The job of a primary care physician has changed faster than the workforce built to support it. At Cleveland Clinic Florida, Surendra Khera, MD, is combining new technology, new roles and a fundamental rethinking of how primary care gets done.
Dr. Khera is president of the Cleveland Clinic Florida Integrated Healthcare ACO and vice chief of the Primary Care Institute for the Florida market of Cleveland Clinic, based in Weston, Fla. Over the past four years, he has led a broad redesign of the market’s primary care operations: recruiting more than 100 clinicians, cutting new patient wait days by nearly 75%, completing annual wellness visits for more than 75% of eligible patients and generating ACO shared savings for two consecutive years.
The urgency behind that work is partly driven by a workload that has accumulated outside the clinic walls. Portal messages to primary care physicians increased 153% over the past five years — from roughly one message per patient annually to about 2.5, according to a recent JAMA study — and no payment, staffing or policy structure has kept pace with that growth.
“For every hour that a primary care physician sees patients, they generate 15 minutes of what we call work outside of work,” Dr. Khera said during an episode of the “Becker’s Healthcare Podcast.”
Dr. Khera’s structural answer is what he calls a “digital corridor” — a parallel care infrastructure staffed by inboxologists, APPs and virtual clinicians that absorbs the digital workload before it reaches physicians. Cleveland Clinic Florida has built an early version of this through its clinical access team, which has managed more than 20,000 visits, handling same-day appointments, in-basket work and coverage for physicians on leave.
He expected resistance when it came to filling these new roles. The response was the opposite.
“Whether it is being a digital primary care clinician or a clinical access team member, where you provide access without being a primary care physician, or recruiting the evening primary care physicians, which I thought would be very hard — we managed to recruit all of them for the pilot to go live in two weeks’ time,” he said.
That pilot is Cleveland Clinic Florida’s first evening and weekend primary care model: four physicians, each with their own patient panel, working alongside daytime colleagues to extend access beyond the traditional clinic day. It is one of several structural expansions Dr. Khera sees as part of the same workforce redesign to build care around when patients need it, not when a traditional schedule allows.
The clinicians who have moved into digital roles have found the work meaningful in ways they did not fully anticipate. Managing the in-basket for a physician on vacation — completing 70% to 75% of the workload before that physician returns — turns out to carry its own sense of impact.
“An in-basket clinician or an APP feels extremely satisfied,” Dr. Khera said.
The business model for these roles remains unresolved. Without a defined financial benefit, expanding the digital corridor beyond its current footprint has proven harder than building it.
“The structure there is not well designed. The return on investments there are not clear,” he said. “If they are doing work that has no tangible business model tied to it, other than offloading the clinicians in the physical space and retention, then I think it just makes it harder for them to understand the work and for us to expand that work from the business point of view.”
Artificial intelligence is becoming a defining part of how Cleveland Clinic Florida is addressing both sides of that equation, reducing the workload that flows to the digital corridor and expanding what the corridor can handle. Ninety percent of the market’s primary care physicians are already using an ambient scribe.
“It’s been life-changing. We used to spend hours doing our notes, and now we have a tool that does that,” Dr. Khera said.
Cleveland Clinic is now running a pilot on AI-generated in-basket responses, an extension of the same logic applied to documentation. Research on this approach is still developing; one recent study found that AI-drafted portal replies can take physicians longer to edit than writing from scratch when generated content requires clinical revision. How Cleveland Clinic’s pilot handles that complexity will shape its reach.
The inbox is one layer of a larger ambition. Dr. Khera envisions AI eventually taking on work across screenings, annual wellness exams, physicals and patient questionnaires, and using predictive risk modeling to reshape how primary care clinics themselves are organized.
“Could future AI delivery tools segment the population so based on the design of the clinic, those patients will be seen?” he said.
Dozens of health systems have been working to scale AI across their operations and translate pilots into enterprise deployments, with ambient documentation, predictive analytics and revenue cycle tools among the most active areas. Dr. Khera’s framing adds a workforce dimension to that picture: AI is not simply augmenting the physicians already in practice. It is changing what those positions require, what supporting roles are needed and, ultimately, who does what in primary care.
A projected shortage of roughly 87,000 to 90,000 primary care physicians by 2037 makes that question more than theoretical. The specialty will not reverse its workforce crisis by recruiting faster. It will have to make the job worth staying in.
“Access is no longer a scheduling problem,” Dr. Khera said. “It’s a health outcome strategy.”
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