1
|
O'Rourke P, Tackett S, Chacko K, Knaus SJ, Shalaby M, Fluker SA, Ma M, Overland M, Wright S. Factors Influencing Primary Care Career Choice: A Multi-Institutional Cross-sectional Survey of Internal Medicine Primary Care Residency Graduates. J Gen Intern Med 2024:10.1007/s11606-024-08846-z. [PMID: 38900381 DOI: 10.1007/s11606-024-08846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Although primary care is associated with population health benefits, the supply of primary care physicians continues to decline. Internal medicine (IM) primary care residency programs have produced graduates that pursue primary care; however, it is uncertain what characteristics and training factors most affect primary care career choice. OBJECTIVE To assess factors that influenced IM primary care residents to pursue a career in primary care versus a non-primary care career. DESIGN Multi-institutional cross-sectional study. PARTICIPANTS IM primary care residency graduates from seven residency programs from 2014 to 2019. MAIN MEASURES Descriptive analyses of respondent characteristics, residency training experiences, and graduate outcomes were performed. Bivariate logistic regression analyses were used to assess associations between primary care career choice with both graduate characteristics and training experiences. KEY RESULTS There were 256/314 (82%) residents completing the survey. Sixty-six percent of respondents (n = 169) practiced primary care or primary care with a specialized focus such as geriatrics, HIV primary care, or women's health. Respondents who pursued a primary care career were more likely to report the following as positive influences on their career choice: resident continuity clinic experience, nature of the PCP-patient relationship, ability to care for a broad spectrum of patient pathology, breadth of knowledge and skills, relationship with primary care mentors during residency training, relationship with fellow primary care residents during training, and lifestyle/work hours (all p < 0.05). Respondents who did not pursue a primary care career were more likely to agree that the following factors detracted them from a primary care career: excessive administrative burden, demanding clinical work, and concern about burnout in a primary care career (all p < 0.05). CONCLUSIONS Efforts to optimize the outpatient continuity clinic experience for residents, cultivate a supportive learning community of primary care mentors and residents, and decrease administrative burden in primary care may promote primary care career choice.
Collapse
Affiliation(s)
- Paul O'Rourke
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Sean Tackett
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Karen Chacko
- Department of Medicine, University of Colorado, Denver, CO, USA
| | | | - Marc Shalaby
- Department of Medicine, Pennsylvania Hospital, Philadelphia, PA, USA
| | | | - Mina Ma
- Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Maryann Overland
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Scott Wright
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
2
|
Nandiwada DR, Farkas AH, Nikiforova T, Leung PB, Donovan AK, Killian K, Thomas ML, Singh MK, Gallagher B, Callender DM. Exploring Models of Exposure to Primary Care Careers in Training: a Narrative Review. J Gen Intern Med 2024; 39:277-282. [PMID: 37989819 PMCID: PMC10853099 DOI: 10.1007/s11606-023-08532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
Multiple models of clinical exposure to primary care exist within undergraduate medical education (UME) and graduate medical education (GME). In this narrative review, we explore the evidence behind these different models of exposure, their alignment with positive promoters of primary care careers, and the pros and cons of each. Without positive exposure to primary care during training, sustaining the future primary care work force becomes increasingly challenging. Here, we explore multiple models of clinical exposure in UME, including longitudinal integrated clerkships, primary care tracks, and primary care clerkships. Within GME, we will review the impact of primary care tracks, Area Health Education Centers, block scheduling models, and continuity clinic scheduling models. The goal of this narrative review is to allow educators to think broadly and intentionally about the array of models to develop positive primary care experiences and perceptions in training, ultimately sustaining the primary care workforce.
Collapse
Affiliation(s)
- D Rani Nandiwada
- Perelman School of Medicine, University of Pennsylvania, 51 North 39Th Street, MAB 102, Philadelphia, PA, 19104, USA
| | - Amy H Farkas
- Milwaukee VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53211, USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 921, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Peggy B Leung
- Weill Cornell Internal Medicine Associates, 505 East 70Th St, HT-4, New York, NY, 10021, USA
| | - Anna K Donovan
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 930, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Katherine Killian
- Weill Cornell Internal Medicine, 178 East 85Th Street, Floor 2, New York, NY, 10028, USA
| | - Mary L Thomas
- University of Tennessee, 920 Madison Ave, Suite 531, Memphis, TN, 38163, USA
| | - Mamta K Singh
- Case Western Reserve University, VA Northeast Ohio Healthcare System, 1620 Magnolia Drive, Administrative Building, RM 5M678, Cleveland, OH, 44106, USA
| | | | - David M Callender
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
| |
Collapse
|
3
|
Esposito AC, Coppersmith NA, Flom EA, Chung M, Reddy V, Leeds I, Longo W, Pantel H, Yoo PS, Mongiu A. So You Want to be a Program Director? Career Paths of Colon and Rectal Surgery Residency Program Directors. JOURNAL OF SURGICAL EDUCATION 2023; 80:588-596. [PMID: 36658062 DOI: 10.1016/j.jsurg.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/11/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The trajectory of colon and rectal surgery residency program director (PD) career paths has not been well described, leaving those who aspire for the position with minimal guidance. The goal of this study is to characterize their career paths in the United States. By understanding their experiences, the path to train and educate the next generation of colon and rectal surgeons as a PD will be better illuminated. STUDY DESIGN This study was an anonymous, cross-sectional survey of all junior and senior colon and rectal surgery residency PDs in the United States during April and May of 2022. PDs were divided into junior and senior PDs. Results were compared using 2-sided independent t-tests and Kruskall-Wallis tests. RESULTS Of 65 colon and rectal surgery PDs, 48% (31/65) completed the survey which encompassed demographics, leadership, education, research, and time utilization. Participants were primarily white and male, although increased female representation was identified among the junior PDs (50%). Junior PDs were also more likely to hold associate or assistant professor positions at time of appointment (p = 0.01) and a majority of all PDs (64%) previously or currently held a leadership position in a national or regional surgical association. When appointed, senior PDs reported increased teaching time. CONCLUSIONS This multi-institutional analysis of colon and rectal surgery residency PDs identified a trend towards equal gender representation and diversity amongst upcoming junior PDs. All respondents were appointed to PD from within the institution. Other key experiences included previous leadership roles and associate or assistant professor positions at time of appointment. While it is impossible to create a single recommended template for every aspiring colon and rectal surgery educator to advance to a PD position, this study provides guideposts along that career path.
Collapse
Affiliation(s)
- Andrew C Esposito
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
| | | | - Emily A Flom
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Vikram Reddy
- Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Yale School of Management, Yale University, New Haven, Connecticut
| | - Ira Leeds
- Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Walter Longo
- Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Haddon Pantel
- Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Peter S Yoo
- Division of Transplant Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Anne Mongiu
- Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
4
|
Fortuna RJ, Tobin DG, Sobel HG, Barrette EP, Noroha C, Laufman L, Huang X, Staggers KA, Nadkarni M, Lu LB. Perspectives of internal medicine residency clinics: A national survey of US medical directors. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2022; 35:58-66. [PMID: 36647933 DOI: 10.4103/efh.efh_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Ambulatory training is an integral component of internal medicine residency programs, yet details regarding operational processes in resident continuity clinics remain limited. METHODS We surveyed a convenience sample of medical directors of residency practices between 2015 and 2019 (n = 222) to describe and share operational and scheduling processes in internal medicine resident continuity clinics in the US. RESULTS Among residency practices, support for the medical director role ranged substantially, but was most commonly reported at 11%-20% full-time-equivalent support. By the end of the survey period, the majority of programs (65.1%) reported obtaining patient-centered medical home (PCMH) certification (level 1-3). For new patient appointments, 34.9% of programs reported a 1-7 day wait and 25.8% reported an 8-14 day wait. Wait times for new appointments were generally shorter for PCMH certified practices (P = 0.029). No-show rates were most commonly 26%-50% for new patients and 11%-25% for established patients. Most programs reported that interns see 3-4 patients per ½-day and senior residents see 5-6 patients per ½-day. Most interns and residents maintain a panel size of 51-120 patients. DISCUSSION Creating high-performing residency clinics requires a focus on core building blocks and operational processes. Based on the survey results and consensus opinion, we provide five summary recommendations related to (1) support for the medical director leadership role, (2) patient-centered and coordinated models of care, (3) support for patient scheduling, (4) recommended visit lengths, and (5) ancillary support, such as social work.
Collapse
Affiliation(s)
- Robert J Fortuna
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Daniel G Tobin
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Halle G Sobel
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Ernie-Paul Barrette
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Craig Noroha
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Larry Laufman
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Xiaofan Huang
- Biostatics, Baylor College of Medicine, Houston, TX, USA
| | | | - Mohan Nadkarni
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Lee B Lu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
5
|
Russell SW, Desai SV, O'Rourke P, Ahuja N, Patel A, Myers CG, Zulman D, Sateia HF, Berkenblit GV, Johnson EN, Garibaldi BT. The genealogy of teaching clinical reasoning and diagnostic skill: the GEL Study. ACTA ACUST UNITED AC 2020; 7:197-203. [PMID: 32146439 DOI: 10.1515/dx-2019-0107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/15/2020] [Indexed: 11/15/2022]
Abstract
The genealogy of graduate medical education in America begins at the bedside. However, today's graduate medical trainees work in a training environment that is vastly different from medical training a century ago. The goal of the Graduate Medical Education Laboratory (GEL) Study, supported by the American Medical Association's (AMA) "Reimagining Residency" initiative, is to determine the factors in the training environment that most contribute to resident well-being and developing diagnostic skills. We believe that increasing time at the bedside will improve clinical skill, increase professional fulfillment, and reduce workplace burnout. Our graduate medical education laboratory will test these ideas to understand which interventions can be shared among all training programs. Through the GEL Study, we aim to ensure resident readiness for practice as we understand, then optimize, the learning environment for trainees and staff.
Collapse
Affiliation(s)
- Stephen W Russell
- Associate Professor of Internal Medicine and Pediatrics, The University of Alabama at Birmingham, c/o UAB Medicine Leeds, 1141 Payton Way, Leeds, AL 35094, USA
| | - Sanjay V Desai
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Paul O'Rourke
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Neera Ahuja
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand Patel
- University of Chicago Hospital, Chicago, IL, USA
| | - Christopher G Myers
- Department of Internal Medicine, Johns Hopkins University Carey Business School - Baltimore Campus, Baltimore, MD, USA
| | - Donna Zulman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Heather F Sateia
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Gail V Berkenblit
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Erica N Johnson
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Brian T Garibaldi
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| |
Collapse
|
6
|
Klein R. Delivering on the Promise: Exploring Training Characteristics and Graduate Career Pursuits of Primary Care Internal Medicine Residency Programs and Tracks. J Grad Med Educ 2019; 11:447-453. [PMID: 31440340 PMCID: PMC6699538 DOI: 10.4300/jgme-d-19-00010.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/20/2019] [Accepted: 06/10/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Specialized primary care internal medicine (PC IM) residency programs and tracks aim to provide dedicated PC training. How programs deliver this is unclear. OBJECTIVE We explored how PC IM programs and tracks provide ambulatory training. METHODS We conducted a cross-sectional survey from 2012 to 2013 of PC IM program and track leaders via a search of national databases and program websites. We reported PC IM curricular content, clinical experiences, and graduate career pursuits, and assessed correlation between career pursuits and curricular content and clinical experiences. RESULTS Forty-five of 70 (64%) identified PC IM programs and tracks completed the survey. PC IM programs provide a breadth of curricular content and clinical experiences, including a mean 22.8 weeks ambulatory training and a mean 69.4 continuity clinics per year. Of PC IM graduates within 5 years, 55.8% pursue PC or general internal medicine (GIM) careers and 23.1% pursue traditional subspecialty fellowship training. Curricular content and clinical experiences correlate weakly with career choices. PC IM graduates pursuing PC or GIM careers correlated with ambulatory rotation in women's health (correlation coefficient [rho] = 0.36, P = .034) and mental health (rho = 0.38, P = .023) and curricular content in teaching and medical education (rho = 0.35, P = .035). PC IM graduates pursuing subspecialty fellowship negatively correlated with curricular content in leadership and teams (rho = -0.48, P = .003) and ambulatory training time (rho = -0.38, P = .024). CONCLUSIONS PC IM programs and tracks largely deliver on the promise to provide PC training and education and produce graduates engaged in PC and GIM.
Collapse
|