BACKGROUND: Physician burnout is associated with deleterious effects for physicians and their patients and might be exacerbated by practice transformation. OBJECTIVE: Assess the effect of the Comprehensive Primary Care (CPC) initiative on primary care physician experience. DESIGN: Prospective cohort study conducted with about 500 CPC and 900 matched comparison practices. Mail surveys of primary care physicians, selected using cross-sectional stratified random selection 11 months into CPC, and a longitudinal design with sample replacement 44 months into CPC. PARTICIPANTS: Primary care physicians in study practices. INTERVENTION: A multipayer primary care transformation initiative (October 2012-December 2016) that required care delivery changes and provided enhanced payment, data feedback, and learning support. MAIN MEASURES: Burnout, control over work, job satisfaction, likelihood of leaving current practice within 2 years. KEY RESULTS: More than 1000 physicians responded (over 630 of these in CPC practices) in each round (response rates 70-81%, depending on round and research group). Physician experience outcomes were similar for physicians in CPC and comparison practices. About one third of physician respondents in CPC and comparison practices reported high levels of burnout in each round (32 and 29% in 2013 [P = 0.59], and 34 and 36% in 2016 [P = 0.63]). Physicians in CPC and comparison practices reported some to moderate control over work, with an average score from 0.50 to 0.55 out of 1 in 2013 and 2016 (CPC-comparison differences of - 0.04 in 2013 [95% CI - 0.08-0.00, P = 0.07], and - 0.03 in 2016 [95% CI - 0.03-0.02, P = 0.19]). In 2016, roughly three quarters of CPC and comparison physicians were satisfied with their current job (77 and 74%, P = 0.77) and about 15% planned to leave their practice within 2 years (14 and 15%, P = 0.17). CONCLUSIONS: Despite requiring substantial practice transformation, CPC did not affect physician experience. Research should track effects of other transformation initiatives on physicians and test new ways to address burnout. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02320591.
BACKGROUND: Physician burnout is associated with deleterious effects for physicians and their patients and might be exacerbated by practice transformation. OBJECTIVE: Assess the effect of the Comprehensive Primary Care (CPC) initiative on primary care physician experience. DESIGN: Prospective cohort study conducted with about 500 CPC and 900 matched comparison practices. Mail surveys of primary care physicians, selected using cross-sectional stratified random selection 11 months into CPC, and a longitudinal design with sample replacement 44 months into CPC. PARTICIPANTS: Primary care physicians in study practices. INTERVENTION: A multipayer primary care transformation initiative (October 2012-December 2016) that required care delivery changes and provided enhanced payment, data feedback, and learning support. MAIN MEASURES: Burnout, control over work, job satisfaction, likelihood of leaving current practice within 2 years. KEY RESULTS: More than 1000 physicians responded (over 630 of these in CPC practices) in each round (response rates 70-81%, depending on round and research group). Physician experience outcomes were similar for physicians in CPC and comparison practices. About one third of physician respondents in CPC and comparison practices reported high levels of burnout in each round (32 and 29% in 2013 [P = 0.59], and 34 and 36% in 2016 [P = 0.63]). Physicians in CPC and comparison practices reported some to moderate control over work, with an average score from 0.50 to 0.55 out of 1 in 2013 and 2016 (CPC-comparison differences of - 0.04 in 2013 [95% CI - 0.08-0.00, P = 0.07], and - 0.03 in 2016 [95% CI - 0.03-0.02, P = 0.19]). In 2016, roughly three quarters of CPC and comparison physicians were satisfied with their current job (77 and 74%, P = 0.77) and about 15% planned to leave their practice within 2 years (14 and 15%, P = 0.17). CONCLUSIONS: Despite requiring substantial practice transformation, CPC did not affect physician experience. Research should track effects of other transformation initiatives on physicians and test new ways to address burnout. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02320591.
Entities:
Keywords:
burnout; control over work; job satisfaction; patient-centered medical home; primary care physician
Authors: Paul A Nutting; Benjamin F Crabtree; William L Miller; Elizabeth E Stewart; Kurt C Stange; Carlos Roberto Jaén Journal: Ann Fam Med Date: 2010 Impact factor: 5.166
Authors: Tait D Shanafelt; Michelle Mungo; Jaime Schmitgen; Kristin A Storz; David Reeves; Sharonne N Hayes; Jeff A Sloan; Stephen J Swensen; Steven J Buskirk Journal: Mayo Clin Proc Date: 2016-04 Impact factor: 7.616
Authors: Christine A Sinsky; Lotte N Dyrbye; Colin P West; Daniel Satele; Michael Tutty; Tait D Shanafelt Journal: Mayo Clin Proc Date: 2017-11-01 Impact factor: 7.616
Authors: Mark Linzer; Linda Baier Manwell; Eric S Williams; James A Bobula; Roger L Brown; Anita B Varkey; Bernice Man; Julia E McMurray; Ann Maguire; Barbara Horner-Ibler; Mark D Schwartz Journal: Ann Intern Med Date: 2009-07-07 Impact factor: 25.391
Authors: Robert J Reid; Paul A Fishman; Onchee Yu; Tyler R Ross; James T Tufano; Michael P Soman; Eric B Larson Journal: Am J Manag Care Date: 2009-09-01 Impact factor: 2.229
Authors: Stacy B Dale; Arkadipta Ghosh; Deborah N Peikes; Timothy J Day; Frank B Yoon; Erin Fries Taylor; Kaylyn Swankoski; Ann S O'Malley; Patrick H Conway; Rahul Rajkumar; Matthew J Press; Laura Sessums; Randall Brown Journal: N Engl J Med Date: 2016-04-13 Impact factor: 91.245
Authors: Zosha K Kandel; Diane R Rittenhouse; Salma Bibi; Taressa K Fraze; Stephen M Shortell; Hector P Rodríguez Journal: Med Care Res Rev Date: 2020-01-22 Impact factor: 3.929
Authors: Debora Goetz Goldberg; Tulay G Soylu; Panagiota Kitsantas; Victoria M Grady; Kurt Elward; Len M Nichols Journal: J Gen Intern Med Date: 2021-01-08 Impact factor: 5.128