Original Research

Utilization of Primary Care Physicians by Medical Residents: A Survey-Based Study

Journal of Clinical Outcomes Management. 2018 October;25(8):357-366

References

1. Kassam A, Horton J, Shoimer I, Patten S. Predictors of well-being in resident physicians: a descriptive and psychometric study. J Grad Med Educ 2015;7:70–4.

2. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358–67.

3. Burstin HR, Swartz K, O’Neil AC, et al. The effect of change of health insurance on access to care. Inquiry 1998;35:389–97.

4. Rhodes KV, Basseyn S, Friedman AB, et al. Access to primary care appointments following 2014 insurance expansions. Ann Fam Med 2017;15:107–12.

5. Polsky D, Richards M, Basseyn S, et al. Appointment availability after increases in Medicaid payments for primary care. N Engl J Med 2015;372:537–45.

6. Gupta G, Schleinitz MD, Reinert SE, McGarry KA. Resident physician preventive health behaviors and perspectives on primary care. R I Med J (2013) 2013;96:43–7.

7. Rosen IM, Christine JD, Bellini LM, Asch DA. Health and health care among housestaff in four U.S. internal medicine residency programs. J Gen Intern Med 2000;15:116-21.

8. Campbell S, Delva D. Physician do not heal thyself. Survey of personal health practices among medical residents. Can Fam Physician 2003;49:1121–7.

9. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83(3):457-502.

10. Weissman JS, Stern R, Fielding SL, et al. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med 1991;114:325–31.

11. Guille C, Sen S. Prescription drug use and self-prescription among training physicians. Arch Intern Med 2012;172:371–2.

12. Roberts LW, Kim JP. Informal health care practices of residents: “curbside” consultation and self-diagnosis and treatment. Acad Psychiatry 2015;39:22-30.

13. Cohen JS, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ 2005;5:21.

14. U.S. Preventive Services Task Force. Cervical cancer: screening. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening. Published March 2012. Accessed August 21, 2018.

15. Health Resources and Services Administration. Women’s preventative services guidelines. https://www.hrsa.gov/womensguidelines2016/index.html. Updated October 2017. Accessed August 21, 2018.

16. Christie JD, Rosen IM, Bellini LM, et al. Prescription drug use and self-prescription among resident physicians. JAMA 1998;280(14):1253–5.

Primary Care Utilization

Among the 348 respondents, 59% (n = 205) reported having established care with a PCP. An additional 6% (n = 21) had established care with an obstetrician/gynecologist for routine needs (Table 2). The 2 most common reasons for establishing care with a PCP were routine primary care needs, including contraception (n = 159, 79%), and access to a physician in the event of an acute medical need (n = 132, 66%).

Among respondents who had established care with a PCP, most (n = 188, 94%) had completed at least 1 appointment. However, among these 188 respondents, 68% (n = 127) stated that they had not made an acute visit in more than 12 months. When asked about wellness visits, almost one third of respondents (n = 103, 31%) stated that they had not been seen for a wellness visit in the past 3 years.

Burden of Chronic Illness

Most respondents (n = 223, 67%) stated that they did not have a chronic medical or mental health condition prior to residency (Table 3). However, 23% (n = 77) of respondents stated that they had been diagnosed with a chronic medical illness prior to residency, and 14% (n = 45) indicated they had been diagnosed with a mental health condition prior to residency. Almost one fifth of respondents (n = 60, 18%) reported seeing a subspecialist for a medical illness, and 33% (n = 111) reported taking a long-term prescription medication. With respect to major medical issues, the majority of residents (n = 239, 72%) denied experiencing events such as pregnancy, hospitalization, surgery, or an emergency department (ED) visit during training.

Inappropriate Prescriptions

While the majority of respondents denied writing a prescription for themselves for an acute or chronic medical condition, almost one fifth (n = 62, 19%) had received a prescription for an acute medical need from a provider outside of a clinical relationship (ie, from someone other than their PCP or specialty provider). Notably, 5% (n = 15) reported that this had occurred at least 2 or 3 times in the past 12 months (Table 4). Compared to respondents not taking long-term prescription medications, respondents who were already taking long-term prescription medications more frequently reported inappropriately receiving chronic prescriptions outside of an established clinical relationship (n = 14, 13% vs. n = 14, 6%; P = 0.05) and more often self-prescribed medications for acute needs (n = 12, 11% vs. n = 7, 3%; P = 0.005).