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It is widely recognized that there is a growing shortage of primary care providers in the
US, and it comes as no surprise that understaffing and time constraints affect primary care
practice quality improvement (QI) study participation. Primary care physicians do not have
adequate time in their day to deviate from patient care. The authors aptly emphasize the great
need for high-level policy interventions to address primary care physician shortages. Further
research should explore how effective scholarship programs like the National Health Service
Corps are at mitigating the primary care workforce shortage and how these efforts can be
scaled up. Another area of interest is medical schools, particularly their primary care pipeline
programs. While these programs may appeal to students hoping to graduate sooner or
minimize cost, it may also be argued that they attract and select students who would have
chosen primary care specialties anyways. Examining the efficacy of primary care pipeline
programs is an important step in addressing the shortage and preventing burnout.
In the meantime, QI projects can offer valuable insight into how to reduce provider
burnout and improve practice efficiency in the face of dramatic understaffing. To do this,
however, project design needs to adjust to the current state of the field. The studies the
authors address offer small financial incentives and likely undersell the time commitment—to
incentivize participation, project designers may need to reevaluate the structure of their
studies. The authors point to a few suggestions worth investigating, such as embedding
dedicated project staff within participating practices or redistributing project responsibilities
among practice employees to reduce the burden on clinicians. Given how many respondents
believed that the QI project had no novel information to offer them, we also wonder if practices
would be more inclined to participate if they generated the topics of the studies. Regardless of
the approach, we believe that further research should focus extensively on QI project design if
we hope to alleviate the overwhelming burden on primary care providers.