Northwell Health CMO: Physicians Are Always the Captain of the Ship

“The patient comes in for standard follow-up for hypertension, but then the patient is in rapid atrial fibrillation with a fever and a complex infectious process,” she says. “That is when you need to have the flexibility for consultation with the physician to decide the next steps such as whether the patient should be admitted to the hospital.”

Different care team members can lead specific kinds of care for the patient, but ultimately the team should be led by a physician, Kalman explains.

“Advanced practice providers, nurses, pharmacists, respiratory therapists, and other healthcare professionals can be part of a team working together moving the patient through a healthcare episode with the guidance and leadership of a physician,” she says.

Care teams in the inpatient setting

At Northwell, Kalman says physicians provide essential leadership in navigating patients through the episode of care in the inpatient setting.

“In the hospital, the physician leading a care team is responsible for coordinating care, ensuring the patient moves through care in a step-wise way through testing and treatment, bringing the team members together and setting a plan, and deciding in consultation with the team when the patient is ready to be discharged,” she says.

A physician always leads care teams in Northwell hospitals, but the constitution of teams varies by setting, Kalman explains.

“An intensive care unit may have a preponderance of physicians and nurses,” she says. “The operating rooms may have a host of physician assistants and nurse practitioners.”

Care teams in the outpatient setting

At Northwell, Kalman says the members of a care team in the outpatient setting depend on the acuity of patients who are seen at a particular clinic or doctor’s office.

“In outpatient settings, teams are geared to provide collaborative care,” she says. “Sometimes, physicians are paired directly with advanced practice providers, with nurses and medical assistants in the mix. Whether it is a physician or another healthcare professional working with the patients is determined by the complexity of the patient and the stability of the patient.”

Northwell’s advanced practice providers play an active role in the care of low-risk patients in the outpatient setting, Kalman explains.

“Advanced practice providers may have rosters of patients they are seeing on their own under the supervision of a physician,” she says. “When the patients are straightforward, advanced practice providers can make decisions about patients in collaboration with a physician.”

Kalman says Northwell’s physicians have a more hands-on approach with high-risk patients in the outpatient setting.

“As patients get more complex, advanced practice providers and physicians often see those patients together and make care plans together,” she says. “There is a collaborative and team approach, with a physician at the lead.”

Kalman says physicians and advanced practice providers at Northwell have tight relationships and lean on each other.

“For example, a physician assistant who is in the operating room with a colorectal surgeon may be assisting with surgery and robotics as well as assisting with the patient journey from the operating room to post-operative care,” she says. “These are dynamic relationships. There is a close and tight relationship between the physician and the advanced practice provider to allow them to leverage each other’s expertise.”

A similar dynamic is present in the outpatient setting, Kalman explains.

“The physician and the advanced practice provider are dependent on each other for their expertise,” she says. “The advanced practice provider is taking care of patients in consultation with the physician. We can create better access for patients with care models that feature advanced practice providers, but still offer safe and high-quality care.”