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Perspectives of internal medicine residency clinics: A national survey of US medical directors
Robert J Fortuna1, Daniel G Tobin2, Halle G Sobel3, Ernie-Paul Barrette4, Craig Noronha5, Larry Laufman6, Xiaofan Huang7, Kristen A Staggers7, Mohan Nadkarni8, Lee B Lu6
1 Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
2 Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
3 Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
4 Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
5 Department of Medicine, Boston University School of Medicine, Boston, MA, USA
6 Department of Medicine, Baylor College of Medicine, Houston, TX, USA
7 Biostatics, Baylor College of Medicine, Houston, TX, USA
8 Department of Medicine, University of Virginia, Charlottesville, VA, USA
Correspondence Address:
Dr. Robert J Fortuna
Department of Internal Medicine University of Rochester, Rochester, NY
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/efh.efh_75_22
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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.
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