Case management support in residency ‘pivotal’ factor in choosing a career in primary care
Graduates who receive more case management support during residency are more likely to pursue a career in primary care, according to a recent study.
Paul O’Rourke, MD, MPH, FACP, an assistant professor of medicine and associate program director for Johns Hopkins Bayview Internal Medicine Residency Program, and colleagues noted that the United States is “suffering from a growing shortage of primary care physicians,” and that many internal medicine primary care residency graduates who initially wanted to work in primary care choose another path.
“Over one-third of primary care physicians in the United States are general internists; however, the number of general internists in recent decades pursuing primary care has been declining,” O’Rourke told Healio.
O’Rourke and colleagues conducted a cross-sectional survey — the first multi-institutional study of its kind — to “identify characteristics of graduates and residency experiences that were most influential when deciding whether to pursue a [primary care] career.”
The study authors used email surveys in the fall of 2020 to hear from graduates from seven internal medicine primary care residency programs. They used descriptive statistics and logistic regressions adjusting for clustering by programs to analyze the factors associated with graduates who ultimately chose to pursue a career in primary care compared with those who did not.
Overall, 262 people responded to the surveys; 65% of the respondents currently practice primary care or primary care with a specialized focus. Those graduates were significantly more likely to report that their residency continuity clinic experience was a positive influence on their decision to pursue a primary care career (OR = 1.51; 95% CI, 1.3-1.74) and were more likely to be satisfied with interdisciplinary case management in their continuity clinic during residency (OR = 1.27; 95% CI, 1.07-1.51).
The data suggest that “continuity clinic experience may be pivotal” to primary care career choice, and that improving the clinic experience might help more graduates choose a career in primary care, according to the researchers.
“Residency continuity clinics have traditionally been under-valued and under-resourced in graduate medical education,” O’Rourke said. “Optimizing residency continuity clinics to have a multidisciplinary team to help physicians care for patients holistically is paramount. A collaborative team is important not only to recruit future PCPs but also to retain our PCPs and help them thrive in practice.”
The researchers also reported that survey respondents who received more case management support were less concerned about burnout (OR = 0.41; 95% CI, 0.31-0.53) and excessive administrative burdens (OR = 0.51; 95% CI, 0.33-0.78) at the end of residency.
“Physicians are looking for opportunities to provide clinical care they find meaningful and fulfilling while also having the time to pursue their personal interests and home life,” O’Rourke said. “High-functioning primary care practices that foster a collaborative clinical team to manage the various aspects of patient care and not have all tasks fall to the physician is a great way to promote a clinic experience that can maintain physician well-being and promote work-life balance.”
O’Rourke said that he and his colleagues were interested in discovering if different training experiences or attributes of internal medicine primary care residency graduates influenced the likelihood to pursue careers in primary care because knowing those attributes could help them “advocate for appropriate changes” in primary care education.
“There is substantive evidence of the benefits of primary care relationships to patient health and the well-being of our health care system,” he said. “It would be important to ensure that our country is producing the primary care physicians of the future.”