Graduate Medical Education

Resident physicians and quality of care

Two recent studies examine the impact of resident/fellow physicians on patients' quality of care. One study, in Neurosurgery, looks at the so-called "July effect"—that patient care suffers when a new cohort of young physicians begin training each summer—and concluded that the phenomenon is a myth.

The study examined 10 years worth of data on patient deaths and surgical complications in neurological surgery, comparing July with all other months, and found no differences between July and the rest of the year. In an interview, the authors said that "Multiple layers of supervision seem to more than compensate for the inexperience of young physicians, providing a safety net for patients."

A second study, in the Archives of Surgery, found a negative impact on trauma care outcomes when resident physicians were involved. Patients admitted to teaching trauma centers faced "an increased risk for major complications and a higher rate of failure to rescue" compared to those admitted to nonteaching trauma centers. The authors call for more study on potential areas of improvement in residency education and processes of care.

Meanwhile, a new study, also in the Archives of Surgery, found that three in 10 surgery residents in six California residency programs needed remediation before they could complete their training, with some requiring a full year of retraining. Among the six general competencies of the Accreditation Council for Graduate Medical Education, the most common deficit was in medical knowledge. On the positive side, the authors noted that the majority of the remediation required occurred in the first year or two of the five-year surgery programs.

A commentary on the study said the results highlight the need for "educational systems that eliminate nonessential tasks so that residents can devote more attention during the compressed work hours to learning what they need to become competent surgeons."

Physician shortage might hinge on family medicine

Despite the impending primary care physician shortage, resident physicians have little incentive to become family medicine practitioners, according to a recent story in the New York Times.

The disincentives come from many directions. Many medical schools subtly (or overtly) disparage family medicine, and many medical students completing clerkships find that primary care physicians are burdened by administrative tasks instead of engaged fully in patient care.

Further, the wage disparity between primary care and specialty practice is another barrier. A new national study in the journal Medical Care, for example, found that "earnings over the course of the careers of primary-care physicians averaged as much as $2.8 million less than the earnings of their specialist colleagues."

The physicians interviewed in the Times' article suggest a few remedies to change the tide. Earlier, yearlong clerkships would help students realize the long-term relationships primary care physicians are able to build with their patients. Medical schools should also bolster primary care education and encourage students to enter the field.

Meanwhile, on the legislative front, Rep. Jim McDermott, D-Wash., a psychiatrist and Navy veteran, has introduced legislation to boost the supply of primary care physicians. Through his RDOCs Act of 2012, full medical school scholarships would be offered in exchange for five years in public service after completing residency training.

The AMA Resident and Fellow Section has created an issue brief for residents seeking more information about the physician shortage.

Residents not practicing what they preach?

Maintaining your own health while proselytizing health to your patients might be one of the most difficult challenges of the resident lifestyle, as chronicled recently by Brian Secemsky, MD, the Huffington Post's residency blogger.

The "do as I say, not as I do" attitude comes with living under the pressure of a resident's schedule, combined with bad health habits picked up before training. Residents should remember they have a "personal responsibility for their well-being but also an obligation to their patients to engage in the same health behaviors they recommend," writes Dr. Secemsky.

Data supporting the need for better resident physician health come from a recent study showing residents are at a higher risk for a range of health concerns, including cardiac, mood and emotional issues.

An AMA toolkit can help physicians reflect on what steps they need to take to live a healthy life. Read more about what the AMA is doing to encourage physicians to live healthier. Also, learn about the International Conference on Physician Health, Oct. 25–27 in Montreal.

News and notes

• The AMA/AAMC GME Track resident/fellow survey is now open and ready for program directors to complete. Survey results are used to update the AMA's Physician Masterfile and estimate the future supply of physicians. Learn more.
• A review of studies on residency duty hour limits notes that the regulations' impact thus far on patient care and education are "mixed" (U.S. News and World Report).
• Is reform of resident physician duty hours a "moral imperative?" (KevinMD.com).
• The physician shortage may reach 130,000 by 2025 (Bloomberg Business Week).
• Quotable: "Increasing the output of medical students will do almost nothing to increase the number of practicing physicians. And understanding this is the key to understanding the problem of physician shortages" (Newsday).
• The NIH Loan Repayment Programs repay the student loans of researchers who conduct biomedical or behavioral research, up to $35,000 annually.
• Attend the 2012 Association for Hospital Medical Education (AHME) November Academy, Nov. 2 in San Francisco. View the agenda and register now.

AMA resources for you and your trainees

• View an archive version of our webinar on ways to expand and improve GME
• Check out our new recommendations on strategies to expand funding of GME
• Get trend data on undergraduate and graduate medical education
• Watch a YouTube video summary of the New Horizons in Medical Education conference
• Help your residents master the ACGME general competency requirements
• Learn more about patient safety in medical education
• Get updated information on medical licensure
• Obtain state-by-state GME data
• Get an updated copy of our GME glossary (email meded@ama-assn.org with "glossary" in subject line)

For more reading

• AMA medical education and professional ethics Twitter pages
• American Medical News
• Ending Disparities e-Letter