Journal of General Internal Medicine

, Volume 34, Issue 6, pp 952–959 | Cite as

Provider and Staff Morale, Job Satisfaction, and Burnout over a 4-Year Medical Home Intervention

  • Robert S. NoconEmail author
  • Paige C. Fairchild
  • Yue Gao
  • Kathryn E. Gunter
  • Sang Mee Lee
  • Michael Quinn
  • Elbert S. Huang
  • Marshall H. Chin



The patient-centered medical home (PCMH) is a widely adopted primary care model. However, it is unclear whether changes in provider and staff perceptions of clinic PCMH capability are associated with changes in provider and staff morale, job satisfaction, and burnout in safety net clinics.


To determine how provider and staff PCMH ratings changed under a multi-year PCMH transformation initiative and assess whether changes in provider and staff PCMH ratings were associated with changes in morale, job satisfaction, and burnout.


Comparison of baseline (2010) and post-intervention (2013–2014) surveys.


Sixty clinics in five states.


Five hundred thirty-six (78.2%) providers and staff at baseline and 589 (78.3%) post-intervention.


Collaborative learning sessions and on-site coaching to implement PCMH over 4 years.


Provider and staff PCMH ratings on 0 (worst) to 100 (best) scales; percent of providers and staff reporting good or better morale, job satisfaction, and freedom from burnout.


Almost half of safety net clinics improved PCMH capabilities from the perspective of providers (28 out of 59, 47%) and staff (25 out of 59, 42%). Over the same period, clinics saw a decrease in the percentage of providers reporting high job satisfaction (− 12.3% points, p = .009) and freedom from burnout (− 10.4% points, p = .006). Worsened satisfaction was concentrated among clinics that had decreased PCMH rating, with those clinics seeing far fewer providers report high job satisfaction (− 38.1% points, p < 0.001).


Control clinics were not used. Individual-level longitudinal survey administration was not feasible.


If clinics pursue PCMH transformation and providers do not perceive improvement, they may risk significantly worsened job satisfaction. Clinics should be aware of this potential risk of PCMH transformation and ensure that providers are aware of PCMH improvements.


primary care safety net medical home morale job satisfaction 



Financial support for the study was provided by The Commonwealth Fund. Dr. Chin was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK071933 and P30 DK092949). Mr. Nocon was supported by an Agency for Healthcare Research and Quality training grant (T32 HS000084).

Compliance with Ethical Standards

This study was approved by the University of Chicago Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_4893_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 24 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Robert S. Nocon
    • 1
    • 2
    • 3
    Email author
  • Paige C. Fairchild
    • 1
  • Yue Gao
    • 1
  • Kathryn E. Gunter
    • 1
  • Sang Mee Lee
    • 2
  • Michael Quinn
    • 1
  • Elbert S. Huang
    • 1
  • Marshall H. Chin
    • 1
  1. 1.Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Department of Public Health SciencesUniversity of ChicagoChicagoUSA
  3. 3.University of ChicagoChicagoUSA

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