Residents and Attending Physicians Provide the Same Quality of Care, Study

Internal medicine residents provided patients of the U.S. Department of Veterans Affairs with a similar quality of outpatient care to that provided by attending physicians, according to a research letter published in JAMA.



“Concerns persist that care provided by resident physicians is of lower quality than that provided by more experienced attending physicians,” Samuel T. Edwards, MD, MPH, of the VA Portland Health Care System, Oregon, and colleagues wrote. “In this large, national study using electronic health record-based measures, we found that residents provide access for new patients and play an important role in caring for vulnerable patient groups with complex care needs.”

To compare the quality of outpatient care provided by internal medicine residents and attending physicians, researchers identified 76,392 patients (mean age, 62.3 years; 90.6% men; 72.1% white) at 10 geographically diverse VA medical centers, separating patients by whether they were assigned to a resident physician (n = 19,324) or an attending physician (n = 57, 068).

Outcome measures — including those related to diabetes care quality, annual renal testing, use of a high-risk medication in patients older than 65 years, hypertension control, ED visits and hospitalizations — were then compared between the two groups.

Researchers noted that residents cared for a greater proportion of younger, female and black patients. Patients of resident physicians also had a higher mean comorbidity score, were more likely to have substance use disorders and were under VA care for less time than patients of attending physicians.

After adjusting for these factors, researchers found that diabetes quality-of-care measures were similar between patients of residents and attending physicians.

Researchers also found that patients of residents were more likely to have appropriate renal testing (difference of 3.2 percentage points; P = .001) but were less likely to have controlled hypertension (difference of 2.9 percentage points; P =.02).

In addition, researchers observed that while older patients of residents were slightly more likely to have at least one ED visit in 2014 (difference of 1.3 percentage points; P < .001), they were less likely to be prescribed high-risk medications (difference of 4.2 percentage points; P < .001).

“Current measures of primary care quality are limited and typically focus on disease-specific process measures and short-term outcomes,” the researchers wrote. “However, according to these measures, residents appear to be providing near-equivalent care to attending physicians. More investigation is needed to understand how residents perform more complex primary care functions, such as integrating and prioritizing patient needs and delivering coordinated, whole-person, relationship-based care.” – by Melissa J. Webb

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