routed through them. A good workflow gives the pharmacist enough latitude to solve the problems that fall in their wheelhouse while creating an obvious path back to the physician when the clinical picture changes. 

Use care coaches to learn what happens after the visit 

Every physician has had visits that seemed productive in the exam room and went nowhere once the patient got home. Three months later you find out they never started their medication, because their pharmacy is a 45-minute bus ride away. Or maybe they just never got around to checking their blood pressure or implementing the diet changes you’d discussed.  

Care coaches can give the clinical team a better view of that in-between period, when much of the work of chronic disease management is happening outside the office. The same rule applies as with the pharmacist: Agree on what needs to reach you and what the coach handles on their own. A missed weight-loss target is something the coach can keep working on, but a patient who stopped their diuretic because they didn’t like getting up in the middle of the night is something you need to know about right away.  

Ask about the team before accepting your next job 

When interviewing for a physician position, questions about compensation, schedule, and call and patient volume tend to be top of mind. Consider the care team as well.  

Ask how APCs are used in day-to-day practice, not just how many are on staff. Find out whether pharmacists or care coaches are woven into the clinical workflow and what happens when they need physician input. Those answers can tell you quite a bit about what the job will feel like once you’re on the team. 

A healthcare recruiter who knows the physician market can also help you get beyond the job description. Judge works with physicians to understand what they want from their next role and identify opportunities that fit those priorities. While compensation and schedule will always matter, the people you practice alongside and the way the work gets shared matter too. 

Click here to learn more about the Judge recruiting process and view our open positions.