Competition, collaboration and caring for the orthopedic patient are key

Improved efficiency and clinical skills will lead to a better patient satisfaction and care.

Jason S. Mazza

Competition is everywhere. Our competitive nature fuels us to be in many cases more innovative, motivated and focused. This holds true in everything from professional sports to the business world. Competition is readily apparent in health care and affects each of us daily. Insurance companies compete for individuals to sign up for their plans. Imaging centers compete for health care providers’ referrals. Device manufacturers compete to be orthopedic surgeons’ top choice for surgical instrumentation.

Consider the different professions of allied health professionals who work with orthopedists. What is the competitive spirit amongst these allied health professionals? Like other things, does it lead to positive benefits? The answer to this is a bit complex as I will explain.

Different skill set

In a previous column, I have described that there are multiple allied health providers who work directly with orthopedic surgeons. This can include orthopedic physician’s assistants (OPAs), physician assistants (PAs), nurses, nurse practitioners, athletic trainers and orthopedic technologists. Each of these allied health professionals receive different training, bring a different skill set to the table and each has a unique scope of practice. In many cases, within a clinical practice, there may be some vast overlap of duties as allowed by state laws and practice policies. Who is most valuable is highly dependent on the end user, including the surgeon, administrator and patients.

The business structure, clinical flow patterns, patient demographics, type of practice and comfort levels of the supervising surgeon are also major factors to consider. As an orthopedic practice, we are in the business of taking care of patients and in large part we compete against other practices or entities who offer equivalent services. This competition can be beneficial and should make us perform at a higher level to offer patients a more efficient and effective delivery of treatment and services.

Among the described health care providers, there has been a competitive sense that drives us and our national organizations to promote each individual profession as the ideal to provide orthopedic patient care. Simply put – rivalry exists and always will. Many allied health professionals compete for jobs and positions within orthopedic practices. At the individual level, the most qualified candidate with experience, knowledge and desired skills usually wins. At the professional level, we spend time “marketing” our professions to help differentiate what makes us potentially a better hire and why our profession is better than others. In some cases, a great deal of time and resources is being spent trying to discredit another profession or credential. The big question is — as allied health professionals, are we too engaged in competition and trying to prove supremacy of one profession vs. another that we have lost focus on our overall objective of improving care to the orthopedic patient?

Having recently served in the role of president of the American Society of Orthopedic Physician’s Assistants (ASOPA), which represents OPAs at the national level, I have found that the competition or rivalry among allied health groups to be the premier provider to the orthopedic surgeon discourages productive dialogue and causes a divergence of ideas and overall efforts. Each group tends to focus solely on their own aspect of improving care, own business objectives and building their membership base to try and be a dominate organization. There comes a point where competition becomes counterproductive. Why is it that our organizations rarely collaborate?

It is true that the type of knowledge fielded by an allied health professional to another varies considerably. I argue this to say that while the breadth of knowledge may vary, it should be looked upon that the level of knowledge is not necessarily greater, but in different areas. As an example, to promote a greater sense of unity within the orthopedic allied health community and to offer further education and training, ASOPA has spent the last few years offering combined educational conferences with other organizations.

Benefits

The benefits of this to individual practices and surgeons are many. Individual participants can go and be educated in a number of different areas of orthopedics, and in some cases, well beyond their normal scope of practice. Obviously, a more well-rounded allied health professional can add value to a practice and enhances patient care. Logistically, there are many challenges to getting other groups together to have a much larger collaboration. The American Academy of Orthopaedic Surgeons offers arguably the best educational cost-effective educational experience for all allied health providers in orthopedics.

The sad truth is that each allied health professional society has an annual or regional meeting yearly but, in many cases, it is not recognized by some rival organizations for continuing education credits. This obviously discourages some people from attending such meetings. In this day and age where specialty care dominates, advancing our training and learning from each other is a key component to improving patient care and making us more valuable and well prepared for continued health care changes. It is about providing patient satisfaction and great care, and not necessarily competing against each to do so.

Patient care

Many of us have also been put in the position of being the patient and needing orthopedic care. Be the patient. Who would you want helping your orthopedic surgeon take care of your treatment needs? Most average patients do not have a full comprehension of the differences among our professions. Some are biased because their level of knowledge is limited to being familiar with one specific allied health professional.

My own personal answer to the question I have posed is “the best trained and knowledgeable provider regardless of professional title.” If I needed a thumb spica cast for a scaphoid fracture, is there any advantage to an orthopedic technologist putting this cast on vs. a nurse who has an equal amount of training and experience? As a patient needing a complex cervical spine reconstructive procedure, would it matter to you if the assistant surgeon was a physician assistant or an orthopedic physician’s assistant — assuming years of experience with this procedure was the same for either provider? Despite different educational pathways, the level of working and procedure specific knowledge may be adequate to provide the safe and effective care regardless of title.

Many practices in the United States employ multiple allied health professionals including nurses, OPAs and PAs who work in complementary roles. In some cases, one practitioner can completely replace another if needed. Others cannot depending on a provider’s scope of practice. We should focus more on improved efficiency, interpersonal patient care and clinical skills. This will lead to a higher degree of patient satisfaction and better care.

We will always compete. It drives us to elevate our game. Within medicine, competition is a somewhat more complex and double-edge sword. As allied health professionals with different credentials and training, we need to learn to collaborate our knowledge and build more skill sets, instead of proving that one profession is better. Our patients, practices, surgeons and level of professionalism will benefit.

• Jason S. Mazza, MSc, OPA-C, CSA, SA-C, CCRC, is immediate past president of the American Society of Orthopedic Physician Assistants (ASOPA) and works with John H. Shim, MD, at Florida Sports, Orthopedic & Spine Medicine in Tampa, Florida. Please direct all questions or comments to orthoopa@mindspring.com.
• Disclosure: Mazza has no relevant financial disclosures.