Discussion
This study investigated the impact of provider co-management on
self-reported burnout, job satisfaction, and intention to leave current
position. Almost 30% of our PCP sample reported experiencing burnout
and job dissatisfaction, irrespective of PCP discipline. While this
number is high, it appear that PCPs that co-manage patients in our study
have less burnout than previously reported at the national
level.36(Peckham C. Medscape National Physician
Burnout & Depression Report, 2019) Our findings further indicated that
PCPs reporting high levels of effective co-management between their
clinical colleagues had significantly less burnout, job dissatisfaction
and intent to leave current position compared to those reporting poor
co-management. Co-management care delivery models may be a promising
approach to help alleviate some burnout causes.
A myriad of work environment characteristics (e.g. EHR, liability risk)
have been found to influence a provider’s burnout
risk.37 The variability of work environments, team
compositions, and policies in practices warrants a closer look and
potentially should be investigated at the individual practice level. For
example, emerging evidence has concluded that each environment where
clinicians practice has its own unique culture.38 It
may be important to develop burnout-mitigation initiatives that are not
a “one-size-fits-all” strategy, but rather focused on the individual
teams and clinician dyads, inclusive of their workflow, relations,
expertise, and resources. The co-management theory itself focuses on
provider-provider dyads and promotes a shared clinical alignment with
effective communication strategies and trust.23 More
attention to individual provider dyads may be more effective at
mitigating stress-induced burnout in primary care rather than focusing
on the whole team. Measuring co-management between such dyads may allow
clinicians, policymakers, and administrators to strategically place
specific providers together to subsequently have better outcomes.
It is also important to note that majority of previous studies have
focused on physician burnout and existing evidence about NP and PA
burnout are limited. More and more clinical teams are made up of
interdisciplinary dyads yet there is limited evidence about the impact
of such hybrid compositions. NPs make up the fastest growing workforce
in the United States with almost 90% of NPs are board certified in
primary care.39 As the demand for primary care
services increases, due to an aging population, physician supply
shortages, and the complexity of chronic co-morbidities, the increase in
NPs entering primary care and co-managing patients with physicians will
likely increase. Future research about how well physicians, NPs, and PAs
co-manage patients is needed to inform clinical practice and policy in
an effort to optimize co-management care delivery.
There are limitations to this study. We used a cross sectional design
that captures only a snapshot of the multifaceted variables that measure
co-management and burnout outcomes. Our sample was also limited to one
US state and PCPs in other states may report different results. More
research is needed across a wider geographic sample. However, New York
State includes the varying scope of practice policies that are
consistent across most US states for NPs and PAs (e.g., independent,
collaborative and restricted written practice agreements). We were also
isolate practice-specific policies that may influence shared care.
However, given the known variability of policies at the
organizational-level, our sample captured real-world evidence of
existing co-management care delivery models. We recommend that future
research should compare practices that are dose-matched in regards to
team compositions, resources, practice size, and provider-type. Given
the detrimental impact of burnout on PCPs, patients, and the healthcare
system, PCMI measures and addressing co-management facets is an
essential step in reducing workforce stress, burden, and improving the
quality of care for patients.