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Team-based Care at Scripps: It’s All About the Patient

NPs, PAs, primary and specialty care physicians working together

Provider looking at an image while talking to a patient in the office.

NPs, PAs, primary and specialty care physicians working together

When it comes to your health, choosing the right provider is essential. Whether for preventive care or a medical crisis, your doctor should be a trusted part of your health journey. At Scripps, your care is put in the hands of not only your primary care doctor, but also an entire team of nurses, advanced practice clinicians (APC) — like nurse practitioners (NP) and physician assistants (PA) — and specialty physicians for whom your health and wellness are their utmost priority. Here, a team of Scripps practitioners highlight why teamwork truly makes the health care dream work. 


“My philosophy is that your primary care physician is really a teammate — someone who is collaborating with you about your care. It’s a partnership,” says Anthony Chong, MD, a family medicine physician and chief medical officer at Scripps Coastal Medical Center.

Choosing the right primary care physician

“You want a physician who knows your family history, what conditions you have and what your preferences are,” he continues. “At the end of the day, it’s a collaboration. The doctor might have medical information and a recommendation, but if the patient is not in tune with the recommendation or if the information is not presented in a meaningful way, chances are, once that visit is over, the patient may not act on it.” That’s why, Dr. Chong adds, trust is key when it comes to choosing your primary care physician. 


“When it comes to your car, you take it to a mechanic you can trust. In the same way, your partnership with your physician should be built on a foundation of trust,” he says. “For me, as a family medicine physician, I may know a person from the time they were a child to when they start their own family. I’m connected to my patients. That longevity is very important to help create a bond between a patient and their physician.” 


Choosing the right primary care physician not only allows you to build a trusted personal bond, it also ensures you have someone closely following any health changes that occur as you age. 


“Your primary care doctor has a 360-degree view of your health,” explains Siu Ming Geary, MD, an internal medicine physician and vice president at Scripps Clinic. “They know your medical history, your risk factors and your preferences for how you want to approach your health care.


“Any doctor can tell you general guidelines for health. Having a primary care doctor whom you see on a regular basis ensures not only that you’re keeping up to date on all the preventive care you need to stay healthy, but they can help you make choices that are customized for you and your lifestyle,” Dr. Geary says. “Plus, when you need specialty care, we have the insight into your preferences and can provide guidance to connect you to specialists that suit you.”

Meeting the integrated care team

Meeting the integrated care team

If the physician is unavailable for days or weeks, the NP or PA is usually available to see the patient that same day.

Bonnie Marblestone, FNP

When you choose your primary care physician at Scripps, you’re also choosing an integrated team of providers that will be by your side throughout your health journey. In your primary care office, you may also be seen by an NP or PA who is part of your care team. They work with your physician to ensure you have continuous care that meets your needs. 


“Even doctors may take a day off or occasionally get sick,” explains Dr. Geary, “so there may be times when your doctor is out of the office. However, your health is important every hour of every day. Having multiple providers who know you and understand your health care needs helps to ensure access of care. At Scripps, our team approach includes NPs and PAs.” 


Bonnie Marblestone, a family nurse practitioner or FNP, agrees that the collaborative practice between APCs and physicians is a true benefit to patients. “Advanced practice clinicians increase access of care for the patient. If the physician is unavailable for days or weeks, the NP or PA is usually available to see the patient that same day and provide for the patient’s health care needs in a timely fashion, while also providing excellent care,” she says.


“The APC can also assist the physician in answering patient messages, refilling medications and following up on the care needs of patients with chronic conditions like diabetes and hypertension. We help to support the physician in providing complete and consistent care of patients.”

Access to specialty care

Access to specialty care

When your health needs require specialty care, you can rest assured that the same exceptional teamwork extends to your Scripps specialist offices. From cardiology to orthopedics and everything in between, Scripps’ specialty departments work in concert with primary care to provide the comprehensive care you have come to expect from Scripps. Thanks to an integrated electronic health record, primary care physicians can work seamlessly with specialists to coordinate care. 


“Our electronic medical record and email system allow for direct messaging from primary care physicians to subspecialists. This can significantly improve patient access to subspecialty care,” explains James Bruffey, MD, an orthopedic surgeon at Scripps Clinic. “Several of our primary physicians use this routinely, which helps me coordinate my care of their patients and allows me to expedite those patients that require more urgent evaluations and treatment recommendations.” 


Dr. Bruffey adds that this seamless integration between primary care and specialty care significantly improves the patient experience. 


“Specialist access allows for improved care across the board, and the process works both ways. Our system allows me to review imaging and history to inform our primary physicians and referring physicians of the need to expedite care for certain patients and conditions, but also to inform those physicians when subspecialty care is not really needed and provide assistance in primary care management of those patients and their conditions,” he says. “That way I can maximize the efficiency of my schedule to really see patients in a timely fashion. It also improves patient satisfaction by having them avoid visits and referrals and their associated costs when subspecialty care is not really indicated or needed.”

NPs and PAs in specialty practice

NPs and PAs in specialty practice

Just like in a primary care setting, APCs enhance a specialty practice with their team approach. 


“As APCs, we allow for the extension of the physician’s ability to manage their patients both in the surgical and clinical settings,” explains Terri Abbott, PA, Scripps Clinic. “This team approach also brings a more comprehensive and expansive approach to the overall care of the patients. We reinforce the recommendation and treatment plans both surgically and nonsurgically for patient care. Patients seem to appreciate the team approach, especially when we connect with the patient in the clinic and in the surgical setting as the surgical assistant.” 


Dr. Bruffey agrees. “Our APCs are utilized to improve patient access to care and the timeliness of that care,” he says. 


“They are well trained and extremely effective at extending our ability to see orthopedic patients. We can use them for independent evaluations when indicated to improve access, and their training allows them to recognize when direct surgeon intervention or more subspecialized assessment is required.


“In addition, their care of patients allows for improved efficiency with regards to imaging and laboratory testing when indicated. Patients should look at them as extensions of their physicians. They can often spend more time to get the nuances of a patient’s condition and their care needs, as our scheduling process affords them the time to do these assessments.”

The cover of San Diego Health magazine.

This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.