The Healthcare Team
It’s important to know who’s who on the healthcare team anytime you’re interacting with healthcare professionals. Understanding the chain of authority and who handles which type of problems can save you a lot of time and wasted energy. In addition, if you attempt to move forward on an issue without this knowledge, you will likely fail to follow the appropriate “rules of healthcare etiquette,” and you lose credibility and possible access.
Who’s in Charge?
If you’re new to an organization and you’re trying to figure out who an unknown person might be, here are some tips for making an identification:
- When making rounds, a “Chief” or “Head” Doctor (the ones who have finished residency and are attendings) is the one walking in the front of the group or sitting at the head of the table. If not at the head, he sits directly to the head’s immediate right or left. (His nametag has MD after his name or on his lab coat.)
- The Chief Executive Officer or President leads the organization, is always in a suit, usually sits at the head of the table, and expects everyone to bring them whatever they need. Their job is to keep the system financially stable.
- The administrators/Vice Presidents do likewise.
- Nurses are the ones in charge hour by hour in the nursing units. They are responsible for making sure the patient stays safe and gets well.
- Therapists treat “something” – physical therapy, respiratory therapy, occupational therapy, etc.
- Technicians run the equipment – Radiology technician, laboratory technician, EEG technician, etc.
- Aides, assistants, and partners assist – assist other healthcare professionals and assistants.
Here’s a basic lesson on who’s who among healthcare team members. This list won’t be all-inclusive. Healthcare facilities tend to make up titles to fit their needs, but this list will give you a general idea of the primary groups. To learn more about healthcare professions and regulations, go to the Virginia Board of Health Professionals for additional information.
Medical Staff Hierarchy
The Chief of the Medical Staff – Directs the healthcare team. The healthcare team refers to more than just doctors. The medical staff includes medical doctors, doctors of psychiatry, surgeons, doctors of osteopathy, dentists, etc. They assess your symptoms, order tests to figure out what’s behind them, hear your story to get clues to what could be causing the problems, and figure out the issues based on that information. They then make an educated guess regarding the diagnosis (which is why they “practice” medicine) and prescribe a treatment plan for you, including medications and therapies (treatments performed by other health disciplines).
Before a doctor can practice medicine independently, they must go through many years of practicing under the supervision of other doctors with more knowledge and skill in a training hospital (i.e., an academic medical facility). Therefore, if you are a patient at an academic medical hospital, you will encounter the following additional “doctors.”
Physicians – Oversee all other medical team members in the plan of care for the patient. Makes all the final decisions regarding the patient’s care that are not the patient’s decisions.
Note: Rounds – The term “rounds” describes the practice of groups of healthcare providers, primarily doctors or doctors-in-training, who go from patient to patient. If the patient is in an academic medical center, “rounds” include a “lecture” type presentation. For example, the circulation process may be completed by one physician checking on just his patients or by a group of physicians talking together. During rounds, the doctors discover what changes occurred in their patient’s condition overnight — new lab results, pain tolerance, nursing concerns, patient complaints, etc. They use this information to train the new doctors in making treatment decisions and deciding any changes needed in that day’s treatment orders for the patient. Rounds usually occur before doctor’s offices open in the morning.
Physician Extenders – Healthcare professionals with medical training who work with physicians and have the same training as physicians concerning identifying conditions, determining a diagnosis, and developing a treatment plan, but their training is not as extensive (examples: physician’s assistants, nurse practitioners). Therefore, they must work under the authority and license of a physician.
Physician’s Assistant – A Physician’s Assistant is a graduate from a PA school and licensed to practice under a physician’s supervision. A PA can write prescriptions and administer treatments just like a Nurse Practitioner but cannot do the same things a nurse has the authority to do. The Board of Medicine licenses them.
Nurse Practitioner (NP), Nurse Midwife (NM) (NPS live in both worlds – nursing and medical staff) – Advanced practice registered nurses licensed to practice under a physician’s supervision and authorized to write prescriptions and administer treatments like physicians.
Medical Staff Training Hierarchy – The Pathway to Becoming a Doctor
Medical Students graduate from undergraduate programs to enter graduate school. When entering graduate school, they become interns. After finishing their first year of residency, they become second-year residents, where they start independent practice. Third-year and fourth-year residents are fine-tuning their skills and rotating through practice specialties before finishing graduate training and becoming eligible to take their board certification exams to practice independently as doctors. If they want to become specialists in a field of practice, they become fellows. The length of a fellowship depends on the specialty.
Medical Student – Medical Students, are not doctors. They are in undergraduate training, very green, and just learning about medicine. They will ask you LOTS of questions, and later the attending physician grills the student on what they heard from you. The student must know all your lab work results and everything about your medical history, social history, and medical condition.
Intern – An Intern is a first-year medical resident. An intern is a recent graduate from college and is in the first year of graduate medical school. They work directly under the supervision of a faculty physician. Though they can do the same things as a doctor, the Attending physician must approve all work before implementation. Essentially, this first year is doctor orientation, where they get their feet wet before being allowed to work independently.
Resident – A Resident is in graduate medical education (years 2-4). Each year, they gain more experience and independence under the watchful eye of an Attending in the hospital. By their fourth year, they practice independently and are ready to take their Boards to become “real” doctors. Most have been practicing in a specialized area of training.
Fellows – Some specialties require an additional 1-2 years of focused practice (“fellowships”) before they can begin practice independently.
Nursing Department Hierarchy
Chief Nursing Officer – Directs Nursing Healthcare Team – The Nursing Staff is a critical healthcare team member. They provide 24-hour care for the patient and are the physician’s eyes and ears. Without vigilant and perceptive insights, physicians would not have the information needed to make the necessary decisions to treat patients.
Clinical Administrator – May be called a clinical supervisor in some areas. Oversees larger hospital areas after hours to ensure everything runs well and problems are solved after leadership goes home.
Nursing Director-The Nurse Manager’s supervisor. Supervises several areas of nursing and often oversees a specialty line of service.
Nurse Manager – Call the Nurse Manager if you have any issues you can’t resolve with nursing staff while your family member is a patient on a nursing unit. If it’s after hours (that’s usually after 5 pm or on weekends) and you have a problem, ask for the Clinical Coordinator on the floor or the Clinical Administrator for the hospital.
Nurse Practitioner (NP), Nurse Midwife (NM) – See above under physician extenders.
Registered Nurses – Registered Nurses coordinate nursing care, teach patients, assess patient needs, and administer treatments and medications. They perform many roles within the hospital setting. Some have titles other than registered nurses when performing administrative roles in non-clinical jobs. RNs control everything on the nursing floors and within the hospital’s nursing units. Nurses are a critical part of everything that happens in the hospital. Without them, nothing would happen, and patients would not heal. They see first-hand what is happening to the patient and take action to make necessary corrections long before the doctor is on-site. They are the true heroes of patient care.
Clinical Coordinator – The RN shift leader is usually called the Clinical Coordinator and supervisors the other staff on the floor. If you have a problem with whoever is giving you care, ask for this person to help you get a resolution.
Licensed Practical Nurse (LPN) – Licensed technical nurses bring patients into rooms, do vital signs, assist doctors with procedures, help with room setups and takedowns, and do what nurses and care partners do. The difference between LPN and RN is in the amount of formal education they have acquired to practice. Most RNs have 2-4 years of intensive clinical education, which helps them be better prepared to assess symptoms, determine a nursing diagnosis, and create and implement a nursing treatment plan.
Care Partners – (formerly called Nursing Assistants) – Support RN and LPNs in the care and treatment of patients with daily care needs, including hygiene, nutrition, mobility, vital signs, transportation, grooming, toileting, and much more. If you need anything for your comfort, ask a care partner to get it for you. They are your “go-to person.”
Student Nurses – Students participating in clinical training from area nursing programs could be from various nursing programs, including community colleges, diploma programs, technical training programs, advanced degree programs, or degree-seeking programs.
Other Healthcare Team Members Providing Services to Patients
Billing Office – When you get your hospital bill, ensure that they have your correct insurance information. If you are paying any amount, they likely won’t take you to court; however, they will sue you if you disregard their notices. Hospitals are a business. They need money to run. My recommendation is to contact the billing office if you have a large bill you need to pay and set up a payment plan right away. Set up what you can afford and make those payments on time, perhaps using automatic payments through your bank, so you don’t have to think about it. It’s the safest way to make sure they always get paid.
Registration or Admissions Clerk – Registers you in each visit, collects co-payments, checks ID, goes over pre-admission paperwork, collects advanced directives, goes over forms for completeness, answers questions, and helps you obtain access to others you might need to see. This person, however, does not have a lot of power. So if you don’t like something they tell you, don’t shoot the messenger.
Discharge Clerk – Schedules appointments and provides copies of discharge paperwork; much like the registration person, has little flexibility. They can be accommodating but are at the person’s mercy on the other end of their calling. They can’t give you what you want in most cases. You need to ask their supervisor or the Billing Office if the issue is your bill.
Care Coordinator – This person works with you to get ready to go home. They coordinate with you to find home health services such as oxygen for home use, a home health agency, transportation home, or whatever you need to get out of the hospital and home. It would help if you had a case manager assigned to you shortly after admission. Some hospitals may use a Social Worker instead of a Care Coordinator. However, both can do the same type of coordination.
Chaplain Services – Religious services for all faiths are available regardless of preference. Let the Patient or Guest Relations office know of a desire for religious connection, and they will contact the chaplain’s office to set up a visit. Healthcare facilities recognize the importance of faith in their patients’ lives. Even if they do not have the service available on-site, they have connections with people of faith who can come to meet with patients for support.
Physical Therapist – Helps persons perform exercises, stretches, warmups, and use equipment to strengthen and restore the muscle to return individuals to full function.
Respiratory Therapist – Provides breathing treatments, sets up oxygen, draws blood gases, helps with ventilators, helps people cough better, and assists with many other things related to breathing and lung care. Their state of residence registers them.
Occupational Therapist – Helps people perform exercises and learn to use muscles in such a way as to regain the capacity to perform daily life activities.
Speech Therapist – Evaluates an individual’s capacity to speak clearly, articulate correctly, say what they intend to say, swallow without choking, learn aspiration prevention tips, etc.