Team Based Care Created to Fix Burnout Found to….Cause Burnout

Remember how the PCMH (patient centered medical home) model was designed to provide better care to patients through a team-based approach?Sure you do because you laughed at how ridiculous it was. Well, now we have this:

“Primary Care Tasks Associated with Provider Burnout: Findings from a Veterans Health Administration Survey,” noted that the challenges that come with undergoing a practice change as immense as transitioning to a team-based model of care “may have led to the unintended consequences of creating new stresses for PCPs, resulting in burnout.”

Ok, stop laughing.  This is serious.

How many times can we say we told you so?

Researchers broke down tasks PCPs reported performing independently. As noted in the findings,

  • 87 percent of PCPs said they evaluated patients and made treatment decisions;
  • 80 percent tracked patient diagnostic data and responded to patient diagnostic and treatment data;
  • 68 percent intervened on patient lifestyle factors; and
  • 65 percent educated patients about disease-specific self-care activities and medications.

PCPs reported some reliance on team members for screening patients for diseases (32 percent), receiving messages from patients (28 percent) and resolving patient messages (43 percent).

When it came to burnout, the researchers reported, “Specifically, intervening on patient lifestyle factors and educating patients about disease-specific self-care activities were significantly associated with PCP burnout.”

It seems to me that there just isn’t enough time to do all this stuff (aka metrics) in the regular hamster wheel of family practice (note: in Direct Primary Care there is).  That’s an obvious conclusion, right?  So what do these authors recommend?

  • Their suggestion: “Expanding the roles of nurses and other health care professionals to assume responsibility for these tasks may ease PCP burden and reduce burnout.”
  • They suggested that a potential strategy to combat PCP burnout would be to “enable PCPs to share this responsibility with other team members,” a transition that would require adequate staffing, focused training and standing orders.

Brilliant!  More team members!

So, in conclusion, a massive cluster f*ck called PMCH with huge teams has caused burnout so to fix it we should keep adding (and spending on) more team members until it is fixed or becomes the blob and takes over the world.  Love it.

Your thoughts?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Team Based Care Created to Fix Burnout Found to….Cause Burnout

  1. chris
    March 22, 2018 at 10:30 am

    One problem with the medical team approach is when the team creates a bunch of uncompensated work for the doctor like when I have to explain to every home health nurse that visits my patient with pulmonary fibrosis that she has had crackles in her lungs all the time for the past 10 years and it is not something that constitutes an emergency.

    I also love it when the medical insurance company sends a nurse to my patients home to give them a checkup (like I haven’t been doing that every 6 months) then sends the patient to me with preventive medication recommendations (the RN or LPN telling the doctor what to do) which I have already done and they would know that if they would have looked at their own billing records. Sometimes they actually send a physician to see these patients. I find it insane that they would actually pay A doctor enough to do housecalls on patients, just not the patients ACTUAL doctor. Instead of wasting all the money on these measures, if they spent the money paying ME then I could spend more time with the patient. I have recently started coming around to the rather odious conclusion that many other physicians have already made that the only solution is to make complex patients come in more frequently rather than spending more time with them at each visit since it is impossible with current billing system to get adequately compensated for the time spent with those patients. A system where you can legitimately bill the same for bronchitis as you do for managing a patient with 10 or 15 chronic medical problems is insane. I know you are going to say that DPC is the answer so maybe I just need to get your book.

    • RSW
      March 22, 2018 at 11:57 am

      “I find it insane that they would actually pay A doctor enough to do housecalls on patients”

      Here’s how that works – these are Medicare Advantage plans. The whore docs and nurses are coming up with 20 or 30 dx codes on healthy patients on no meds and with no significant medical history. This increases the payments the insurer gets from the feds. A major scam that everyone, including our corrupt medical societies, completely ignores.

      And you’re completely right about “team-based” care. Every player added to the team just means that much more bull-shit work for the doc to deal with gratis.

      • Chris
        March 26, 2018 at 1:40 pm

        Ok…I knew there was some kind of crazy thing like that going on (“unintended” consequences of some gov’t program).

    • Doug Farrago
      March 22, 2018 at 1:03 pm


  2. Ray
    March 21, 2018 at 8:32 pm

    Yeah. Familiar senerio Dougie. I told my boss and yours (the prestigious Primary Care Czar) of our hospital, that I did not sign up to be a manager of mid levels, I signed up to be a physician. That “pods” are bullshit. Dr Bill informed me that I had an old “internal medicine attitude”. I laughed. He said..that Ray, PODS, or the use of mid levels with physician supervision is the future of medicine. I was insensed, but he was correct. We are obsolete in this system. Dinosaurs of a different era. Ironically, the “Quality” that the “System” is seaking is a mirage. It is replaced by a system that pretends to be quality based but is Truly a fake or substitute for the real thing system. Ie. You, the patient, think you are seeing a doctor with extensive medical school training and residency training. Never mind years of experience. What you get is “Pod Medicine”. This is a bullshit system that saves insurers and hospital systems money because it employs providers pretending to be board certified physicians. If the public understood this it would blow up. They refer to their mid level providers as Dr so and so. What a scam! They are deceived. Plain and simple. Sad. See a recent Consumer Reports article on providers. Very good article on medical care. The article delineates the difference between mid level practitioner training and capabilities compared with board certified physicians. There is a difference! Consumer reports stated basically if you have a serious medical problem…see a physician MD or DO. Buyer beware!

  3. RSW
    March 21, 2018 at 12:33 pm

    The comments on the referenced article from practicing physicians are great.

    The ability of the AAFP bureaucracy to ignore and demonstrate pure contempt for the membership is without parallel.

    • Perry
      March 21, 2018 at 3:10 pm

      I just filled out a survey for AAFP. Boy did I give them an earful, doubt they listen.

  4. Jennifer Hollywood
    March 21, 2018 at 12:01 pm

    They instituted a broad PCMH program in PA several years ago. It had doctors and nurses and social workers and nutritionists etc. They were checking all the boxes off. Patients got to see more people for more things. Patient outcomes were NOT improved. Patient satisfaction was also decreased. So more money spent, more layers added, no improvement in care, and patient’s less happy. I sure there was a lot of burn out as well, but that was not addressed in the study as no one really cared if the doctor’s were happy or not.

  5. Perry
    March 21, 2018 at 9:37 am

    For hundreds of years there was the “patient-centered medical home”. It was called the Family doctor’s office.

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