An Analysis of Trainee Status of the Primary Care Physician and Ambulatory Care Outcomes

Abstract Purpose Prior studies report disparities in outcomes for patients cared for by trainees versus faculty physicians at academic medical centers. This study examined the effect of having a trainee as the primary care physician versus a faculty member on routine population health outcomes after adjusting for differences in social determinants of health and primary care retention. Method This cohort study assessed 38,404 patients receiving primary care at an academic hospital–affiliated practice by 60 faculty and 110 internal medicine trainees during academic year 2019. The effect of primary care practitioner trainee status on routine ambulatory care metrics was modeled using log-binomial regression with generalized estimating equation methods to account for physician-level clustering. Risk estimates before and after adjusting for social determinants of health and loss to follow-up are presented. Results Trainee and faculty cohorts had similar distributions of acute illness burden; however, patients in the trainee cohort were significantly more likely to identify as a race other than White (2,476 52.6% vs 14,785 38.5%, P < .001), live in a zip code associated with poverty (1,688 35.9% vs 9,122 23.8%, P < .001), use public health insurance (1,021 21.7% vs 6,108 15.9%, P < .001), and have limited English proficiency (1,415 30.1% vs 5,203 13.6%, P < .001). In adjusted analyses, trainee status of primary care physician was not associated with lack of breast cancer screening but was associated with missed opportunities to screen for colorectal cancer (relative risk RR, 0.77; 95% confidence interval CI, 0.68–0.88), control type 2 diabetes mellitus (RR, 0.78; 95% CI, 0.64–0.94), and control hypertension (RR, 0.80; 95% CI, 0.69–0.94). Conclusions Primary care physician trainee status was associated with poorer quality of care in the ambulatory setting after adjusting for differences in socioeconomic factors and loss to follow-up, highlighting a potential ambulatory training gap.