Primary Care Physician- Compass PLUS Program

About Compass PLUS Compass PLUS is designed for clinicians who thrive in high-need, outpatient environments. This innovative program supports patients facing complex medical and social challenges, using a hands-on and highly collaborative care approach that prioritizes individual patient needs. Care is delivered outside traditional offices, with teams-including a Nurse Practitioner, Nurse, and Community Health Worker-working directly in patients' homes or community spaces. Most patients stay connected to their existing PCP, but for those with the greatest needs, the Compass PLUS physician takes over care, aiming to eventually transition them back to standard primary care. For patients requiring the most intensive support, the Compass PLUS physician becomes their primary provider, focusing on reintegrating them into traditional outpatient care when feasible. About the Role This role is ideal for primary care physicians seeking to spend more time with fewer patients-managing a small panel of approximately 100 medically and socially complex individuals. You'll serve as the PCP for those fully transitioned into the Compass PLUS program and consult with other providers caring for high-risk patients. The majority of your work will be conducted in homes and community settings, allowing you to address barriers directly and build strong relationships with patients. Key Responsibilities Deliver comprehensive outpatient primary care to a small group of high-acuity patients, focusing on relationship-based, intensive care Work closely with multidisciplinary care teams in community and home settings Create and execute personalized care plans that address medical, behavioral, and social needs Consult with PCPs and teams across the system, sharing expertise in managing complex patients Support transitions between inpatient, emergency, and outpatient care, always with a patient Collaborate with patients and teams to improve health outcomes and decrease unnecessary hospital use Practice Details Panel size of about 100 patients enables more dedicated, intensive care Care is primarily delivered in homes and community locations-no traditional office visits required Work is centered in the Greater Boston area Local travel is necessary, with occasional regional trips (1-2 times per month) No evening or weekend call obligations Enjoy significant clinical autonomy within a supportive, collaborative environment Qualifications MD or DO in Internal Medicine or Family Medicine Board certified or board eligible Preference for candidates with outpatient experience in high-need environments, such as health centers or home care Interest in population health and health equity Proven ability to work effectively in collaborative care settings Comfort with independent practice across varied care environments Eligible for Massachusetts medical license and DEA