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The authors' conclusion that their model of team-based primary care "demonstrates team development is a plausible key to protect against burnout" is completely unjustified by their data. No significant differences in burnout were demonstrated; a nonsignificant trend of 2 data points is not evidence of a plausible key. Furthermore, their non-significant trend was wiped out completely by the loss of MAs for in-room scribing. Scribes alone have been shown to improve physician satisfaction without other practice re-design factors(1).
The authors also report in their results section lower labor costs in the case clinic, but their abstract only refers to a "suggestion of labor cost savings," and since no data is reported we can only assume no significant differences were found.
In addition, there was no improvement in any quality of care or patient satisfaction measures. This is truly disappointing since a major goal of primary care redesign is improvements in quality of care and population health.
There are also many unaccounted-for variables - how was the implementation clinic chosen, why compare just one case clinic to several control clinics, why did the case clinic use APCs and did they replace physicians or were they hired to complement them? Why were MA ratios decreased 18 months into the experiment - was it staff attrition, cost concerns, or where the quality improvements insufficient to justify them?
We could learn valuable lessons from the authors if they focused on why their re-design experiment failed to yield the improvements in clinician satisfaction, care quality, or patient satisfaction that we are looking for in these new models of primary care delivery. Given the stakes for the future of primary care it is essential that we understand both what works, and what doesn't.
1. Shultz CG, Holmstrom HL. The use of medical scribes in health care settings: a systematic review and future directions. J Am Board Fam Med. 2015 May-Jun;28(3):371-81. doi: 10.3122/jabfm.2015.03.140224. PMID: 25957370.