Professional Dissonance and Burnout in Primary Care: A Qualitative Study.

Qualitative interviews with 26 PCPs (21 physicians, 3 NPs, 2 PAs). Participants described their workloads as excessively heavy, increasingly involving less “doctor” work and more “office” work, and reflecting unreasonable expectations. They felt demoralized by work conditions, undervalued by local institutions and the health care system, and conflicted in their daily work. Participants conveyed a sense of professional dissonance, or discomfort from working in a system that seems to hold values counter to their values as clinicians. Solutions clustered around 8 themes: managing the workload, caring for PCPs as multidimensional human beings, disconnecting from work, recalibrating expectations and reimbursement levels, promoting PCPs’ voice, supporting professionalism, fostering community, and advocating reforms beyond the institution.