Almost every organization is piloting some change to their care team model.Since the primary goal of most of these changes is to prevent physician burnout,groups often take a physician-centric approach to the redesign process. As aresult, care team redesign often looks like what you see below: Leaders offloadtasks from the physician’s plate onto advanced practice providers (APPs). Then,when APPs start feeling burnt out too, they do the same to nurses, and this taskshifting continues down the line, setting a trickle-down effect in motion.

Using this approach, physician leaders could historically offset turnover by hiringmore staff. But this trickle-down approach is unsustainable for three reasons:

Care team members are still working below top-of-license: Shifting tasksin response to physician burnout means that team members are too often giventhe tasks that physicians do not want or have time to take on, as opposed tothose that are top-of-license. This inadvertently builds gaps and redundanciesinto the model—and this can be costly even in small doses. For example, evenwhen an RN spends just 15% of their time on tasks that are below top-of-license,that’s still $6,000 worth of work that the RN does that could’ve gone to an MA.

Physicians are an increasingly smaller subset of the workforce: From 2018to 2028, physician jobs are expected to grow 7%—which is less than the 10-yearprojected growth rate for other non-physician roles, such as RNs (12%), MAs(23%), NPs2 (26%), and PAs3 (31%). As groups employ more non-physicianteam members, the total percentage of the workforce—and associated laborcosts—made up by physicians will shrink. Therefore, basing care team redesignon the physician at the expense of other team members has diminishing returns.

Non-physician team members are disengaged and burned out: Downshiftingtasks to APPs, RNs, and MAs without getting them to top-of-license leads tocostly turnover. As one example, 56% of MAs, who are usually at the end of thetrickle-down process, plan to leave for another job in health care in the next fiveyears—and worse, 21% plan to leave health care altogether.

To build a care team model that’s sustainable for the future, organizations needto design an ambulatory care team that maximizes the ROI and reduces theburnout of every team member—not just physicians. This requires a shift inmindset from seeing the care team as individual roles to viewing it holistically:looking at how individual care team members come together to work as a singlecohesive unit. Rather than piloting changes to one team member at a time,leaders must redesign the entire care team at once to ensure everyone isworking at top-of-license and as one high-performing team.

In practice, this means evaluating all tasks the care team needs to perform, andthen matching those tasks to the appropriate team member. In other words,rather than starting with the physician and shifting tasks down the line, begin withthe tasks and assign them to the right role. The key is completing this exercisefor the entire team at once and then rolling out the new roles—again, all at once.

The goal isn’t to create one uniform care team across all providers, but rather,design a blueprint that practices and specialties can adapt depending on theirstaffing resources, patient populations, and strategic goals. Generally,organizations should strive for a consistent care team model at the practice orspecialty level.

This holistic approach to care team redesign often surfaces redundancies andinefficiencies in the care team that you would not have identified using a trickledown approach. For example, one organization who used this holistic approachwas able to hire a new scheduler in place of a new RN, resulting in about$35,000 in labor savings.

Specialty and inpatient considerations

Most leaders begin care team redesign in primary care. However, progressiveorganizations are beginning to refine their approach to team-based care inspecialty and inpatient care as well. While roles and responsibilities will likelylook different across specialties and sites of care, leaders should considerapplying the same holistic redesign principles and process to other care teams.

Population health considerations

Many organizations roll out team-based care with more universally deployedroles first, which is why you’ll see us refer to physicians, APPs, RNs, and MAsfrequently throughout this document. However, as organizations hire and deploymore population health-focused roles, such as pharmacists, care managers, andbehavioral health specialists, leaders should take a similar holistic approach tointegrating them into the care team—or deploying them across several careteams—rather than piloting these roles one-off.

In the past, team-based care pilots were limited to a few practices at a time.Because holistic redesign affects all care teams at once, it requiresorganization-wide commitment and leadership.

In the following pages, we’ll look at the role that you as a physician leader play inholistic care team redesign and the responsibilities you should allocate to others.We’ll also discuss a critical element of securing buy-in: involving frontline careteam members throughout the entire process.

Holistic redesign requires a greater upfront investment than care team pilots. Yourbiggest investment will be in human capital: taking the necessary frontline careteam members offline to serve on the planning team and spearhead this work.

However, this investment is one worth making.

Pulling frontline care team members from the clinic for a week has a price tag.According to Advisory Board estimates, it costs about $30,000 to take theplanning team offline to reallocate tasks and design new roles. It’s a significantupfront investment—but the ROI is worth it when you consider the downstreamimpact on turnover and team sustainability. In fact, it only takes retaining one MAto break even on your investment.