Although physician unionization efforts have been focused on the West Coast, the trend is growing and spreading across the country, this consultant says.
In recent years, physician unionization has been focused on the West Coast, but it is now being seen on the East Coast and in the South, says Clark Bosslet, MBA, a partner at ECG Management Consultants. Bosslet expects the trend to grow and continue for the foreseeable future.
A Journal of the American Medical Associationarticle published in December found physician unionization picked up momentum over the past two years. Recent physician unionization efforts include primary care physicians seeking to unionize at Mass General Brigham.
"There is a general awareness of unionization as an option, which is driving it forward," Bosslet says. "I was at a couple of physician society conferences over the past six months, and unionization was on everybody's mind. What is the viability of it? Have there been positive outcomes from it? It is increasingly top of mind for physicians as the ultimate fallback option."
Physician unionization drivers
Several factors are driving physician unionization efforts, according to Bosslet.
"More than ever, physicians are seeking sustainable work-life balance," Bosslet says. "They are seeking predictability both in terms of their compensation and their time commitment."
While higher base compensation is a significant factor, there are other forces at play, particularly the sense that physicians have a seat at the table in decision-making, Bosslet explains. Physicians want to have a say in how quality measures are established, how their clinical definition is established, how their schedule is established, and how their care teams are defined.
"When they feel that these things are being dictated down to them, that is where they start to bristle," Bosslet said.
Physicians are objecting to feeling that they are always on the clock and always on call, according to Bosslet.
"That is finally starting to reach a boiling point, where physicians are saying that they have to have clear lines of definition around when they are available and when they are not available," Bosslet says. "That is sustainability of work-life balance."
Physicians want to have a better understanding of the financial status of their health system or medical group, Bosslet explains.
"Where I am seeing successful physician engagement is when there is a willingness to sit across from all of the physicians and executives say how the health system is doing and how the medical group is doing," Bosslet says. "There needs to be a willingness to share what is driving success."
How CMOs can discourage unionization
One of the reasons why more physicians are seeking to unionize is the increase in direct employment of physicians over the past 20 years, according to Bosslet.
"When those physicians decide to give up or forego the inherent autonomy of private practice and join a health system or medical group, they think it is going to be easier to practice—there is going to be a burden lifted off of them," Bosslet says.
To discourage physicians from unionizing, CMOs and other healthcare leaders need to focus on ease of practice, Bosslet explains.
"They cannot layer on extra layers of bureaucracy, although there is usually a rationale behind it," Bosslet says. "The extra electronic health record obligations and time commitments take physicians away from direct patient care. That is where they start to feel frustrated."
CMOs should make sure their physicians feel respected and empowered, according to Bosslet. Physicians recognize their role in the success of health systems, and they want a degree of transparency from leadership.
"They do not need to sit with the CFO to comb through all the numbers," Bosslet says. "But you need to make sure they have a degree of transparency into the financial health of the health system or the medical group. That makes them feel empowered."
Physician engagement is critical to head off unionization efforts. CMOs should make an effort to check in with their physicians to see how they are doing.
"To the extent that you can survey your faculty and physicians to get a pulse check, or even better, try to meet with as many of them as possible on a regular basis, you can hear their problems and empathize with them," Bosslet says. "That is what is going to keep physicians engaged in a positive way and keep them away from ultimately pursuing unionization."
What CMOs can do if their physicians unionize
Physician unions pose a challenge to CMOs and other healthcare leaders, according to Bosslet.
"Once a union has been established, it adds a degree of rigidity and it adds a degree of separation," Bosslet says. "Once a union is established, it adds a degree of formality to conversations. … When you have a union, it makes it harder to be nimble."
To cut through this rigidity and formality, CMOs should compartmentalize union conversations, Bosslet explains.
"If you are a CMO, your clinical leaders can't get engaged with union conversations. You are going to hear things from the providers," Bosslet says. "It is important to show a degree of empathy and show a degree of respect. You need to make sure you are hearing concerns and taking them back to the proper representatives."
The formation of a physician union should not result in a CMO being alienated from the doctors because everybody is ultimately pursuing the same mission, according to Bosslet.
"From the CMO's perspective, at the end of the day, these are still your people," Bosslet says. "They are in your clinics. They are in your operating rooms. They are in your ER. They are your people and your medical staff. They are part of your team keeping patients healthy. That must be at the forefront."
CMOs should not let strains with union representatives strain the relationship with their physicians, Bosslet explains.
"No matter how adversarial the conversations with the union representatives might get, in the healthcare facilities, physicians are your people and there is no distance between you," Bosslet says.
Legislation before Congress would allow AI tools or machine learning technologies to prescribe medication if approved by state law and the FDA.
Legislation that would allow AI tools to prescribe medication is premature, according to an AI expert at Sutter Health.
AI is taking on increasing roles in clinical care. For example, there are AI tools that help radiologists to read and interpret medical images. In addition, AI tools can provide clinical decision support. Ambient listening AI tools record interactions between clinicians and patients, then develop a clinical note for the electronic health record.
In January, U.S. Rep. David Schweikert, R-Arizona, introduced the Healthy Technology Act of 2025. The legislation, which is being considered by the U.S. House of Representatives Committee on Energy and Commerce, would allow AI tools or machine learning technologies to prescribe medication.
Under the Healthy Technology Act of 2025, an AI tool or machine learning technologies would be considered a practitioner licensed by law to prescribe medication under two circumstances. First, the technology would have to be approved as a practitioner to prescribe medication by state law. Second, the technology would have to be approved, cleared, or authorized by the U.S. Food and Drug Administration.
Kiran Mysore is chief data and analytics officer at Sutter Health. Photo courtesy of Sutter Health.
AI tools or machine learning technologies are not ready to play the role of a practitioner who prescribes medication, according to Kiran Mysore, MS, chief data and analytics officer at Sutter Health, and a HealthLeaders AI in Clinical Care Mastermind member.
"AI exists to supplement physicians, not supplant them," Mysore says. "AI helps elevate the level of patient care and reduce physicians' cognitive burden. Use of AI in this fashion is still premature; there are several risks and unknowns that we should work through."
AI tools can help make decisions on prescribing medications, but a clinician still needs to have the final say, Mysore explains.
"Our general rule of thumb is that we need a human in the loop across the board as a requirement in clinical decision-making," Mysore says.
Several hurdles must be cleared before AI tools are ready to prescribe medication without the supervision of a clinician, according to Mysore. First and foremost, AI tools must have reliable knowledge and understanding of a wide range of illnesses and treatments.
"It has to have a deep awareness of the patient's entire medical history and be able to get the latest information easily," Mysore says. "The tool has to also have internal guardrails to prevent errors and bias, with some level of explainability and chain of reasoning."
In addition, there needs to be a mechanism to rate actual prescriptions against a physician's recommendations, Mysore explains.
"We have a long way to go before all these requirements are in place," Mysore says.
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Students earn their medical degree in three years tuition-free, then transition into a three-year family medicine residency program.
As CMOs know, there is a primary care physician shortage across the country, and South Carolina is no exception. By 2030, the Cicero Institute projects that the state will have a shortfall of nearly 1,000 primary care physicians.
The University of South Carolina School of Medicine Greenville has launched an innovative program to help address the primary care physician shortage in The Palmetto State.
Frank Beacham, MD, a clinical assistant professor and director of the Primary Care Accelerated Track (PCAT) program at the University of South Carolina School of Medicine Greenville, has direct experience with the primary care physician shortage.
"I practice family medicine, and I see firsthand how many patients struggle to find a primary care physician," Beacham says. "Even when they have one, getting an appointment can be a major challenge. The demand for primary care physicians is constantly growing."
The Connecticut-based health system will be offering an AI-enabled virtual primary care service in partnership with K Health.
Beginning in April, Hartford HealthCare will launch a 24/7 AI-enabled virtual primary care service called HHC 24/7.
With a primary care physician shortage across the country, access to primary care has become problematic. Patients often must wait weeks or months to get into a primary care physician's office.
HHC 24/7 will provide patients with access to a primary care physician or advanced practice provider around the clock
The providers will be employed by Hartford Healthcare and dedicated to working through the HHC 24/7 app, according to Padmanabhan Premkumar, MD, president of Hartford Healthcare Medical Group.
"We are going to have dedicated providers who only work in this service line," Premkumar says. "At Hartford Healthcare Medical Group, we started a virtual service line for telehealth in January 2023. So, we have a dedicated group of people who are just focused on providing virtual care."
Hartford Healthcare has seen success in recruiting and retaining virtual care providers, Premkumar explains.
"With workforce shortages, we want to diversify our portfolio to ensure that we give providers the ability to work in many different ways," Premkumar says. "Many providers want to be in an office setting to see patients. But with an emphasis on work-life balance and other things that are occurring, there are many providers who want the ability to work away from an office setting such as working from home."
HHC 24/7 is being offered in partnership with K Health, which has developed the AI tools that will be used with the service. HHC 24/7 visits start with the patient interacting with the AI tool.
"Patients spend a few minutes with our AI answering questions prior to a primary care visit," says Ran Shaul, co-founder and chief product officer at K Health. The patient talks about their medical history. The AI asks how long symptoms have been present. The AI proactively solicits and understands the patient's complaint."
Based on this interaction, the AI generates a chart that is entered into Hartford Healthcare's electronic medical record, and the primary care provider can quickly review the chart at the start of a virtual visit.
"As a provider, the primary care physician can start the visit with a perfect chart," Shaul says. "That makes the provider more productive. The provider can talk with the patient and spend time explaining a diagnosis and treatment plan."
HHC 24/7 will provide greater access to care while maintaining quality, according to Shaul.
"We are not rushing our visits—the AI is cutting down on a significant amount of provider labor such as the collection of symptoms, the automatic creation of a chart, and the documentation that it is created," Shaul says. "All of that is saving time, so the provider can be more productive."
HHC 24/7 will provide care for more than 200 conditions, Premkumar says.
Advantages of using AI
The future of AI in healthcare is to enhance and simplify the patient experience, according to Premkumar.
"The AI augments our ability to gather information from the patient," Premkumar says. "It allows for information to be gathered from the electronic medical record and be placed in front of a provider, who can then make a much more informed and objective decision about diagnosis and treatment."
The AI used in HHC 24/7 not only enhances the patient experience but also serves as a helpful aid for clinicians, Premkumar says.
"The AI capabilities in HHC 24/7 will allow us to focus on patient care while limiting the time that the provider has to spend combing through the electronic medical record and asking the patient a multitude of questions," Premkumar says.
Despite the power of the AI used in HHC 24/7, clinicians still have a vital role to play, according to Premkumar.
"AI helps to augment the patient experience, but it does not obviate the need of having a clinician put the pieces of the puzzle together to make a diagnosis and form a treatment plan," Premkumar says.
Bethany Casagranda brings experience of establishing centers of excellence at diagnostic imaging sites.
The new CMO of Allegheny Health Network is focused on delivering high quality and high-value care.
Bethany Casagranda, DO, MBA, became CMO of AHN and president of Allegheny Clinic effective Jan. 1. She had previously served as chair of AHN's Imaging Institute since 2017. Casagranda is succeeding Donald Whiting, MD, who is remaining at the health system as chair of AHN's Neuroscience Institute.
High quality and high-value care go hand in hand, according to Casagranda.
"If you elevate the quality in a health system, you elevate value," Casagranda says.
Casagranda pursued quality and value as chair of AHN's Imaging Institute, which grew significantly under her leadership. In 2017, when she became the chair of imaging, the institute covered three hospitals and had 30 radiologists. When she left that role on Dec. 31, the institute covered 14 hospitals and had 130 radiologists.
"In imaging, we thought the best way to improve value was standing up centers of excellence," Casagranda says. "It was a four-year journey to do that work, and we were able to establish every diagnostic imaging site as a center of excellence. It involved not only regulatory work but also decreasing radiation for our patients and increasing appropriate use of contrast. We were also able to decrease the cost of care, which benefits the patient tremendously."
Achieving high quality and high-value care requires having a just culture, Casagranda explains.
"We have processes and procedures in place to track quality metrics, but people need to be able to bring problems forward if they affect quality," Casagranda says.
At AHN, staff members are encouraged to report safety and quality issues through an online incident reporting program called RL6. The program allows for anyone in the health system to be able to put in something as simple as a needlestick during a procedure versus more complicated issues that happen in settings such as operating rooms.
"People can put in all of the issues that arise," Casagranda says. "There are dropdown menus so people can select different categories and put in information that elevates up to clinician leaders, nursing leaders, and regulatory staff."
All serious incidents are subject to a root-cause analysis.
"We get together and talk about every step of the process involved in an incident and how we can help to rectify an issue in the process or to provide a necessary resource," Casagranda says.
The keys to success in providing high quality and high-value care include the ability to build teams where everybody is focused on the mission of keeping people healthy, according to Casagranda.
"We often talk about the role of doctors on these teams," Casagranda says, "but other staff members such as our nursing colleagues, advanced practice providers such as physician assistants, and pharmacy colleagues all need to be part of a culture to keep people as healthy as possible."
Bethany Casagranda, DO, MBA, is CMO of Allegheny Health Network and president of Allegheny Clinic. Photo courtesy of Allegheny Health Network.
Boosting patient experience
Providing a positive patient experience has an easy component and a hard component, Casagranda explains.
"The easy way to provide a good patient experience is to follow-up diligently on the Press Ganey surveys that our patients submit," Casagranda says. "You need to celebrate wins whenever we provide a good patient experience and tackle the challenges that arise in these surveys."
The more difficult component is linking patient experience with provider experience, according to Casagranda.
"When the workforce is healthy and well supported, we are in a better position to provide a remarkable experience for our patients," Casagranda says. "I try to remind staff members that in our journey to provide the best experience for our patients, we cannot forget the puzzle piece of the clinician experience. This is harder to tackle than a survey, but it is worth the work."
Supporting the 'Living Health' clinical model
AHN and its parent organization, Highmark Health, have adopted a long-term strategy called the Living Health clinical model.
"It features our ability to provide programs and resources to Highmark Health customers and AHN patients that allow them to live their healthiest lives," Casagranda says. "Examples of these programs include Onduo for diabetes management, Spring Health for mental health and behavioral health, and opportunities to utilize apps on smart phones."
The goal of the Living Health clinical model is to focus on health rather than illness.
"Instead of being in the business of taking care of sick people, we would like to be in the business of taking care of healthy people as long as they can be healthy," Casagranda says. "We want to give people everything they need to stay healthy on their own."
As CMO, Casagranda is playing the role of communicator and facilitator to support the Living Health clinical model.
"I have an opportunity to connect all of the programming that Highmark Health is putting forth in the Living Health clinical model with our clinicians, who can then communicate about these programs with our patients," Casagranda says. "I want our patients to know these programs are available."
Casagranda communicates about Living Health clinical model programs in simple ways such as email and more complicated ways such as engaging the health system's clinical leadership teams.
"When we do rollouts, I communicate with all of the physician chairs and the hospital presidents, who are physicians," Casagranda says. "We talk about these opportunities, then they cascade the information down to frontline clinicians throughout the enterprise."
Efforts include physician recruitment and retention as well as establishing a pipeline for entry-level professionals.
As health systems and hospitals across the country are struggling with staffing shortages, OU Health is rising to the challenge of recruiting and retaining healthcare workers.
A shortage of physicians in several specialties has been vexing for recruitment efforts, according to the CMO of OU Health.
"There is a national physician shortage across the country and particularly in Oklahoma," says Carolyn Kloek, MD, CMO of OU Health. "We work hard to recruit physicians, but the bottom line is we wish there were more physicians to recruit. The physician shortage is not unique to us—it is an issue across the country."
When OU Health recruits physicians, they try to articulate the mission of the organization, particularly aspects of the mission that are unique to OU Health, Kloek explains.
"What we find is that those who are invested in academic medicine quickly see the opportunity not only for being a physician in academic medicine, but also having the opportunity to influence the outcomes in our region and state, which have tremendous health needs," Kloek says.
Being part of an academic health system is an attraction for some physicians, according to Kloek, because there is an opportunity to be part of the tripartite mission of clinical care, teaching, and research.
"That tripartite mission creates a vibrant environment and culture," Kloek says. "We can also give physicians flexibility in how they are going to shape their role and position within the health system."
Service line chairs play a pivotal role in recruitment of physicians, according to Jimmy Duncan, SHRM-SCP, SPHR, chief human resources officer at OU Health. Service line chairs are responsible for helping the organization develop recruitment strategies.
"When you talk about physician recruitment, whether it is the pipeline of residents we have through the college of medicine or external recruiting, people tend to want to come and work for the service line chair," Duncan says.
OU Health offers enticements in physician recruitment, Duncan explains.
"Physicians want to feel that they are going to be mentored and have an opportunity for professional development," Duncan says. "We offer those things at OU Health, which differentiates us from other academic health systems and health systems in general."
Retaining physicians at OU Health
Culture is critical in the retention of physicians, according to Kloek, who adds physicians want to feel valued and deeply connected to their work.
"Like all professionals in healthcare, physicians are mission-driven, and, at the end of the day, they want to know that they are making a difference," Kloek says. "You need to have a culture and an environment in which physicians can feel valued and see their contribution."
At OU Health, being an academic health system is a retention tool, Kloek explains.
"We provide a dynamic environment," Kloek says. "It is fun to work with students and trainees. It is fun to work with colleagues in different specialties to think about how we innovate care or discuss cases."
Providing flexibility in career development is another aspect of physician retention at OU Health, according to Kloek.
"They can continue to practice their core specialty, but we give them room to move," Kloek says. "They can do more teaching. They can start a new research project in a particular area. We also have a culture of continuous learning."
Leadership also plays a role in retention. Duncan explains that when it comes to retention, it is important for staff members to have a relationship with a leader who is invested in them.
"That is a driver of retention, which is why there is a big focus on leadership development in our organization," Duncan says. "We want our leaders to be effective every day."
Effective onboarding is a critical step in setting up physicians' careers, according to Duncan.
"Staff members know what is expected of them," Duncan says. "Through our onboarding, we have a focus on careers. We make sure our people can make strides toward growing their careers."
Additionally, physicians must have a voice in decision making and other aspects of the organization, Duncan and Kloek explain. OU Health uses annual physician engagement surveys, which are then shared with the staff with the goal of promoting action planning.
"With healthcare and health systems becoming more complex, you need to ensure that physicians' voices are heard in the organization," Kloek says. "There has been a lot written and discussed about how it is getting harder to practice medicine, and having a process where physicians' voices can be heard and engaged is important for retaining physicians."
As CMO, Kloek has worked to build a team of physician leaders who are committed to improving quality and safety, and physicians have a voice in this effort.
"Engaging physicians in this type of team-based and collaborative work can be critical for the health system as a whole and the outcomes for our patients," Kloek says. "It is also helpful for physician engagement, so it becomes a win-win."
Building a workforce pipeline
Dealing with workforce shortages goes beyond physician recruitment and retention. OU Health is building a strong workforce pipeline to fill a variety of clinical roles, according to Duncan.
The health system's talent pipeline initiative focuses on students at junior high schools, high schools, vocational schools, and colleges.
"We are bringing students on site and exposing them to things such as healthcare career days, where we give them an opportunity to see healthcare professionals in action," Duncan says. "We are incentivizing these students with things such as scholarships, with an opportunity to study at the OU Health Sciences Center."
OU Health is also providing students with on-the-job experience, Duncan explains.
"We have looked at several of our needs over the next three to five years, and we have defined some career pathways that start with what we call 'healthcare explorers' or students," Duncan says. "We want to give them on-the-job experience that will ultimately lead them to join our organization as entry-level professionals."
These healthcare explorers are paid for their work.
"We are making sure that students are being paid market-level compensation in order for them to be able to earn while they learn," Duncan says. "This also helps students build a resume that is going to help them accelerate getting into the workforce."
Students earn their medical degree in three years tuition-free, then transition into a three-year family medicine residency program.
As CMOs know, there is a primary care physician shortage across the country, and South Carolina is no exception. By 2030, the Cicero Institute projects that the state will have a shortfall of nearly 1,000 primary care physicians.
The University of South Carolina School of Medicine Greenville has launched an innovative program to help address the primary care physician shortage in the Palmetto State.
Frank Beacham, MD, a clinical assistant professor and director of the Primary Care Accelerated Track (PCAT) program at the University of South Carolina School of Medicine Greenville, has direct experience with the primary care physician shortage.
"I practice family medicine, and I see firsthand how many patients struggle to find a primary care physician," Beacham says. "Even when they have one, getting an appointment can be a major challenge. The demand for primary care physicians is constantly growing."
The PCAT program offers a medical degree on a three-year track, with students receiving full-tuition scholarships for their degree if they commit to practicing in South Carolina for four years. The program started in July 2024 with five students enrolled in the three-year program who will pursue a residency in family medicine.
"We see the PCAT program as one way to offset the need for primary care physicians," Beacham says. "Our accelerated program is going to graduate students who do not have student loan burdens, who have had family medicine mentorship, who have seen family medicine done the right way, and who have had curriculum tailored to family medicine physicians."
The PCAT program is a parallel-track curriculum with the medical school's traditional four-year medical degree program.
"We take all of the required courses of the four-year program, and we efficiently put the courses in three years of curriculum," Beacham says. "Our three-year students are receiving the same requirements as the four-year students. We just do it in a more time-efficient manner."
Although there are other three-year medical degree programs in the country, the PCAT program has some unique characteristics, according to Beacham.
"There are similar three-year primary care curriculums, but we put our students in a three-year curriculum designed for family medicine students," Beacham says. "We are also putting our students into a family medicine clinical environment within the first month of them being a medical student."
An emphasis on mentorship is another unique aspect of the PCAT program. The PCAT students are learning in a residency-clinic program where they may eventually do their residency training.
"They learn from the faculty. They learn alongside fellows and residents. They have exposure to our department of family medicine leadership," Beacham says. "They are working alongside community faculty members with whom they are eventually going to be colleagues."
There are also monthly check-ins with PCAT students to make sure that they are managing their stress and wellness.
Frank Beacham, MD, is a clinical assistant professor and director of the Primary Care Accelerated Track program at the University of South Carolina School of Medicine Greenville. Photo courtesy of the University of South Carolina School of Medicine Greenville.
Model for CMOs to follow
The PCAT program provides a blueprint for CMOs and other healthcare leaders to follow in their states, Beacham explains.
"First, you must identify the need within the state," Beacham says. "Are there certain targeted areas within a state that need more primary care physicians?"
CMOs should look at their healthcare organization's partnerships, according to Beacham.
"Do they have graduate medical education programs within their own organization, or can they partner with GME programs to help a graduating resident from a GME program transition seamlessly into their organization," Beacham says. "CMOs should look at what partnerships they have with medical schools."
Providing financial support for a program such as PCAT has a return on investment, Beacham explains.
"A CMO should consider paying for a student's tuition, then have the student have an employment agreement with the CMO's organization," Beacham says.
The return on investment comes in the form of avoiding physician recruitment costs, avoiding lost revenue when primary care physician positions are vacant, and avoiding the relatively high cost of paying a locum tenens physician to fill an open position.
"What you may find is that you are paying about the same as what you would pay for three years of tuition for a student," Beacham says.
Plans for expansion
Currently, the PCAT program is being funded with philanthropic money through the medical school.
"We have a mission here that we educate, innovate, and serve," Beacham says. "Our program embodies that mission. We are educating students in an innovative way, then they serve patients in the state of South Carolina."
The medical school would like to expand the program in the future.
"Right now, we are focused on family medicine," Beacham says. "But if we can get some additional dollars, which we are trying to seek out, we can expand our program to internal medicine, pediatrics, or another primary care specialty."
Physician-led care teams are no longer the only option.
Advanced practice providers (APPs) such as nurse practitioners and physician assistants are going to play leading roles on care teams more often, says the CMO of Tower Health.
With a physician shortage across the country, health systems, hospitals, and physician practices have turned to APPs to maintain access to medical services. In some states APPs can practice autonomously, but many states require APPs to practice under the supervision of a physician.
Historically, CMOs and other healthcare leaders have thought that physicians should lead care teams under all circumstances, but that view is changing, according to Suzanne Wenderoth, executive vice president and CMO of Tower Health.
"Now, we recognize with both changes to laws in the states, which allow for full practice authority for advanced practice providers, and the physician shortage in the post-COVID era, there has been an evolution in our thinking," she says.
Physician-led care teams are no longer the only option, this CMO says.
Advanced practice providers (APPs) such as nurse practitioners and physician assistants are going to play leading roles on care teams more often, says the CMO of Tower Health.
With a physician shortage across the country, health systems, hospitals, and physician practices have turned to APPs to maintain access to medical services. In some states APPs can practice autonomously, but many states require APPs to practice under the supervision of a physician.
Historically, CMOs and other healthcare leaders have thought that physicians should lead care teams under all circumstances, but that view is changing, according to Suzanne Wenderoth, executive vice president and CMO of Tower Health as well as HealthLeaders CMO Exchange member.
"Now, we recognize with both changes to laws in the states, which allow for full practice authority for advanced practice providers, and the physician shortage in the post-COVID era, there has been an evolution in our thinking," she says.
At Tower Health, APPs are under consideration for leadership roles on care teams, Wenderoth explains.
"At Tower Health, we do believe that every care team should have access to a physician," she says. "But whether care teams need to be led by a physician is up for discussion."
There are circumstances where a care team can be led by an APP or a nurse, according to Wenderoth.
"When we talk about leading care teams, we are really talking about making sure the leader has leadership skills such as maintaining accountability, demonstrating professionalism, and having good facilitation skills," she says. "That can be done by a physician, advanced practice provider, or nurse."
It is ideal for APPs to operate at the height of their license and capability, Wenderoth explains.
"Their role depends on their level of expertise and experience," she says.
Inexperienced APPs at Tower Health are often paired with a peer mentor, Wenderoth says, adding that APPs are subject to ongoing professional practice evaluations as part of the medical staff process.
"We want to make sure that they feel confident and competent," she says. "We also make sure they have completed enough supervised procedures before they move into more independent work."
More experienced APPs can take on more responsibilities at Tower Health, according to Wenderoth.
"There are some advanced practice providers who are very skilled and have been practicing for a long time," she says. "They can take the lead of a care team."
Tower Health operates facilities in Pennsylvania, where Gov. Josh Shapiro is considering allowing full practice authority for nurse practitioners who have worked under a physician for at least three years.
"When you have that kind of statutory or regulatory approval in combination with the ability to be reimbursed for nurse practitioner services, you can broaden the care team," Wenderoth says. As there are more statutory and regulatory changes, we will see more advanced practice providers leading care teams. We will use physicians as resources more in the background than they have been in the past."
Suzanne Wenderoth, MD, is executive vice president and CMO of Tower Health. Photo courtesy of Tower Health.
Inpatient care teams
At Tower Health, inpatient care teams are physician-led in a classic way, with APPs on the team working at the height of their scope of practice, according to Wenderoth.
"For example, with a cardiology team, a cardiologist leads the team and conducts consultations for undiagnosed patients," she says. "Advanced practice providers may conduct follow-up visits or encounters for protocolized care such as heart failure."
A physician leads other care team members in the inpatient setting, including clinical pharmacists, nurse care managers, wound care nurses, and respiratory therapists, Wenderoth says.
Outpatient care teams
Care team models are more flexible in the outpatient setting at Tower Health, Wenderoth explains.
In the first model, there are physicians and APPs in parallel practice. For example, in primary care there are physicians and APPs seeing patients in parallel, with the patients having similar levels of complexity. This arrangement includes urgent care and family medicine clinics.
In the second model, there is a physician leader of a care team that includes APPs, where the APPs are operating at the height of their scope of practice, but they are seeing more protocolized and straightforward cases.
The third model is for particular specialty clinics, according to Wenderoth.
"For example, we have a weight management center, which includes dieticians and experts in physical medicine and rehabilitation, who can guide patients who are losing weight rapidly through a physical recovery period," she says. "We have physicians who work with dieticians, social workers, and physical therapists."
Easing physician burdens
Tower Health is utilizing the full effort of the health system's physicians by relying on technology and other care team members, Wenderoth explains.
"Telemedicine in combination with remote patient monitoring has allowed us to off-load work from physicians," she says. "You can have equipment available for the patient to use at home, whether it is iPads, Bluetooth-enabled scales, blood pressure monitors, or other devices. The information can be imported to the physicians and other care team members can be involved in assessments."
In some circumstances, APPs can conduct telemedicine visits with little support from physicians, according to Wenderoth.
"At the most basic level, an advanced practice provider could conduct telemedicine visits in primary care or urgent care with autonomy," she says. "They have access to a physician in the background, but they would rarely need to consult with a physician."
Clinical pharmacists are an example of how Tower Health is using care team members to ease the administrative burdens on physicians, Wenderoth explains.
"We have a retail pharmacy program, where clinical pharmacists can essentially do the prior authorization of medicines, then we can mail the medication to the patient's home," she says. "We have seen that improve medication compliance, reduces readmission rates, and off-loads administrative work from physicians."
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Physician leadership is ideal in collaborative care teams, this CMO says.
At Northwell Health, clinical teams function most effectively when they are physician-led, with multidisciplinary team members working at the top of their competencies, to deliver the best outcomes. Physicians bring years of training, experience, and expertise in navigating complex medical situations, making them best equipped to lead care teams while fostering a collaborative approach.
There is a shortage of physicians across the country. To address these shortages, many health systems, hospitals, and physician practices have been turning to advanced practice providers (APPs), such as physician assistants and nurse practitioners, to fill the gap.
"We are so lucky to lead talented clinical teams," says Jill Kalman, MD, chief medical officer of Northwell Health. "Multidisciplinary care teams should be collaborative, with flexibility to adapt based on the patient's needs and setting. Whether in the hospital or outpatient clinic, well-structured teams ensure the best outcomes."
While the growing role of APPs helps address physician shortages, physician-led teams provide the optimal structure for delivering high-quality, patient-centered care, Kalman says.
Jill Kalman, MD, is chief medical officer of Northwell Health. Photo courtesy of Northwell Health.
Dynamic and flexible team approach
In a well-designed care model at Northwell, different team members contribute their expertise, with physicians providing oversight and team decision-making for complex cases. Kalman highlights the importance of flexibility: "For example, an advanced practice provider may manage a patient’s diabetes and hypertension, but if that patient presents with rapid atrial fibrillation and a fever, physician consultation is essential to determine next steps."
Physicians, APPs, nurses, pharmacists, respiratory therapists, and other healthcare professionals all play key roles in guiding a patient through their care at Northwell, with physicians providing clinical oversight.
Care teams in the inpatient setting
In Northwell hospitals, multi-disciplinary teams ensure patients receive coordinated and efficient care, implementing diagnostic testing, setting treatment plans and interventions with the team determining readiness for transitions to home or other settings. The composition of the team varies by clinical setting.
Clinical teams consist of physicians, advanced practice practitioners, nurses, social workers, pharmacists, respiratory therapists, mental health professionals, hospitalists, and specialists— all support patient care based on individual needs.
Care teams in the outpatient setting
In outpatient care at Northwell, team composition depends on patient acuity and clinic specialization, according to Kalman.
“Advanced practice practitioners have their own patients with physician supervision," Kalman says. "And with complex patients, physicians and APPs will collaborate directly to develop diagnostic and treatment plans for patients."
This approach expands patient access while maintaining high-quality care. "As patient complexity increases, the team structure adapts to ensure the best possible care," she adds.
The physician-advanced practice provider relationship
At Northwell, physicians and APPs develop close, collaborative relationships built on trust and mutual expertise.
"For example, a physician assistant in the operating room may assist in surgery, manage robotic technology, and oversee post-operative care, working seamlessly with the surgeon," Kalman says.
The same dynamic applies in outpatient care.
"APPs manage patients in consultation with physicians, ensuring timely access to care while maintaining safety and quality," Kalman explains. "When structured correctly, these teams maximize efficiency and deliver exceptional outcomes."
Northwell’s model emphasizes both leadership and teamwork.
"Collaboration strengthens the talent of all practitioners," Kalman says. "By leveraging the expertise of every team member, we create an environment where patients receive the highest level of care."
Physician-led, multidisciplinary teams represent the best path forward in delivering safe, effective, and patient-centered care, Kalman says.
Kiran Mysore is chief data and analytics officer at Sutter Health. Photo courtesy of Sutter Health.
Suzanne Wenderoth, MD, is executive vice president and CMO of Tower Health. Photo courtesy of Tower Health.
