Primary Care Research

Use of time in outpatient residency training does not reflect the actual community practice of family physicians

How medical residents use their time during outpatient residency training does not reflect community practice, concludes a new study. It found that experienced family doctors provided more technical care and less preventive and psychosocially oriented care than residents. This may reflect differences in patient mix, practice setting, physician experience, and the time and financial pressures of community practice, explains Edward J. Callahan, Ph.D., of the University of California, Davis.

In a study supported in part by the Agency for Healthcare Research and Quality (HS08029 and HS06167), Dr. Callahan and his colleagues compared the use of time during 244 new adult outpatient visits to 92 family practice residents at a university clinic in California and 277 similar visits to 96 experienced family physicians in Ohio.

The researchers coded observed physician behaviors into 20 different categories that reflected different physician styles of interaction with patients. Physically examining the patient and taking their medical history formed the core of the visit for both groups. However, after controlling for differences in patient mix, residents had longer visits (mean of 33 vs. 13 minutes) and a less technical focus.

Residents spent a greater percent of the visit on efforts to promote health behavior change (27 vs. 22 percent) and patient activation—that is, listening to patients' questions or their view of their condition (15 vs. 12 percent), preventive services, (8 vs. 4 percent), discussion of substance abuse (6 vs. 4 percent), and counseling (2 vs. 1 percent). These differences may reflect the current emphasis of residency training on prevention and health promotion, as well as the divergent pressures of the community practice setting to focus on billable behaviors.

More details are in "Does time use in outpatient residency training reflect community practice?" by Dr. Callahan, Kurt C. Stange, M.D., Ph.D., Klea D. Bertakis, M.D., M.P.H., and others in the June 2003 Family Medicine 35(6), pp. 423-427.

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