Primary care in the US is being pushed to the brink of collapse due to historic highs of physician stress, burnout, and exhaustion; mass departures from the profession; and the inability to care for vulnerable populations due to an inequitable health system. These problems are compounded due to a lack of effective advocacy to improve primary care on a national scale and a reimbursement system that chips away at time with patients while keeping primary care physicians (PCPs) on a volume-based hamster wheel. The end result is a shortage of doctors who want to practice primary care under these challenging circumstances, which can lead to potentially devastating consequences for the future of healthcare in America.
PCPs are fundamentally poised to make an impact on the organizations they lead. Healthcare organizations who understand and work to address the issues PCPs face — and encourage their professional development — will have a distinct competitive advantage. They will be able to better engage and recruit PCPs in leadership and thereby reap the benefits of better quality of care, higher patient satisfaction, and decreased provider burnout.
Primary care in the U.S. is being pushed to the brink of collapse due to historic highs of physician stress, burnout, and exhaustion; mass departures from the profession; and the inability to care for vulnerable populations due to an inequitable health system. These problems are compounded due to a lack of effective advocacy to improve primary care on a national scale and a reimbursement system that chips away at time with patients while keeping primary care physicians (PCPs) on a volume-based hamster wheel. The end result is a shortage of doctors who want to practice primary care under these challenging circumstances, which can lead to potentially devastating consequences for the future of healthcare in America.
If primary care is touted as the foundation of a well-functioning health care system — the front line of clinical care and the initial point of contact for most patients — how can it be allowed to deteriorate without unified and passionate intervention? Our research suggests that the answer may be straightforward. While primary care accounts for roughly one in three practicing physicians and is seen as the bedrock of the health care system, it is also the most overlooked and underrepresented in the realms of health care leadership.
Transformational changes to primary care will require leadership with holistic training, a clear vision, an insider’s perspective, and skin in the game. PCPs are uniquely positioned to lead this change. They are the Swiss Army Knives of medicine, offering an increasingly rare generalist perspective, requiring strong communication skills, and a community-focused approach to care delivery. Not only are they responsible for managing day-to-day concerns for their patients, they also coordinate care across specialties and organizations for those who may have medically complex diagnoses. These clinicians are accustomed to leading teams every day to care for their patients, and must be adaptable, thoughtful, and flexible, given their vast breadth of clinical responsibilities.
However, it is paradoxical that those best poised to lead are often reluctant to do so. In fact, many physicians are not only reluctant but averse to taking on leadership roles.
We interviewed PCPs in leadership roles to better understand what they believe prevents so many other physicians from pursuing such positions. Our research highlights three key deterrents:
- PCPs viewed leadership roles as a path to losing autonomy and limiting their ability to develop long-term therapeutic relationships with patients — a key reason many physicians chose careers in medicine in the first place.
- PCPs associated leadership roles with major resource constraints, evaporating both time and earnings potential.
- PCPs lamented the loss of camaraderie with other physicians when taking on leadership roles, feeling that the roles interrupted collaboration with peers and generated uncomfortable conflict.
Despite these concerns, PCPs are fundamentally poised to make an impact on the organizations they lead. Health care organizations who understand and work to address these deterrents will have a distinct competitive advantage. They will be able to better engage and recruit PCPs in leadership and thereby reap the benefits of better quality of care, higher patient satisfaction, and decreased provider burnout.
Here are three ways that health organizations can counteract these disincentives and support PCPs embracing leadership roles.
Provide the On-Ramp
PCPs crave system change and personal growth, but often feel disempowered. They see their experience as valuable and want to leverage it to make a positive impact on the health care system.
Executives and health administrators can tap into this motivation by framing leadership as a constructive opportunity to be a change agent. While organizations may not have the ability to alter a position’s specific title, the job description can be used to reflect openness to an entrepreneurial mindset and an opportunity for improving perceived system deficits. Instead of drafting a typical (and often dry) administrative job description, frame it to emphasize how the role will enact change or address major obstacles in health care. Postings should speak to a PCP’s adaptability based on the breadth of their training and diversity of practice experience, and PCPs should be encouraged to apply.
By using the frustration PCPs experience with the status quo and their frontline experience, health care organizations can promote vacant or novel leadership roles as opportunities to expand the impact on patients and to garner a broader scope of knowledge and expertise for PCPs identified as having leadership interest or potential.
Role Design and Definition
PCPs want to grow and develop professionally, but our study showed that they also identified clear disadvantages in taking on leadership roles. They identified the least attractive aspect of leading, in a word, as “loss.” They feared the loss of autonomy, time, close patient relationships, and camaraderie with peers. This can be due, in part, to their exposure to disappointing experiences observed in peers who have assumed leadership roles.
Executives and health administrators can help mitigate this with the use of strategic job design, where organizations create an optimal job role, and job crafting, which allows PCPs to define and customize their role themselves. These two complementary pieces of the puzzle yield large gains in employee satisfaction and fulfillment.
When organizations realize that fear of loss is a major barrier, they are better positioned to design purposeful and motivating work for PCPs taking on leadership roles. To address the concern for loss of autonomy, the role should be intentionally constructed to allow PCPs the agency to make decisions per their expertise. For those apprehensive about losing time, the role can be devised to encourage a flexible approach in how goals are achieved, including the freedom to decide how they will balance their clinical responsibilities with their new leadership role. In order to address concerns about losing relationships, organizations must provide opportunities for leaders to meet with their colleagues in informal settings and encourage leaders to continue to be actively engaged as a member of their clinical team.
Empowering PCPs to engage in job crafting allows them to adjust aspects of the job to suit individual interests, values, and passions, making them more likely to be engaged and more likely to thrive at work, while being successful in their leadership role. PCPs can independently alter the type and scope of tasks; relationships and with whom they work; and how to think, communicate about, or conceive of the job. When PCPs have some degree of ownership and authority over how the job is defined, they will have the opportunity to include more of their passion points, while also thoughtfully reducing those aspects of the job that are seen as pain points.
Tools, Training, and Mentorship
PCPs may want system change and growth, but they also need the tools, training, and mentorship to be successful. In most cases, PCPs aren’t taught finance, accounting, management, or leadership skills in medical school, nor is there an emphasis on systems operations, despite the fact that, as physicians enter residency, they immediately begin leading medical teams.
There are stark contrasts, both operationally and culturally, between business and medicine. Executives and health administrators should provide opportunities for PCPs to cross-train with current administrators and to have access to mentors who can help with the transition. Providing resources to support the transition into leadership can help highly qualified and motivated PCPs avoid the common pitfalls than can derail their ability to influence others and be successful in their expanded role. This may include offering or supporting continuing medical education (CME) or credentialing opportunities that feature management and leadership skills building, partnering with institutions of higher education to create pathways into graduate business or policy programs, or engaging with organizations that specialize in physician leadership training.
Having PCPs in leadership roles has never been more important. Without a highly functioning and sustainable primary care system, all health care in the U.S. will suffer. If we want a system that promotes effective and sustainable primary care, PCPs need to be involved in co-designing that system and leading change. Ultimately, this will benefit the entire health care system, and all of us who will, at any stage of our lives, depend on it for our own care and that of our families and communities.