From American Board of Family Medicine, Lexington, KY (MD, LEP); Center for Excellence in Primary Care, Department of Family & Community Medicine, University of California, San Francisco (RW-G, KG); University of California, Berkeley (MK); University of Florida, Gainsville (SAL); Department of Family and Preventive Medicine, University of Utah, Salt Lake City (MKM); Department of Family and Community Medicine, University of Kentucky, Lexington (LEP).
J Am Board Fam Med. 2020 May-Jun;33(3):368-377. doi: 10.3122/jabfm.2020.03.190336.
The delivery of team-based care relies on team structure and teamwork. Little is known about the landscape of team configurations in family medicine practices in the United States. Teamwork between diverse team members likely impacts both performance and physician well-being. We examined team configuration and teamwork and whether they are associated with family physician (FP) well-being.
We used data from practice demographic questionnaires completed by FPs who registered for the American Board of Family Medicine Family Medicine Certification Examination in 2017 and 2018. We grouped 14 types of health care professionals into medical assistant (MA)/nurse, nurse practitioner (NP)/physician assistant (PA), and specialist, and we characterized 3 common team configurations. We used FPs' subjective ratings to measure perceived teamwork efficiency and a validated single-item measure to identify FPs who were burned out.
Among 2575 FPs in our sample, 22% worked collaboratively with MA/nurse only; 40% with MA/nurse and NP/PA or specialist; and 38% with MA/nurse, NP/PA, and specialist. The distribution of perceived teamwork efficiency was not statistically different across team configurations. In teams with greater perceived teamwork efficiency, FPs were less likely to be burned out. For FPs working with expansive teams, optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout after controlling for practice and physician characteristics.
Most FPs practice in multidisciplinary teams. Regardless of the team structure, FPs who perceived their teams as having greater efficiency were less likely to be burned out. We found that optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout for FPs in all types of team configurations. Improving teamwork efficiency may be an effective strategy for practice organizations to support not only team functioning but also physician well-being.
团队式医疗服务的开展依赖于团队结构和团队合作。目前，人们对于美国家庭医学实践中的团队配置情况知之甚少。不同团队成员之间的协作可能会影响绩效和医生的幸福感。我们研究了团队配置和团队合作情况，以及它们是否与家庭医生的幸福感相关。
我们使用了参加 2017 年和 2018 年美国家庭医学委员会家庭医学认证考试的家庭医生填写的实践人口统计学调查问卷的数据。我们将 14 种医疗保健专业人员分为医疗助理（MA）/护士、护士执业医师（NP）/医师助理（PA）和专家，并描述了 3 种常见的团队配置。我们使用家庭医生的主观评价来衡量感知的团队合作效率，并使用经过验证的单项措施来确定是否有倦怠的家庭医生。
在我们的样本中，2575 名家庭医生中，22%的人仅与 MA/nurse 合作；40%的人与 MA/nurse 和 NP/PA 或专家合作；38%的人与 MA/nurse、NP/PA 和专家合作。感知到的团队合作效率在不同的团队配置中没有统计学上的差异。在具有更高感知团队合作效率的团队中，家庭医生更不容易倦怠。对于与扩张型团队合作的家庭医生来说，在控制了实践和医生特征后，具有最佳感知团队合作效率与倦怠的可能性显著降低有关。
大多数家庭医生都在多学科团队中工作。无论团队结构如何，认为团队效率更高的家庭医生倦怠的可能性更小。我们发现，对于所有类型的团队配置，具有最佳感知团队合作效率的家庭医生倦怠的可能性显著降低。提高团队合作效率可能是实践组织的有效策略，不仅可以支持团队的运作，还可以支持医生的幸福感。
