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