By NextBestFitTeam-based care with physician oversight
Expand roles within teams under physician supervision.
Draft decision:RejectedConfidence: medium · not yet reviewed
Supervision is a bottleneck in rural areas; full scope chosen instead.
Review ledgerHow this path connects
This path
Team-based care with physician oversight
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Expand roles within physician-supervised teams
- Allow remote supervision
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Scope-of-practice limits waste capacity
Expanding roles within teams adds capacity while retaining physician oversight.
- Longer waits if demand grows faster than capacity
Expanded roles within physician-supervised teams add capacity for care.
What it creates or worsens
- Raises spending or loosens control over it
Physician-supervised team roles involve supervision fees that add costs.
- Solves only part of the problem
Expanded team roles still depend on physician supervision, which can be a bottleneck in rural areas.
Who's affected
Who gains
- Residents of areas with too few health professionals
- Scope-of-practice limits waste capacity: Practice limits prevent trained professionals from filling care gaps.
- Doctors, nurses, and other clinicians
- Scope-of-practice limits waste capacity: Expanding roles within teams adds capacity while retaining physician oversight.
- People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
- People with ongoing or specialist care needs
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
Who loses
- Doctors, nurses, and other clinicians
- Scope-of-practice limits waste capacity: Physicians benefit from a protected market.
- Taxpayers and public budgets
- Raises spending or loosens control over it: Public budgets pay the added spending.
Other ways to soften the losses
- Remote supervision
Where it has been tried
- Kaiser Permanente, VA: Team-based models.
- United States: In 2014, the VA reported a 12% decline in acute hospital admissions associated with implementation of its Patient Aligned Care Teams.