Voices of Frontline Leaders: Challenges and Opportunities from Frontline Primary Care Clinic Leaders in a Safety-Net Health Care System

Background: Burnout, disengagement, and turnover among clinicians is a major challenge for the US health care industry. Research has shown that higher direct supervisor leadership scores correlate with decreased provider burnout and increased professional fulfillment. Safety-net health systems such as Federally Qualified Health Centers (FQHCs) face increased challenges due to limited financial resources, more complex social determinants of health among patients, and often fewer physician leaders who can serve as mentors compared to large, integrated health systems.

Methods: The authors interviewed frontline physician leaders of primary care clinics in a large, urban FQHC network regarding their approach to leadership, prior training and support, opinions related to provider burnout, and ideas for improvement. Qualitative data analysis was completed using the Immersion-Crystallization method, reaching theme saturation.

Results: Key themes were structure of leaders' roles, challenges in daily leadership that outstripped time set aside for leadership activities, and the nature of and response to team members' burnout. Leaders found their roles meaningful and viewed themselves as a bridge between institutional decisions and frontline providers. Longer duration in leadership roles, formal and informal mentoring, and networks of support were related to increased confidence. Variation existed in the amount and perceived value of leadership training, development, and support. Physician leaders emphasized the importance of a high-functioning clinic leadership team and expressed frustration with a lack of connection to institutional decision-making. Leaders were empathetic to the drivers of burnout among their teams and strove to assist individual providers while facing challenges from structural causes of burnout.

Conclusion: Frontline leaders in safety-net clinics play a powerful role in the well-being and resilience of their provider care teams and typically are highly engaged despite facing significant barriers to success. Investing in development and formal support for frontline physician leaders in primary care safety-net settings is important to ensure their longevity and a resilient provider workforce.