Team Configurations, Efficiency, and Family Physician Burnout

Mingliang Dai; Rachel Willard-Grace; Margae Knox; Samantha A. Larson; Michael K. Magill; Kevin Grumbach; Lars E. Peterson

doi:10.3122/jabfm.2020.03.190336

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Figure 1.
Family physician burnout by perceived teamwork efficiency.

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Table 1.

Care Team Configurations of Family Physicians in Continuity Practice by Practice and Physician Characteristics

Parameter	Full Sample, % (N)	MA/Nurse Only, % (N)	MA/Nurse + NP/PA or Specialist, % (N)	MA/Nurse + NP/PA and Specialist, % (N)	P Value
Full sample	100% (2575)	22% (565)	40% (1040)	38% (970)
Practice organization					^*
Academic health center	7% (189)	6% (11)	31% (58)	63% (120)
Safety net	9% (238)	2% (4)	24% (58)	74% (176)
Hospital owned	35% (895)	20% (179)	46% (415)	34% (301)
Independently owned	32% (823)	39% (323)	46% (381)	14% (119)
Managed care/HMO	6% (148)	14% (21)	36% (53)	50% (74)
Other	11% (282)	10% (27)	27% (75)	64% (180)
Practice size					^*
Solo	11% (285)	75% (213)	22% (63)	3% (9)
Small (2–5)	34% (863)	26% (224)	54% (463)	20% (176)
Medium (6–20)	32% (834)	8% (63)	42% (351)	50% (420)
Large (>20)	23% (593)	11% (65)	27% (163)	62% (365)
Social deprivation^†					^*
High deprivation	20% (517)	25% (131)	36% (187)	38% (199)
Not high deprivation	80% (2058)	21% (434)	41% (853)	37% (771)
Practice environment
Satisfaction with practice					^*
Satisfied	82% (2102)	21% (436)	41% (855)	39% (811)
Not satisfied	18% (473)	27% (129)	39% (185)	34% (159)
Control over workload					^*
Satisfactory	68% (1758)	25% (432)	40% (706)	35% (620)
Not satisfactory	32% (817)	16% (133)	41% (334)	43% (350)
Value alignment					^*
Aligned	64% (1648)	20% (334)	40% (659)	40% (655)
Not aligned	36% (927)	25% (231)	41% (381)	34% (315)
Physician characteristics
Age					^*
Under 40	12% (314)	18% (55)	39% (121)	44% (138)
41–50	37% (953)	21% (197)	42% (397)	38% (359)
51–60	34% (873)	23% (199)	39% (340)	38% (334)
Over 60	17% (435)	26% (114)	42% (182)	32% (139)
Sex					^*
Female	46% (1177)	20% (240)	39% (462)	40% (475)
Male	54% (1398)	23% (325)	41% (578)	35% (495)
Degree
MD	89% (2292)	23% (516)	40% (912)	38% (864)
DO	11% (283)	17% (49)	45% (128)	37% (106)
Race					^*
White	72% (1860)	20% (375)	41% (764)	39% (721)
Black	5% (141)	24% (34)	40% (56)	36% (51)
Asian	14% (364)	30% (109)	36% (130)	34% (125)
Other	8% (210)	22% (47)	43% (90)	35% (73)
Ethnicity
Hispanic	7% (185)	26% (49)	34% (63)	39% (73)
Non-Hispanic	93% (2390)	22% (516)	41% (977)	38% (897)

↵* P < .05.
↵† High deprivation if social deprivation index was ≥75.
MA, medical assistant; NP, nurse practitioner; PA, physician assistant; HMO, health maintenance organization.

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Table 2.

Perceived Teamwork Efficiency by Care Team Configuration

Team Configuration^*	Perceived Teamwork Efficiency, N (%)
Team Configuration^*	Optimal	Good	Poor
All teams	351 (14%)	2049 (80%)	175 (7%)
MA/nurse only	92 (16%)	439 (78%)	34 (6%)
MA/nurse + NP/PA or specialist	139 (13%)	827 (80%)	74 (7%)
MA/nurse + NP/PA and specialist	120 (12%)	783 (81%)	67 (7%)

↵* χ² = 5.19, P = .27.
MA, medical assistant; NP, nurse practitioner; PA, physician assistant.

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Table 3.

Prevalence of Burnout by Team Configuration and Practice and Physician Characteristics

Parameter	Full Sample, % (N)	Burnout, %	P Value
Full sample	100% (2575)	41%
Team configuration
MA/nurse only	22% (565)	38%
MA/nurse + NP/PA or specialist	40% (1040)	43%
MA/nurse + NP/PA and specialist	38% (970)	41%
Practice organization			^*
Academic	7% (189)	34%
Safety net	9% (238)	42%
Hospital owned	35% (895)	45%
Independently owned	32% (823)	40%
Managed care/HMO	6% (148)	41%
Other	11% (282)	38%
Practice size			^*
Solo	11% (285)	35%
Small (2–5)	34% (863)	45%
Medium (6–20)	32% (834)	41%
Large (>20)	23% (593)	40%
Social deprivation^†			^*
High deprivation	20% (517)	35%
Not high deprivation	80% (2058)	43%
Practice environment
Satisfaction with practice			^*
Satisfied	82% (2102)	35%
Not satisfied	18% (473)	68%
Control over workload			^*
Satisfactory	68% (1758)	30%
Not satisfactory	32% (817)	67%
Value alignment			^*
Aligned	64% (1648)	32%
Not aligned	36% (927)	58%
Physician characteristics
Age			^*
Under 40	12% (314)	42%
41–50	37% (953)	43%
51–60	34% (873)	43%
Over 60	17% (435)	33%
Sex			^*
Female	46% (1177)	45%
Male	54% (1398)	38%
Degree
MD	89% (2292)	42%
DO	11% (283)	37%
Race
White	72% (1860)	42%
Black	5% (141)	40%
Asian	14% (364)	38%
Other	8% (210)	41%
Ethnicity
Hispanic	7% (185)	35%
Non-Hispanic	93% (2390)	42%

↵* P < .05.
↵† High deprivation if social deprivation index was ≥75.
MA, medical assistant; NP, nurse practitioner; PA, physician assistant; HMO, health maintenance organization.

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Table 4.

Logistic Regression Estimates of Perceived Teamwork Efficiency on Burnout, Stratified by Team Configuration

Team Configuration^*	Perceived Teamwork Efficiency	Burnout
Team Configuration^*	Perceived Teamwork Efficiency	Odds Ratio	95% CI
MA/nurse only^†	Poor	Reference
	Good	1.29	0.53–3.13
	Optimal	0.58	0.20–1.65
MA/nurse + NP/PA or specialist^‡	Poor	Reference
	Good	0.86	0.48–1.53
	Optimal	0.54^§	0.27–1.09
MA/nurse + NP/PA and specialist^‖	Poor	Reference
	Good	0.75	0.40–1.40
	Optimal	0.40^§	0.18–0.88

↵* For all team configurations, satisfaction with practice, having control over workload, and having professional values aligned with practice management were significantly associated with reduced odds of burnout.
↵† For teams with MA/nurse only, other significant contributing factors of burnout were being female and practicing in highly socially deprived counties.
↵‡ For teams with MA/nurse + NP/PA or specialist, no other factors were significantly associated with increased odds of burnout.
↵§ P < .05.
↵‖ For teams with MA/nurse + NP/PA and specialist, other significant contributing factors of burnout were being female, MD, and practicing in independently owned practices.
MA, medical assistant; NP, nurse practitioner; PA, physician assistant; CI, confidence interval.