Mitigating primary care provider burnout with interdisciplinary dyads and shared care delivery
Short Title: Interdisciplinary primary care dyads
Allison A. Norful PhD, RN, ANP-BC (Corresponding Author)
Assistant Professor
Columbia University School of Nursing
630 West 168th Street- Mail Code 6
New York, NY 10032
Remote Office: 203-529-3897
Email: aan2139@cumc.columbia.edu
Yun He, MPH
Columbia University Mailman School of Public Health
Department of Biostatistics
Adam Rosenfeld, MPH
Columbia University Mailman School of Public Health
Department of Sociomedical Science
Cilgy M. Abraham PhD, RN
Columbia University School of Nursing
Bernard Chang, MD
Columbia University Irving Medical Center
Abstract
Rationale, aims and objectives : Increased incidence of chronic illnesses coupled with physician shortages have yielded strain on primary care providers (PCP) to meet care demands. Interdisciplinary providers such as nurse practitioners and physician assistants have increasingly been embedded into primary care teams to alleviate some workload demand. Little evidence exists about the impact of interdisciplinary PCP care delivery models, including provider relations and cohesiveness, on provider outcomes. The objective of this study was to investigate the attributes and impact of interdisciplinary PCP care delivery on provider burnout, job satisfaction and intention to leave current position.
Methods: We conducted a cross sectional mail survey of primary care practices (e.g., internal medicine) across New York State using Dillman methodology. A random sample of interdisciplinary PCPs (physicians, nurse practitioners, and physician assistants) (n=333) participated. The Provider Co-management Index (α = .85) was used to measure interdisciplinary dyad attributes (effective communication; mutual respect and trust; shared philosophy of care). Provider outcomes were measured with validated AHRQ and HRSA items for burnout, job satisfaction and intention to leave position. Descriptive statistics, logistic regression models, crude and adjusted odds ratios were calculated, controlling for participant and practice characteristics.
Results: Almost 30% of PCPs in our sample reported burnout with three times the odds of intending to leave their current position within one year. With each unit increase in effective co-management between interdisciplinary dyads there was 15% less burnout and 10% less odds of intention to leave position.
Conclusion: Incorporating interdisciplinary specialties in primary care appears promising to alleviate some adverse provider outcomes. Increased attention to interpersonal relations within a PCP dyad may be a targeted method to promote well-being and retention. Cost effectiveness research is needed to determine financial sustainability of interdisciplinary care delivery that includes more than one provider co-managing the same panel of patients.
Key Words: Burnout, teamwork, primary care, nurse practitioner, physician assistant, philosophy of medicine