Dallas Nephrology Associates (DNA), a 54-year-old independent physician practice, has grown from a small group practice into one of the largest independent nephrology practices in the country, with more than 111 physicians and 32 nonphysician providers. While proud of its independence and reputation for patient care, the practice’s leaders understood that thriving in today’s shifting health care environment required more than clinical expertise.
“Everything about health care around us is constantly changing. There are new challenges and new ways of being and practicing medicine,” said Archana Rao, MD, a nephrologist and executive vice president of Dallas Nephrology Associates. “So, we’re in a state of constant flux and we are an extremely diverse group, and our president, Dr. Alexander Liang’s vision was to really grow the company in the right direction.”
That is why the leaders at Dallas Nephrology Associates needed to pause, reflect and build a high functioning and cohesive team—a process that does not happen overnight.
“We have been at the forefront of value-based care and what that means, and that actually takes health care teams into a whole other extraordinary challenge where we have to now manage the patient even beyond the one-on-one encounters that we see—whether in the office or the hospital,” Dr. Rao said. “Value-based care requires us to manage patients longitudinally, holistically, long term.”
“So how do we do that? We need everyone who’s in the company—plus all our physicians and nonphysician providers—to embrace this idea. It’s a very tough thing. It’s like climbing a mountain where we’re not trained to climb this mountain,” she said. “That was the challenge we looked at. The opportunity is we want to do something that lasts beyond all of us.”
This led to the “thought that we have to do some self-reflection. We have to listen to everybody and create well-being,” Dr. Rao said.
Dallas Nephrology Associates is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Why measure physician well-being
The executive team began asking how Dallas Nephrology Associates could remain strong and sustainable for decades to come.
“One of the thoughts was: How do we make DNA a company that is built to last?” said Dr. Rao. “This led to an intentional pause.”
For Dr. Rao, the decision to measure physician well-being also grew out of her philosophy as a physician.
“The reason I am excited to venture into this is I see all aspects of why there is a health care crisis. On the one side, I see why it’s tough for patients—I understand their angst, the agony that they go through in this current health care system,” she said. “I also see how we as physicians feel the same angst. Everyone is finding it challenging to navigate health care today.”
“True healing of patients only happens when evidence-based, excellent care is delivered by healthy well-balanced physicians,” Dr. Rao said. “All of us who are in the position to deliver health care, to be in that healing space, we cannot provide healing if we ourselves are stressed out.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
Turning to the AMA
While Dallas Nephrology Associates has long conducted patient satisfaction and employee engagement surveys, leaders wanted something different: a tool that spoke directly to physicians’ experiences and challenges. That led them to measuring for the first time with the AMA’s Organizational Biopsy®.
At Dallas Nephrology Associates, the initial results showed that 33.4% of physicians at the system reported feeling symptoms of burnout compared with the national rate of 43.2%.
“I was pleased with our initial results, but not totally surprised as our annual employee-engagement survey data for physicians has typically been very positive,” said David Knop, director of human resources at Dallas Nephrology. “What the biopsy survey did was help us focus on questions more specific to the challenges our physicians face.”
The AMA team has been a great help throughout the process, said the leaders at Dallas Nephrology Associates.
“We have loved the support from the AMA team because we didn’t know how to go about measurement and determining what to do with our results—and they were able to tell us,” said Dr. Rao. “We started to have conversations with the AMA in January 2025, but we launched the Organizational Biopsy in the middle of April.”
“It took a little time to make sure that everyone understood the process, what this was measuring and what questions we wanted to ask that were relevant to the way we practiced,” she said. “Once the survey went out, we put a lot of effort into socializing it.
“Physicians’ work is precious, and this needed to be worth their time,” Dr. Rao added.
“We’ve done some employee-engagement surveys with physicians and staff previously,” said David Knop, director of human resources at Dallas Nephrology Associates. “And while the questions were not as in depth as the AMA’s Organizational Biopsy, physicians are really engaged here as well … but we didn’t have a lot of good national benchmark data to compare to. The Organizational Biopsy did.”
Engaging physicians
Physician engagement was critical to the survey’s success. Dallas Nephrology Associates leaders acknowledged survey fatigue but stressed the value of authentic feedback.
“The more people share their thoughts, the better we are going to be at implementing changes that are necessary,” Dr. Rao said.
Ultimately, 70% of physicians participated in the survey—giving Dallas Nephrology Associates a robust foundation of data to guide action.
Building for the future
The well-being survey marked an important turning point for the practice. Rather than relying on assumptions about physician well-being, Dallas Nephrology Associates now had data-driven insights that could help chart its future direction.
“Our work with the AMA has just begun and the Joy in Medicine Health System Recognition Program would be a great next step,” Knop said. “I hope it will further validate our efforts to not only provide exceptional patient care but also make Dallas Nephrology Associates a ‘best place to work.’”
