When looking at measures of primary care quality, resident physicians provide nearly equivalent care as attending physicians in US Department of Veterans Affairs (VA) primary care clinics, according to a letter published in JAMA Internal Medicine.

In the study, researchers evaluated the quality of outpatient care with internal medicine resident physicians vs attending physicians. A total of 10 geographically diverse VA medical centers affiliated with internal medicine residencies were examined as part of an evaluation of the Centers of Excellence in Primary Care Education. Patients who had ≥1 primary care visit in 2014 were seen in teaching primary care clinics at each site (N=76,392). They were assigned to either a resident physician (n=19,324) or attending physician (n=57,068). Researchers collected demographical characteristics and information about comorbidities, quality of care, and health service utilization measures. Outcomes of interest were measures of diabetes (eg, annual glycated hemoglobin testing); renal testing; hypertension control; use of high-risk medication in patients >65 years of age; emergency department visits; and hospitalizations, including all-cause hospitalizations and from ambulatory care-sensitive conditions.

Patients of resident physicians had a higher mean comorbidity score than patients of attending physicians (14.1±16.1 vs 12.5±15.1; P <.001). Between the 2 groups, diabetes quality-of-care measures were similar, but patients of residents were more likely to have appropriate renal testing (0.85 [95% CI, 0.82-0.87] vs 0.82 [95% CI, 0.79-0.84]; P =.001). Patients of residents were less likely than patients of attending physicians to have controlled hypertension (0.6 [95% CI, 0.57-0.64] vs 0.63 [95% CI, 0.6-0.67]; P =.02). Patients of residents were less likely than patients of attending physicians to be prescribed high-risk medications (0.23 [95% CI, 0.22-0.25] vs 0.27 [95% CI, 0.26-0.29]; P <.001). Emergency department visits were higher among patients of residents than patients of attending physicians (0.35 [95% CI, 0.32-0.38] vs 0.34 [95% CI, 0.3-0.37]; P <.001).

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The limitations of this work included there being only VA-specific context with the analysis of only VA data.

Through this research, the researchers confirmed the findings of previous studies that have demonstrated that primary care treatment provided by resident physicians is similar to that provided by attending physicians. More research is needed to elucidate how resident physicians perform more complex primary care functions.


Edwards ST, Kim H, Shull S, Hooker ER, Niederhausen M, Tuepker A. Quality of outpatient care with internal medicine residents vs attending physicians in Veterans Affairs primary care clinics [published online April 1, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.8624