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.