Primary care has an acute need for team-based care to tackle our outsized tasks: prevention, chronic disease management, acute care, and care coordination.1,2 How many of our clinic leaders are equipped to recruit and retain the best clinicians and staff to sustain top-of-license work? Last year, ACLGIM launched several task forces to explore ways to improve primary care practice, one of which was “Enhancing Focus on Team-Based Delivery of Care.” While this group’s work is underway, we can start by devoting leadership time and talent to these best-practice management techniques.

Build a Team-Care Culture

A “share the care” culture means that physicians have confidence and trust in staff, and vice-versa, to work reliably at top of license, often with delegated authority. This requires a collaborative relationship between the clinic’s business and physician leaders to align the financial and patient care impacts of operational decisions.

Staff Appropriately and Define Roles

Part-time clinicians and residents in academic clinics introduce inefficiencies that may require extra staffing, especially for inter-visit care. Benchmark staffing ratios assume clinicians are full time but may need to be adjusted to reflect the larger number of part-time faculty and residents common to academic clinics. Nurses should perform inbox triage for patient symptoms and also see (and bill)3 patients for chronic disease management by protocol. Medical assistants (MAs) should focus on rooming, including screening questions, medication reconciliation, and teeing up orders. Office assistants and administrative staff can complete non-clinical tasks. Only high performing team-members can handle the breadth and complexity of academic primary care.

Ongoing Recruitment and Onboarding

Getting the right people “on the bus” and providing ample training are critical jobs for leaders. Be transparent with candidates about the pace and complexity of primary care and the benefits and challenges of learners. Candidates should be interviewed by a panel of care team members from each discipline to build team culture. Investing in training staff and clinicians pays dividends in efficiency and effectiveness and detects underperformers early. MAs and nurses may train and work under supervision of another staff member for up to six weeks with advancing independence. Shadowing members of each clinic discipline is essential for staff and clinicians to understand everyone’s unique role in the team. Anticipate higher turnover in staff, and be prepared for ongoing recruitment, interviewing, and onboarding. As these activities are time-consuming, ensure clinic leaders have the time and skills to build the best team of physicians and staff.

Retention and Accountability

Retaining the best team requires simultaneously investing in professional development, holding all equally accountable, and supporting psychosocial challenges. Leveraging financial assistance, tools for accountability, and psychosocial support is key to both engaging high-performers and managing those that may be a poor fit.

We can only fulfill our promise of healthier populations through effective team-based care. We must drive efficient and top-of-license direct patient care by all clinicians and staff. Appropriately accounting for the realities of academic primary care will foster improvements in team-based care, recruitment, and retention. Through intentional leadership, planning, and accountability, we can foster a primary care practice that meets our patients and our team’s needs.


  1. Porter J, Boyd C, Skandari MR, et al. Revisiting the time needed to provide adult primary care. J Gen Intern Med. 2023 Jan;38(1):147-155. doi:10.1007/s11606-022-07707-x. Epub 2022 Jul 1.
  2. Crowley R. Principles for the physician-led patient-centered medical home and other approaches to team-based care: A position paper from the American College of Physicians. Ann Intern Med. 2024 Jan;177(1):65-67. doi:10.7326/M23-2260. Epub 2023 Dec 26.
  3. Witwer SG, Mattson A, Jessie AT. Perspectives in ambulatory care. Registered nurse billing in primary care. Nursing Economic$. 41.4:July/August 2023.




Author Descriptions

Dr. Willens ( is Vice Chair of Quality & Safety and Division Head of General Internal Medicine, Department of Medicine Henry Ford Hospital and Medical Group. Dr. Nair ( is Associate Division Head, General Internal Medicine, Department of Medicine Henry Ford Hospital and Medical Group. RN Maxwell ( is Group Practice Director of General Internal Medicine and Palliative Care, General Internal Medicine, Department of Medicine Henry Ford Hospital and Medical Group.