Survey Measures
PCPs were asked to complete a demographic form including age, gender, race, job title, education, work experience, and certification type. Next, we asked questions regarding practice characteristics including geographic setting (e.g. urban), practice size (# PCPs), patient volume, practice ownership, patient panel size, average number of hours worked per week.
The Provider Co-Management Index (PCMI) 33 was used to measure co-management. PCMI, a 20-item instrument, asks clinicians to rate the presence of co-management characteristics in their practices. For example, “My co-managing provider and I communicate patient needs in a timely manner.” A 4-point Likert response scale from “strongly agree” (4) to “strongly disagree” (1) is used. Researchers have determined PCMI subscales have high internal consistency reliability: 1) Effective Communication (α=.811); Mutual Respect and Trust (α=.746); and Shared Philosophy of Care (α=.779). Higher mean scores on each subscale indicate better provider co-management. A mean score for the overall scale was computed.
Job Satisfaction and Intention to Leave Current Position were measured using 2 items, previously validated in large scale surveys.34 Job satisfaction was captured via, “What is your overall level of satisfaction with your principal position?” This item uses a 4-point Likert response category ranging from “Very Satisfied” to “Very Dissatisfied”. Intention to leave current position was measured using the item, “Do you plan to leave your principal position?” The response categories were also categorical: “Yes, plan to leave in 1-2 years,” “No plans to leave in next 2 years,” and “Undecided”. Burnout was measured using an item from theMini-Z burnout study 35 via the AHRQ public domain. Categorical response options range from “I enjoy my work. I have no symptoms of burnout” to “I feel completely burned out and often wonder if I can go on.”
Statistical Analysis
Normality of continuous variables was checked through the Shapiro–Wilk tests. Sample characteristics were analyzed and presented as medians and interquartile ranges (IQR) for continuous variables, and absolute and relative frequencies (%) for categorical variables. Differences between disciplines were evaluated using the Kruskal-Wallis tests for continuous variables and Chi-squared tests for categorical variables. Logistic regression models were built to assess the relationship of the Provider Co-Management Index (PCMI) and its subscales with the provider burnout related outcomes which are self-reported burnout, job satisfaction and intention to leave. Crude odds ratios (COR) and its 95% confidence interval (CI) were obtained from bivariate logistic regression models. Adjusted odds ratios (AOR) were obtained from multivariable logistic models controlling for all related sample demographics and practice characteristics. P values were attained from Wald tests. Two-sided statistical tests were performed with the significance level set at P ≤ 0.05 using the R software package (v. 3.6.2).
Results
Out of 355 returned surveys, 333 eligible participants in total were analyzed after assessing for missing data. The final sample consisted of 158 (47.4%) nurse practitioners, 96 (28.8%) physicians, and 79 (23.7%) physician assistants. The demographics and practice characteristics of the study population are shown in Table 1. The median age overall was 55 years old with IQR (44, 62). The median years of experience overall was 20 with IQR (12, 29). 285 (86.4%) of them were white. 12 (3.6%) of them were Hispanic. 248 (74.9%) were female. Most of them (166 (50.0%)) worked in the provider-owned practice. 187 (56.5%) of them had been worked for 10 years or more. 190 (58.1%) worked part-time. 198 (61.1%) of them worked in the co-managing panel.