A Team-Based Care Model That Improves Job Satisfaction


Expanding the role of medical assistants to better support providers can improve not only traditional outcomes but also job satisfaction.

Fam Pract Manag. 2018 Mar-Apr;25(2):6-11.

Author disclosures: no relevant financial affiliations disclosed.

Burnout and job dissatisfaction pose a significant threat to primary care. Less than one-third of family and internal medicine physicians report they would choose the same specialty again,1 and one-third of health care employees report they are planning to look for another job.2

The factors contributing to burnout and dissatisfaction are many, including the use of electronic health records (EHRs), demand to see more patients, and change fatigue as practices reshape the way they deliver care consistent with the “Triple Aim” (improved population health, enhanced patient experience, and reduced cost). One study found that physicians spend only 27 percent of their time providing direct, face-to-face care to patients and almost half their time on the EHR or desk work.3 Delivering all of the appropriate preventive, chronic, and acute care to a standard primary care panel has proven to be impossible for a single physician, requiring an estimated 21.7 hours per day.4 Suboptimal access, poor outcomes, and escalating burnout, frustration, and early retirement are not surprising when providers shoulder most of this burden.

As a result of these pressures, the “Quadruple Aim,” which adds provider and staff satisfaction to the Triple Aim, has been proposed as a more sustainable approach to improving health care. To achieve the Quadruple Aim, leading primary care organizations are exploring advanced team-based strategies such as team-based documentation, previsit planning and testing, an expanded scope of practice for medical assistants (MAs) and nurses, team-based motivational interviewing and coaching, and delegation of certain elements of chronic disease care, preventive care, medication reconciliation, refills, and acute care to staff using standardized protocols. These strategies are designed not only to reduce provider burnout but also to reduce staff burnout by ensuring that they can grow professionally and engage more intimately in patient care.5 Beyond reducing burnout, delivery models that rely on a high-functioning team have become essential given rapid increases in medical information and more prevalent chronic disease.6


  • When our health care system places too much burden on providers, we should not be surprised at the result: suboptimal access, poor outcomes, and escalating burnout.

  • Increasing the MA-to-provider ratio to 2.5:1 and expanding the role of MAs throughout the patient visit can help practices achieve the “Quadruple Aim.”

  • This team-based care model increased visit volume and patient access, improved clinical quality, and cut provider burnout in half.


Our organization's advanced team-based care model was inspired by the University of Utah's “Care by Design” model, which provided a financially viable Quadruple


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Dr. Lyon is an associate professor and medical director of the AF Williams Family Medicine Center and associate program director of the University of Colorado Family Medicine Residency Program in Denver. He led the APEX model transition at AF Williams....

Dr. English is the associate medical director of practice transformation at the AF Williams Family Medicine Center, former practice transformation fellow, and core faculty member of the University of Colorado Family Medicine Residency Program.

Dr. Smith is an associate professor of family medicine and assistant dean for clinical affairs at the University of Colorado School of Medicine. He spearheaded development and implementation of the APEX model.

Author disclosures: no relevant financial affiliations disclosed.


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1. Kane L, Peckham C. Medscape Physician Compensation Report 2014. http://www.medscape.com/features/slide-show/compensation/2014/public/overview#24. April 15, 2014. Accessed February. 12, 2018....

2. More than one-third of employed health care workers plan to look for a new job this year. CareerBuilder website. https://cb.com/2C7tnfb. April 30, 2013. Accessed February 12, 2018.

3. Sinksy C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in four specialties. Ann Intern Med. 2016;165(11):753–760.

4. Yarnall KS, Østbye T, Krause KM, Pollak KI, Gradison M, Michener JL. Family physicians as team leaders: “time” to share the care. Prev Chronic Dis. 2009;6(2):A59.

5. Bodenheimer T, Sinksy C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576.

6. Mitchell P, Wynia M, Golden R, et al. Core Principles & Values of Effective Team-Based Health Care. Washington, DC: Institute of Medicine of the National Academies, 2012.

7. Magill MK, Lloyd RL, Palmer D, Terry SA. Successful turnaround of a university-owned, community-based, multidisciplinary practice network. Ann Fam Med. 2006;4(Suppl 1):S12–S18.

8. Smith PC, Brown Levey SM, Lyon C. Evaluating transformation with available resources: the influence of APEX on depression screening. Families Systems & Health. 2017;35(2):238–247.

9. Fahey P, Cruz-Huffmaster D, Blincoe T, Welter C, Welker MJ. Analysis of downstream revenue to an academic medical center from a primary care network. Academic Med. 2006;81(8):702–707.


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