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.