Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine

Abstract

BACKGROUND: The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis. OBJECTIVE: To assess the relationship between IM residents' satisfaction with continuity clinic and interest in GIM careers. DESIGN: Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM. PARTICIPANTS: IM residents at three urban medical centers. MAIN MEASURES: Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career. KEY RESULTS: Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents' likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p≤0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0,) and being very satisfied with the continuity of relationships with patients (OR 4.08, were the strongest independent predictors of likelihood to enter GIM as a result of clinic. CONCLUSIONS:Resident satisfaction with most aspects of continuity clinic was high; yet, continuity clinic had an overall negative influence on residents' attitudes toward GIM careers. Targeting resources toward improving ambulatory patient continuity, workflow efficiency and increasing pre-residency interest in primary care may help build the primary care workforce.

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

“…Emphasizing outpatient training and education during residency while simultaneously providing protected time to practice ambulatory medicine may help retain resident interest in primary care. In addition to maximizing protected outpatient training time, there have been multiple appeals for a reform of the clinic experience itself 24,[30][31][32][33][34] as satisfaction with IM residency continuity clinic directly influences career choice toward primary care. 31,32 A recent study compared internal medicine residents' likelihood of entering GIM as a result of clinic to likelihood of entering a career in GIM before clinic, and demonstrated that 28 % were less likely to enter GIM as a result of their clinic experience, 59 % had no difference in likelihood, and only 11 % were more likely to enter general IM as a result of clinic.…”

“…31,32 A recent study compared internal medicine residents' likelihood of entering GIM as a result of clinic to likelihood of entering a career in GIM before clinic, and demonstrated that 28 % were less likely to enter GIM as a result of their clinic experience, 59 % had no difference in likelihood, and only 11 % were more likely to enter general IM as a result of clinic. 34 Current attempts to improve the outpatient clinic experience include the development of patientcentered medical homes and accountable care organizations, 35,36 efforts to decrease panel size, and the creation of multidisciplinary, inter-professional teams. 10 These changes should help to train residents in team environments that allow physicians to work at the peak of their training levels and in more satisfying work conditions.…”

Ambulatory Education Redesign: Time to Get Inspired

“…9 They found that residents were generally satisfied with their clinic experience, but were overall less likely to enter a career in GIM as a result of their continuity clinic. However, residents who were highly satisfied with the number of patients they cared for and the continuity of care they achieved were more likely to choose a career in GIM.…”

The Selling of Primary Care 2015

“…20,[22][23][24] This effect is more commonly discussed in the context of residency training where teaching clinics are often under-resourced and illsuited to manage the socially and medically complex patients served in these venues. [25][26][27][28][29] Residents turn from careers in primary care when they experience the stress, disorganization, lack of continuity, lack of support, and low prestige in these settings, 26,[28][29][30] and students who observe these experiences may also opt away from primary care careers.…”