Better-Functioning Offices Make PCPs Work Enjoyable

Using “joy” and “primary care physician” in the same sentence can be downright provocative these days, as the authors of a study that does just that point out. “We set out in search of joy. What we found were pockets of professional satisfaction.”

Specifically, the authors — who include Thomas Bodenheimer, MD, a member of Managed Care’s Editorial Advisory Board — focus on 23 high-performing primary care practices to find out “how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life’s vocation.”

Their study, “In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices,” is in the May/June issue of the Annals of Family Medicine (

“We question why young people would devote 11 years preparing for a career during which they will spend a substantial portion of their workdays, as well as much of their personal time at nights, on form-filling, box-ticking, and other clerical tasks that do not utilize their training,” the study states.

They also question whether patients are being optimally served by this situation.

The study’s authors shadowed physicians for a day and also met with administrators and clinical leaders.

The study looks at seven methods that make practices more efficient. They are:

  • Reducing work through pre-visit planning and pre-appointment laboratory tests
  • Adding capacity by sharing the care among members of a team
  • Eliminating time-consuming documentation through collaborative documentation and nonphysician order entry
  • Saving time by ordering medications for an entire year in some cases
  • Reducing unnecessary physician work by having a nurse or physician assistant passing on to the physician only information that specifically requires a doctor’s expertise
  • Improving team communication through huddles and more formal meetings
  • Improving team functioning by, for instance, having a medical assistant and physician sit side by side

The study notes, “No single practice has solved every issue; each practice still struggles to overcome its own set of constraints.”

Case studies illustrate the effectiveness of different approaches. For instance, six of the practices have nurses or medical assistants enter the orders and follow up with the patient.

“At the Cleveland Clinic Strongsville, primary care physicians work with two medical assistants or one medical assistant and one registered nurse.”

They take notes while the physician talks to and examines the patient.

“After one year of the new model, average daily visits increased from 21 to 28, thereby improving access and continuity.

“Revenue was up 20% to 30%, which has exceeded the cost of the additional medical assistant or nurse.”