To Team or Not to Team: A Foundational Debate for the Future of Family Medicine—Insights from the Family Medicine Leadership Council

Pro: The Promise of Team-Based Primary Care

Team-based care offers substantial potential benefits. Evidence from collaborative care models integrating behavioral health, pharmacist-physician partnerships, and advanced care management demonstrates improvements in patient experience, care coordination, and selected process and quality measures.^6,7 Data from national surveys and observational studies suggest that many family physicians now practice in team-based settings, particularly early in their careers.⁸ When intentionally designed, high-functioning teams can distribute work more equitably, reduce physician administrative burden, and improve clinician experience, consistent with the Quadruple Aim.^3,9

Team-based care may also be critical to addressing the US primary care access crisis. The Milbank Memorial Fund’s Primary Care Scorecard 2024 documents declining access to family physicians and prolonged appointment wait times, underscoring the urgency of scalable primary care delivery models.¹⁰

Structured teams can expand panel capacity, align tasks with training, and offer multiple modalities of care delivery. Delegation of lower-complexity services to appropriately trained team members—including nurses, medical assistants, dietitians, and pharmacists—has been associated with improved access while maintaining safety, quality, and patient and staff satisfaction, consistent with the Quadruple Aim.^3,9,11

From this perspective, team-based care is not simply an optional innovation; it may represent essential infrastructure for sustaining access, continuity, and comprehensiveness in the setting of workforce constraints.^2,4

Evidence and Limitations

Not all team-based models succeed. A Cochrane synthesis of interprofessional collaboration found consistent improvements in care processes and professional satisfaction, but mixed or insufficient effects on clinical outcomes, utilization, and costs.⁵ Interventions that were clearly defined, high-intensity, and characterized by regular team engagement demonstrated the most consistent benefits.

American Board of Family Medicine (ABFM) survey data indicate that although many family physicians work in multidisciplinary settings, perceptions of team efficiency and effectiveness vary widely. Lower burnout appears to be associated not with team size or composition, but with clear roles, stable workflows, and shared accountability.^8,12 Larger or loosely structured teams may increase operational complexity and contribute to burnout when these design features are absent.⁴

At the FMLC retreat, leaders from multiple academic health systems—including the University of Chicago, the University of Pittsburgh, and Mayo Clinic—described multidisciplinary models integrating pharmacists and behavioral health clinicians that improved outcomes and mitigated burnout. These examples underscore that the benefits of team-based care are contingent on thoughtful design, training, and sustained organizational support.^2,7

Con: The Case for Caution

Despite its promise, team-based care should not be universally prescribed. It stands in tension with established models such as direct primary care and micropractice, which emphasize low overhead, high access, and strong continuity between a single physician and patients. These models report high levels of patient and physician satisfaction. Moreover, continuity of care—one of the most consistently demonstrated determinants of better outcomes and lower costs—is strongest when a clearly accountable clinician maintains longitudinal responsibility.¹³

Critics also note the financial and administrative burden associated with building and maintaining interprofessional teams. Such models require additional staffing, infrastructure, and coordination, yet outcome improvements are not uniform. Payment systems, including Medicare and most commercial insurers, do not reliably support the infrastructure necessary for effective team-based care. In the absence of aligned payment and leadership support, practices may default to parallel rather than integrated workflows.²

Training represents an additional barrier. Most US medical schools and residency programs provide limited preparation for practicing or leading high-functioning interprofessional teams. Without role clarity, shared goals, and early interprofessional exposure, teams may inadvertently reinforce fragmentation rather than address it.¹⁴

A Matter of Identity and Design

Team-based care also raises fundamental questions about the identity of family medicine. Is the discipline defined primarily by the breadth of services personally delivered by an individual physician, or by its commitment to whole-person, relationship-centered care regardless of care delivery structure?¹

Well-designed teams may enhance continuity and comprehensiveness when anchored by clear accountability and durable patient-clinician relationships. Conversely, patients consistently report valuing a single clinician who knows their history and context.^13,15,16

Synthesis and Path Forward

The FMLC discussion revealed several areas of agreement. First, team-based primary care is likely necessary in many settings to meet rising demand and clinical complexity. Second, team function—defined by intentional design, role clarity, and shared accountability—matters more than team size. Third, continuity and comprehensiveness must remain central organizing principles. Finally, team models must be adaptable to local context and supported by aligned training and payment reform.^2,3,6

Poorly supported or loosely structured teams risk eroding continuity, increasing clinician burden, and frustrating patients. In contrast, purpose-built teams with clear goals and adequate resources can enable family medicine to deliver on its promise at scale.

Prior Presentation

Portions of this work were informed by a discussion convened by the Family Medicine Leadership Council (FMLC). This manuscript represents a substantially expanded and independently written synthesis.