The Association of Teamlets and Teams with Physician Burnout and Patient Outcomes

Abstract

Background: Primary care “teamlets” in which a staff member and physician consistently work together might provide a simple, cost-effective way to improve care, with or without insertion within a team. Objective: To determine the prevalence and performance of teamlets and teams. Design: Cross-sectional observational study linking survey responses to Medicare claims. Participants: Six hundred eighty-eight general internists and family physicians. Interventions: Based on survey responses, physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team). Main Measures: Descriptive: percentage of physicians in teamlet/team categories. Outcome measures: physician burnout; ambulatory care sensitive emergency department and hospital admissions; Medicare spending. Key Results: 77.4% of physicians practiced in teamlets; 36.7% in teams. Of the four categories, 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who practiced neither in a teamlet nor in a team had significantly lower rates of burnout compared to the three teamlet/team categories. There were no consistent, significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general or for dual-eligible beneficiaries. Conclusions: Most general internists and family physicians practice in teamlets, and some practice in teams, but neither practicing in a teamlet, in a team, or in the two together was associated with lower physician burnout, better outcomes for patients, or lower Medicare spending. Further study is indicated to investigate whether certain types of teamlet, teams, or teamlets within teams can achieve higher performance.