“Practicing at the top of your license” is a catchphrase that refers to healthcare workers operating at their highest level of education, training, and competencies. The most common example is medical practices supplementing physicians with nurse practitioners and physician assistants who can assume many of the same responsibilities like routine follow-up care or managing medications for patients with stable conditions.

There are several goals of working at the top of your license. The first is to ensure patients receive the best care possible. Studies have linked top-of-license staffing to improved patient safety and population health.

Applying top-of-license staffing can also increase professional satisfaction because workers use more of their specialized skills. Helping healthcare workers stay engaged is especially important given the rising rates of physician burnout often associated with too much documentation and administrative work.

How to practice at the top of your license

Practicing at the top of your license is a nice idea, but what does it look like? Here are some practical tips for physicians interested in applying this approach. 

1. Delegate tasks

Effective delegating can ensure that physicians and other staff aren’t spending too much time on tasks they are overqualified to perform.

Delegating begins with assessing the tasks you typically handle before identifying which could be safely performed by staff with less training. For example, a primary care physician might notice they spend lots of time on routine follow-up appointments for stable patients. These visits could be performed by a qualified nurse practitioner, making better use of staff time and the practice’s resources. 

It’s critical to delegate thoughtfully. Collaborate with your healthcare team to ensure clear communication and mutual respect throughout the delegation process. 

2. Focus on skill development

Practicing at the top of your license works best when the entire care team focuses on continuous learning. Whether you’re a family physician, specialist, or physician’s assistant, prioritize expanding your knowledge and skills.

Prioritizing ongoing education helps ensure that staff experience working at the top of their license as an opportunity rather than a burden. Model continuous improvement by attending conferences and staying up to date with the latest research, and encourage your team to do the same. 

3. Advocate for your role

Practice or health-system leadership can prioritize top-of-license staffing, but so can individuals. As a physician, engage in open discussions with colleagues and administrators to ensure your contributions and specialized skills or training are recognized.

Advocating for your role goes hand-in-hand with building strong teams. If you’re a hospitalist, surround yourself with competent, qualified professionals who can assist with delegation and collaborate effectively.

Potential pitfalls of practicing at the top of your license

Organizations pushing for new roles in healthcare should ensure that the rush to lower costs doesn’t degrade the quality of care through a cascade of false equivalencies across professional lines. 

When delegating tasks, evaluating their impact on staff and patient outcomes is essential. Consider asking these three questions before delegating: 

  1. Can this task be safely delegated?
  2. Is this task appropriate for the training and competency level of the worker?
  3. How will we manage communication and collaboration? 

To ensure that working at the top of your license improves efficiency and patient outcomes, organizations should establish clear boundaries delineating what level and type of care is appropriate for an individual to provide, depending on their level of training. When in doubt, refer up to ensure that your team maintains the integrity of specialized care.

Making “practicing at the top of your license” work

By effectively delegating tasks, continuously improving skills, and advocating for their roles, healthcare practitioners contribute to better patient outcomes and a more efficient healthcare system. 

But don’t just do it for patients. Evidence shows that using more of your skills contributes to higher professional satisfaction. Thoughtfully approached, practicing at the top of your license can be a win-win for patients, healthcare systems, and providers.

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