Addressing the Burden of Asynchronous Work to Promote Clinician Retention in Ambulatory General Internal Medicine Practices.

Abstract

The growing burden of asynchronous work-such as managing messages, test results, and care coordination-has contributed to clinician burnout and attrition in primary care. To develop and evaluate scheduling templates that allocate time for asynchronous work during clinic sessions and assess their impact on clinicians, patients, and clinical operations. We conducted a two-phase Plan-Do-Study-Act (PDSA) quality improvement initiative at four academic internal medicine clinics in metropolitan Denver. PDSA1 tested five alternative templates with asynchronous work blocks over 3 months for feasibility. PDSA2 evaluated the preferred template over 6 months for effects on clinician and patient satisfaction, clinician career plans, clinical quality, productivity, and access. In total, 27 attending physicians and APPs volunteered for the intervention group in PDSA1; 43 in PDSA2. Clinical schedule templates with blocked time for non-patient-facing work. Survey items on career plans and clinician satisfaction, A1C and hypertension control, breast cancer screening, patient satisfaction, wRVUs, visit volume, and access (appointments made within 14 days). Clinicians in PDSA1 favored a template with asynchronous time embedded in regular sessions with staff support present. Evaluating the preferred schedule template in PDSA2, clinician satisfaction improved (+ 2.25 on a -3 to + 3 scale), and the intention to continue clinical practice effort rose (from 8/37 to 20/34). Clinical quality and patient satisfaction remained stable. Visit volume dropped (-18.3 visits/EffcFTE/month, p < 0.01), but wRVUs were unaffected (-3.2 wRVUs/EffcFTE/month, p = 0.89). Access declined for both intervention and reference groups (-10% vs. -4%). A focus group emphasized enhanced clinician autonomy and control as key benefits. Integrating asynchronous work time into clinic schedules appeared to improve clinician satisfaction and retention without compromising care quality or wRVU productivity, while visit volume and access saw modest declines. This approach may support primary care workforce stability amid increasing asynchronous demands.