13 people behind your care
Gone are the days of the Norman Rockwell family doctor, whose icon of singular, cradle-to-grave care resonated with Americans for decades. Nowadays, going to the doctor is more complicated: You check in with one person, have your blood pressure taken by another; then your blood is drawn by a third person -- all before you even get to the doctor, who might actually be a nurse practitioner. Figuring out who's who at the doctor's office can be daunting, so we've provided some key figures at family practice clinics.
This is the person behind the front desk, and the voice behind the phone. Registration associates, commonly known as receptionists, check patients in and out, and collect their copay and insurance information. Christina Gillespie, a family practice physician and the medical director of a MedStar Health Center in Washington, D.C., calls this "the hardest job in the office" because they are the first line of defense against patients who might be angry or confused. Registration associates usually lack medical training themselves, so they likely won't have answers to the variety of questions they must field.
This is the person who draws your blood, takes your X-rays or examines other lab specimens like urine samples. They are not necessarily employed by the medical office but are contracted out by various labs. They often follow medical assistants in your checkup experience. Like MAs, lab technicians should have a pleasant demeanor and refrain from diagnosing or offering medical advice. They hand off information to the next person down the line -- usually a nurse or a physician assistant.
Not to be confused with physician assistants, medical assistants are not required to have medical or technical training. They meet and greet patients, and are usually their first line of entry to the whole checkup experience. "They set the tone. It matters if the person is nice or not," Gillespie says. The MA takes vital signs and a medical history. They might tell patients about the flu vaccine without actually administering it. They also make follow-up calls to patients to ensure they go to referral appointments.
It takes three years to become a PA, and the training mirrors medical school. Once certified, PAs can do many of the same things that primary care doctors can do -- routine physicals, Pap smears, and diagnose and adjust medications. They perform these tasks under a doctor's supervision.
"A nurse is worth her weight in gold" at a family practice clinic, Gillespie says. The nurse will know whether a patient has to be seen that day or can wait three days. "A nurse triage is critical to the office," she adds. There are various types of nurses: registered nurses and nurse practitioners are the most common, but there are also specialists such as certified registered nurse anesthetists, who administer a patient's anesthesia before surgery. Nurses are still largely the go-to people to whom you tell how you're really feeling.
At clinics affiliated with teaching hospitals -- like Gillespie's clinic, where the physicians are also professors at Georgetown University -- medical students are par for the course. They act as the examining physician, following through with the checkup begun by the nurse or PA. They also diagnose and summarize information for the doctor, who comes in at the end of the patient's visit to check off on the diagnosis and discuss a treatment plan. "I like patients to accept that [medical students] are part of the process. They are very helpful to us," Gillespie says.
This is a physician who also oversees the clinic's other physicians. "The captain of the ship," Gillespie says. "We view ourselves as working on a team. We're no longer trying to go it alone." This doctor has medical oversight but recognizes that other people may be better at actually carrying out the work of caring for patients, she adds. "Lots of people can offer more intense management services." Team-based health care also means closer partnerships between patients and providers, so increasingly empowered patients are stepping up to the plate and taking charge of their own care.
Not all clinics have medical scribes, but scribes are a great asset when clinics do have them, Gillespie says. For doctors, "[scribes] give you back your eye contact with the patient." Often compared to court reporters, scribes sit in on the patient's appointment with the doctor to take notes and enter data for insurance claims into the computer via electronic medical records. "They enter the data the way Medicare wants us to enter the data," Gillespie says.
Also known as patient navigators, patient educators help orientate patients -- often those who have been diagnosed with a serious condition and will need ongoing care. As with a scribe, it's a little bit of a luxury for a clinic to have one. Because of that, patient educators may be more prominent at specialty clinics like ones focused on oncology. Or they may be disease-specific, like a diabetes patient educator charged with overseeing a newly diagnosed patient's lifestyle and dietary changes.
Social worker/case manager
While millennial patients tend to be in and out of the doctor's office, a small subset of typically older patients are always at the doctor or in the hospital, says Reid Blackwelder, a family physician in Kingsport, Tennessee, and the president of the American Academy of Family Physicians. These patients benefit from a social worker or case manager checking in on them -- to see if they are taking their medications or having any problems. In the old days, waiting for the patient to contact you might have meant a medical emergency, Blackwelder adds. Now, contacting patients before things happen is the cornerstone of preventive care.
As the clinic's business manager, practice managers supervise staff, oversee patient satisfaction surveys and ensure that patients' billing is done correctly. It's a tedious job, says Vincent Orange Jr., the practice manager at MedStar Clinic. Orange has to go back through unpaid claims and figure out why each wasn't paid. He also prepares scheduling templates to ensure there are enough slots in the week for physicals, children's visits, ER sick visits and more.
Having someone with a Pharm D -- a doctorate of pharmacy -- can be a great asset in a clinic, Blackwelder says. "It allows for a great deal of immediate attention on drug interaction and is so much better than relying just on the pharmacy." Even if a pharmacist isn't actually in the office, having a pharmacy or a pharmacy school nearby opens up a great communication channel that allows doctors and patients to be proactive about potential side effects of drugs.
At the end of the day, patients still come to the doctor to see the doctor -- and that expectation follows patients out the door. "The bottom line is that my patients still want me to be the one who calls them," Gillespie says. However, as clinics move toward team-based models, other players -- like nutritionists, therapists and social workers -- will step in to tailor patient care. "If you want to lose weight, are you better off with a 15-minute doctor's appointment, or a once-a-week call from a nutritionist?" Gillespie says. It's the nutritionist, she adds, who will get you to your goal.