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Creating Practices That Don't Breed Burnout

As a National Health Service Corps scholar, Kohar Jones was required to serve for a few years after residency in a federally qualified health center. After her service was complete, the medical director was surprised that Jones planned to stay. Here, she explores ways to create practice settings that primary care providers won't want to leave.

By Kohar Jones, M.D.

Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death cost a lot, and our country can go broke in the process. We save money and lives when everyone sees a primary care doctor who works to keep people well. But we don’t and won’t have enough primary care providers in the United States to meet the needs of all those who now have access. We’re already facing a shortage. The Affordable Care Act is only going to make it worse.

Many people, including me, are thinking about how to build the future health care workforce that we need to keep Americans healthy. How do we train more primary care providers? How do we encourage them to work in the communities where their services are needed most?

The National Health Service Corps is one answer. The president is banking on it through a proposed $3.5 billion expansion through 2020, which will increase the number of primary care providers in the program from 9,000 to 15,000. But once we have recruited and trained these health care professionals committed to providing primary care in underserved communities, how do we get them to stay in the profession and the places where they are needed most?

I went into medical school knowing I was going to practice primary care. I knew I would care for the underserved. I had a National Health Service Corps scholarship from the federal government saying it was so. For each year of medical school the American people paid for, I would complete a payback year of doctoring in an underserved community, providing the cost-saving care people needed to stay well. I would be a doctor to the community, saving money for society.

Today I am a family physician working in a community health center on Chicago’s South Side. In this federally qualified health center, we have some old-timers  – people who have been here for ten years or more, who have found their niche and stay with community medicine. However, we have many more new graduates — NHSC scholars doing their payback, or NHSC loan-repayors who get significant dollars to pay back school loans. These NHSC-sponsored physicians come and go. Burnout.

A few years back, my medical director informed me that he assumed I would be leaving as soon as I was done with the NHSC payback. He planned to lose his physicians to burnout. He planned for me to leave. I was a cog in a broken machine to be worn out and replaced as soon as my NHSC contract expired. This was disheartening. In March, I submitted the final paperwork signing off from the NHSC program, and my medical director expressed surprise at my decision to stay.

Why should staying in a community health center be the surprising decision?

There is a two-fold trick to increasing the number of primary care providers in underserved communities. First there is bringing them into the community health centers through financial incentive and professional development programs such as the National Health Service Corps. Second there is ensuring a sustainable practice environment, so that primary care providers work in a positive environment and choose to stay in the communities that need them most.

We need policies and programs to incentivize the creation of healthy practice environments. There are new programs that incentivize community health centers to become patient-centered medical homes, with extra points awarded for implementing practices that optimize patient care. We need new incentive programs for community health centers to become provider-centered practice settings that physicians don’t want to leave, with extra points awarded for implementing systems that ensure input from all who are directly involved in patient care to optimize patient care delivery in their center.

The first step could be as simple as paying community health centers a $10,000 bonus for each physician who signs on to stay after the end of their NHSC contract. This external incentive could drive practices to think about what they need to do to retain their physicians, instead of automatically planning to lose them and replace them with a new set. Funding could be made available to study the management practices of the most effective community health centers, who retain their practitioners and provide outstanding care, then scale those practices nationally.

As a nation, we can’t continue to invest in building a primary care provider workforce that we plan to lose to burnout. We need to find and implement successful strategies for provider engagement and empowerment, making health care providers equal partners with community health center administration in the provision of quality, affordable, and accessible health care for all Americans.

Kohar Jones, M.D., is a physician-writer with an interest in the social and structural determinants of health and health equity. She began practice as a National Health Service Corps Scholar at the federally qualified Chicago Family Health Center on Chicago's South Side, where she continues to practice today. This post originally appeared on her blog, Prevention not Prescription.

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