Study Finds Higher Morale, Job Satisfaction Associated With PCMH Model

According to a recent study, practices that adopt the patient-centered medical home (PCMH) model of care experience higher morale and job satisfaction rates among physicians and staff members. However, the study also indicates that adopting the PCMH model leads to an increase in physician burnout.

"The overriding headline is the medical home is positively correlated with good morale and high job satisfaction," says Robert Nocon, M.H.S., a senior health services researcher at the University of Chicago and one of the co-authors of the study, "PCMH Characteristics and Staff Morale in Safety Net Clinics," (abstract) in the Jan. 9 Archives of Internal Medicine. "But that comes with a concern that there seems to be a risk of burning out the physicians who are implementing the model."

The study findings have important implications, according to Nocon. "Workforce is a major issue in primary care. Satisfaction, morale and burnout are key factors that drive whether there is a workforce in place to provide care."

The study itself speculates that the burnout factor in PCMH practices may arise because of the work involved in successfully implementing the PCMH, as well as the changes that result.

The study is based on a 2010 survey of physicians and clinical staff members working at 65 safety net clinics in five states: Colorado, Massachusetts, Idaho, Pennsylvania and Oregon. All of the safety-net clinics are participating in a five-year Commonwealth Fund project to help the clinics transform into high-functioning PCMHs, according to Nocon. The project is scheduled to end in 2013.

Researchers mailed the survey to 391 physicians and other professionals and 382 clinical staff at the 65 clinics. They received 603 completed surveys, for an overall response rate of 78 percent. The response rate for physicians and other professionals was 79.8 percent, and for staff it was 76.2 percent.

The survey used five subscales to measure respondents' perceptions of PCMH characteristics within their respective clinics on a scale of zero to 100 -- zero being the worst and 100 the best. These five subscales were

"Specifically, access to care and communication with patients subscale scores and quality improvement subscale scores were associated with better morale and job satisfaction for both providers and staff, and care management subscale scores were associated with better morale for staff," says the study.

The survey found that a 10 percent increase in how respondents rated PCMH characteristics translated into higher rates of morale. "For example, let's say you have two people who are exactly the same in all other aspects except the way they rated the medical home," says Nocon. "The person who rates the PCMH quality improvement subscale 10 percent higher on the zero to 100 scale has over two-and-a-half times higher odds of having good morale."

The survey also queried respondents about burnout, asking them to what extent they agreed or disagreed with the following statements:

Nearly half of the respondents (49.5 percent) said they are occasionally under stress at work, but they don't feel burned out. About 30 percent, however, reported having one or more symptoms of burnout, such as physical or emotional exhaustion.

Perhaps most importantly, higher PCMH scores translated into higher rates of burnout, demonstrating a clear association between PCMH characteristics and job burnout, according to the study. The study results showed that physicians and other health professionals who rate their clinic's medical home function 10 percent higher had twice the odds of experiencing burnout.

"Core components of the PCMH include comprehensive primary care, quality improvement, care management and enhanced access," the study states. "For many practices, the (PCMH) model may increase workload and significantly change staff roles. Therefore, providers and staff may be strained by the transformation that occurs with implementation of the PCMH."

The study authors say that "PCMH models may be helpful for improving provider and staff satisfaction, increasing the primary care workforce and reducing turnover." But they warn that burnout in PCMH practices must be monitored.