Date of Award


Document Type



College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Michael Huggins


Jeffrey Wolff-Gee, Lindsey McKeen


Background: Levels of burnout have reached epidemic proportions among health care professionals, resulting in a number of negative consequences, including loss of productivity, increased turnover, and increased organizational costs. Advanced Practice Clinicians (“APCs”- a term that encompasses both ARNPs and PAs) were integrated into teams with physicians at a network of primary care clinics in a greater metropolitan area in the United States with the goal of reducing provider burnout. This approach has not yet been evaluated to determine whether there are benefits for reduction of burnout levels in clinicians. Few studies have been conducted to date about the impact of comanaged primary care teams on provider burnout.

Objectives: To evaluate implementation of a comanaged care team model piloted over the last three years at a network of primary care clinics. This study had two objectives: 1) to determine if practicing as part of an MD-APC comanaged panel compared to independent panel management is correlated with lower levels of provider burnout; and 2) to determine if a higher quality comanaging relationship is correlated with lower levels of burnout compared to lower quality levels of comanagement.

Methods: The Mini-Z Burnout Survey was administered to a sample of 102 physicians and APCs at seventeen clinics within a regional network. Demographic data regarding practice model, credentials, and clinical experience were also collected. Providers who indicated that they practiced in a comanaged care team model were additionally given the Provider Comanagement Index (PCMI) to assess the quality of the comanaging relationship.

Conclusions: Nearly all APCs who participated in the survey indicated that they practiced in a comanaged model, preventing comparisons in burnout between the different practice models for APCs; physicians who practiced both independently and in a comanaged model also participated. Physicians in each practice model did not demonstrate statistically significant differences in rates of burnout, whereas APCs participating in comanaged panels had significantly lower rates of burnout than physicians in both care models.

Implications for practice: The comanaged care team model in this study appears to have benefits in reducing burnout for APCs but not for physicians. While the reason for the differences in the level of burnout between physicians and APCs is unclear, APCs in this study had more administrative time and less patient care time each day compared with physicians, and the physicians had been in practice an average of ten years longer than the APCs. As no pre-implementation study of burnout was performed, evaluation of whether this model reduces burnout is not possible. In order to determine how comanagement can be implemented to mitigate burnout for both physicians and APCs, additional research is needed to identify which aspects of the current model had the strongest correlation with lower levels of burnout.

Included in

Nursing Commons