Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative

What is the optimal staffing to achieve maximum value in primary care? Whatever it is, it will undoubtedly be higher than the typical 1:1 MA to physician ratio found in most primary care practices. In our personal observations of more than 50 primary care practices across the country, some as part of the "In Search of Joy in Practice" study (1), we found three important trends:

1. Practices with 3:1 staffing appear to provide the best care to the most patients and be the most enjoyable in which to work.

2. Higher skill level of the team members (i.e. RN or exceptionally highly skilled MA) is associated with greater trust, reliance and shared care between physician and team. When the skills gap between physician and clinical assistant are high, the physician performs more work that others could do, and spends less time "working to the top of her license."

3. The payment model influences team size and composition. Those practices with external subsidies, either from their larger institution or from a global payment initiative, are more likely to hire an extended care team of pharmacists, behaviorialists, and/or nutritionists. On the other hand, those practices in a fee-for-service setting are more likely to have a higher clinical support staffing ratio (2:1 or 3:1 MA/nurse per provider) and are more likely to provide access for a larger panel of patients.

Competing interests: None declared