Promoting patient and physician well-being through practice redesign 


Joy in Practice:

Practical ideas for better patient care and improved physician well-being.




This is a website and blog for physicians in search of greater efficiency, meaning and joy in their work. My husband Tom and I are general internists in Dubuque, Iowa, and have been engaged in practice redesign efforts in our own practice as well as across the country.  The goal is to build an environment that minimizes busy work, and leaves room for meaning, purpose and well-being. 


We are fortunate to practice in one of the best models in the country: our clinic was one of the first to be designated a level 3 Patient-Centered Medical Home (PCMH), we work closely with a stable team of nurses, our large multi-specialty clinic is physician owned, and we own our own health plan. And yet we have found that what drives us--providing good care, and relationships with patients and colleagues--is increasingly being driven out by growing regulatory, administrative and compliance issues. 

Tom is thus working with nursing colleagues and the American Board of Internal Medicine (ABIM) Foundation to enhance the roles nurses play in primary care. I am helping the AMA on its core strategic initiative to improve physician career satisfaction and practice sustainability. I have also served on multiple Comprehensive Primary Care/PCMH advisory committees, including for the VA, NCQA and for the CMS Innovation Center. I am a co-author of the Institute of Medicine's report: HIT and Patient Safety and have twice provided testimony to the Office of the National Coordinator for HIT as well as at a congressional briefing. I am on the advisory boards of Primary Care Progress and a national Industrial Engineering-Primary Care Collaborative Both Tom and I are co-authors on the ABIM Foundation study: In Search of Joy in Practice: A report of 23 high functioning practices. In addition we have consulted on practice redesign with several academic medical centers and private healthcare organizations. 

We've included practical resources on how to organize your clinical practice, build stronger teams, work more efficiently with the EHR and manage administrative and regulatory tasks. We've also shared information on providing more patient-centered care, with health coaching, care coordination and approaches to improve patient engagement