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Med Clin North Am. 2017 Sep;101(5):1031-1040. doi: 10.1016/j.mcna.2017.04.014.

In Pursuit of the Fourth Aim in Health Care: The Joy of Practice.

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Department of Family Medicine, Boston Medical Center, 1 Boston Medical Center Place, Dowling 5th Floor, Boston, MA 02118, USA. Electronic address:


In today's health care system where there are increased demands for health care provider productivity, increased pay for performance metrics, decreased reimbursements, and ever-increasing demands of electronic medical records, providers are at risk for high rates of burnout. Indeed, recent studies have indicated that more than 50% of US physicians are now experiencing burnout and that burnout is rising dramatically faster among physicians than in any other US professional field. These high rates of burnout have many downstream consequences, for both the providers and for the patients they serve.


Accountable Care Organizations; Physician burnout; Quadruple aim; Value-based care; Wellness

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