Only one-third of physicians in the United State practice primary care, compared to about one half in other developed nations. Fewer aspiring physicians are choosing to focus in primary care, threatening the quality of care patients receive, citing:

  • long hours of clerical work that doesn’t utilize their training;
  • lower payments; and,
  • frustrating models of practice.

To begin finding solutions to these challenges and revitalize primary care, a team of researchers, funded by the ABIM Foundation, visited 23 high-performing practices across the United States seeking innovations that could help restore joy in practice. Learn more about this research in a Patient-Centered Primary Care Collaborative webinar presented by Drs. Christine and Tom Sinsky.

Among the sites with high-levels of satisfaction, the researchers found common themes, including:

  • Proactive planned care, with pre-visit planning and pre-visit laboratory tests;
  • Sharing clinical care among a team, with expanded rooming protocols, standing orders and panel management;
  • Sharing clinical tasks with collaborative documentation (scribing), non-physician order entry and streamlined prescription management;
  • Improved communication by verbal messaging and in-box management; and,
  • Improved team functioning through co-location, team meetings and work flow mapping.


The team’s research culminated in “In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices,” published in Annals of Family Medicine.

In addition to the Annals article, the authors wrote a white paper that describes the innovations at each site in more detail, and includes a discussion of several themes, such as:

  • the surprising finding of a hidden anti-team culture in policy and technology;
  • the influence of payment on innovation (practices in a fee-for-service environment developed efficiencies that lead to greater capacity; practices in a subsidized environment developed extended services, such as those of a pharmacist and social worker);
  • two contrasting approaches to dealing with the volume of work in primary care (decreasing visits per physician versus reducing the amount of non-physician level work done by each physician); and,
  • the degree of waste in primary care.

This research also informed a 2012 conference of the ABIM Foundation entitled, Primary Care Innovation: Improving the Efficiency and Appeal of Practice: “How Did They Do That?” The conference brought together representatives from the visited practices with leaders in primary care to reflect on the research findings, identify a set of principles that could transform the efficiency and appeal of practice, and consider how those principles could be spread more widely.

The authors created a set of action steps for key actors, including insurers, institutions, regulators, payers and technology vendors, as well as a research agenda for improving the practice of primary care.

This work led to the creation of the American Medical Association's Steps Forward website, which hosts modules and offers information on how physicians can revitalize their practice and improve patient care.

Site Visits

Read summaries of the 23 sites visited and learn more about their innovations: