I met Dr. Maury McGough in 2002 when my husband Bob and I moved to The North Shore of Massachusetts and he took on a new role at Salem Hospital. Maury was an integral member of his leadership team. 

I learned so much by observing her leadership skills and her success growing primary care practices. With that in mind, this month, I share some of her wisdom in meeting the challenges we face.

A Team Approach

The primary care world we lived in for the past 40 years has permanently changed, forcing us to alter our expectations and behaviors. The volume of healthcare information and the speed at which it accumulates has made it difficult for a primary care physician to be completely up to date and be the “be all and end all” for their patients.

As Maury explained, “The role of the primary care physician has changed. They must recognize the need to work effectively as a team member. They must know how to identify and use appropriate resources.”

As consumers, we tend to view physicians as lone practitioners; we are not accustomed to thinking of them working in teams. This change in mindset can open our eyes to alternative ways of accessing care.

Changes Since the COVID-19 Pandemic

The pandemic forced physicians to quickly pivot and (permanently) reinvent how care is delivered. 

For example, virtual appointments have opened access in amazing ways. As a healthcare advisor who has attended hundreds of appointments with older adults, often in places difficult to access and therefore very disruptive to the lives of vulnerable clients, I am thrilled when certain appointments can occur in a much easier and less anxiety-provoking way. Virtual appointments are also extremely useful as a first step when seeking second opinions.

Still these are not always appropriate. Balancing the need for virtual with in-person visits is something that requires ongoing attention.

Administrative Changes

In most healthcare institutions, call centers are now centralized. This is a major change from when we could reach the practice directly, leave a message, and get a call back within a reasonable period. 

Maury’s suggestion is to ask your provider and set expectations: “I know the world has changed. What is the best and most effective way to work with you, your team, and your office?”

Working Wth the Team

Many speakers at Maury’s retirement celebration emphasized how she “modeled the way” by being one of the first primary care physicians on the North Shore to integrate a blended team model that included a nurse practitioner. In her opinion, primary care is best delivered by a nurse practitioner, since they have a smaller panel of patients and can focus on:

• Chronic disease management
• Conducting annual physicals
• Delivering and monitoring preventive care
• Educating patients about a host of topics including self-care

In her practice, Maury and her nurse practitioner had standards of practice they followed that included when they needed to confer about a patient’s care. This collaborative approach provided fresh perspectives and improved outcomes.

The Patient-Specialist Relationship

For patients with chronic medical conditions that require diligent and frequent oversight, Maury believes the relationship with a patient’s specialist is possibly more important than the primary care relationship. 

Examples of patients she mentioned are those with neurological diseases such as Parkinson’s disease or endocrine diseases such as diabetes. These were cases where she was also dependent on the specialist knowledge and experience to help manage patients in a team approach. 

Life Stage and New Delivery Models 

Maury recommended different solutions for different patients, and often had to encourage them to be open-minded about the options available.

For younger, healthy patients, an Amazon-owned delivery model (One Medical) may be a good option. One Medical is membership-based, with heavy reliance on technology that blends in-person care with digital health tools. 

For some older patients, including those with complex medical needs, two specialized options are often most appropriate:

• Geriatric practices tend to limit the number of patients a provider must manage and focus more on improving quality of life rather than solely focusing on life extension. “What Matters to You” is practiced more diligently in these settings.

• Concierge practices are membership-based and offer enhanced access and personalized care from primary care physicians. Doctors see fewer patients, allowing more time for patient appointments, more comprehensive care, and more proactive coordination.

Summary of Tips

Our discussion reinforced some of the suggestions I provided last month and offered some new ideas. I summarize them here:

• Identify your needs. What type of practice and/or provider is most suitable for your particular circumstances? A person who seeks care once a year for assistance with preventive care has very different needs than those of someone managing multiple chronic conditions and who interacts with their primary care physician every three months.

• Do your homework. When researching practices, ask about their model to help identify if they use a team approach and, if so, how providers share patients. Focus on the role of a nurse practitioner and their relationship with the physicians in the practice. Ask if the nurse practitioners have done advanced training and/or are certified in specialty care such as cardiology, diabetes, or geriatric care. If you are an older adult, ask if they practice the 5 Ms of geriatric care.

• Be open to a nurse practitioner as your primary care provider. With smaller patient panels and a focus on preventive care, management of chronic medical conditions, and teaching, a nurse practitioner may be a perfect match.

• Be open to the use of technology… but be realistic about its limitations. To access care more efficiently and foster your relationship with a practice, learn to use whatever technology that practice employs to its full potential. But be realistic — it does not mean you have instantaneous access to your provider.

• Determine the best way to communicate. With centralized scheduling systems in place, discuss with your provider the best alternatives to an office phone call.

• Use waiting lists and be open to a provider who just completed training. Be open to being placed on a waiting list in late spring when practices know that an individual who has just completed their training and taken their boards will join in September. Their recent training, fresh eyes, and eagerness and excitement about formally beginning their career can lead to a positive, and long-term relationship.

Summary

As we wrapped up our discussion, we moved onto how large health systems are attempting to deal with shortages and the daunting economic challenges. It is Maury’s opinion that health systems must invest in multiple solutions that include support of primary care training and prevention of burnout. 

As healthcare consumers, we must understand how our health care system is changing, keep an open mind, and adapt accordingly.