Family Physicians’ Views of Who They Are Accountable To and Current Quality Metrics

Importance: Primary care physicians are expected to demonstrate accountability for their work to health care administrators. Objectives: To determine family physicians' views about common approaches to demonstrate accountability to health care administrators and for physicians who desire changes, to ascertain those proposed changes. Design, Setting, and Participants: In this qualitative study, semistructured focus group interviews were conducted from November 2021 to March 2024 in primary care offices of purposively sampled family physicians who concurrently saw patients in 5 different cities in Texas. Exposure: Interviewers queried participants about their views on existing accountability approaches by health care administrators and their views on improving accountability systems. Main Outcomes And Measures: Codebook thematic analysis identified themes characterizing participant views on demonstrating accountability to health care administrators, common quality metrics, and suggestions to improve accountability approaches. Results: Thirty-six participants were interviewed in 12 focus groups (15 [42%] were aged 31-39 years, 20 [56%] were female, and 20 [56%] were residency or medical school faculty). Significant themes included that participants were accountable to multiple stakeholders, and all stakeholders should be held equally accountable for their work. Existing quality metrics were perceived as useful tools to improve preventive and chronic disease goals for patient populations. Concerns about common quality metrics included that they sometimes contradicted patients' wishes, were sometimes inappropriate, were sometimes corrupted by erroneous data, expected the physicians to control patient behaviors they could not, and penalized physicians who care for vulnerable populations. Participants reported moral distress caused by tensions between the demands of the metrics vs patient-centric care and their professional duties. Many participants had suggestions for improvement for assessing the quality and accountability of their work. Conclusions and Relevance: In this qualitative study of family physicians' beliefs about accountability and common quality metrics, no participant was fully satisfied with the existing approaches for family physicians to demonstrate accountability for their work to health care administrators. Based on their responses, 2 proposals were created for a better approach to primary care accountability: minor adjustments that preserve some of the existing systems and major changes that represent a paradigm shift in the use of metrics to evaluate the work of primary care physicians and teams.