Title

Eliminating Barriers for Our Own: An Inclusive Approach to Ensuring Access to Primary Care for Medical Trainees

Authors

Alexandra Johnston, DO, Sana Khan MD, Sharon Aufman, Pamelasue Kozlowski Medicine Institute, Allegheny Health Network, Pittsburgh, PA

Introduction

Despite the proximity to the healthcare system, access to primary care for medical residents is a challenge. Physician trainees access primary care and psychological healthcare at a lower rate than age matched peers. A recent study showed that 37% of residents reported that they did not have a primary care provider (PCP) and in other studies this number was approached 50%. These figures highlight the importance of systemic initiatives to facilitate trainee access to healthcare.

Methods

An exploratory analysis was conducted at a one hundred resident internal medicine residency program to assess the rate of current residents that report having established with a PCP in the area. An electronic survey was sent to newly matched residents prior to starting residency inquiring about their desire to establish with a PCP in the area in addition to a list of providers that would not precept or evaluate them during their training. Prior to orientation, the incoming residents’ schedules were reviewed and preferred appointment dates were identified for each resident. During orientation, scheduling representatives met with each incoming resident, and utilizing the program provided availability and resident preferences, scheduled each new resident for a PCP appointment. Residents were provided protected time from work to attend their appointment.

Results

The incoming PGY1 class consisted of 42 residents and 38 of these residents attended orientation. Of the 38 residents who attended orientation, 35 (92%) had a PCP appointment scheduled during orientation. Three of the 42 residents indicated that they already had a PCP in the area. Of 48 current residents surveyed at the end of the prior academic year only 56% of the current residents surveyed had an established PCP in the area and only 64% had established with a PCP by the end of their 3 years of residency. The top 3 barriers (>1 could be selected) to establishing with a PCP were work schedule (39%), lack of time (35%), and lack of appointment availability (25%).

Conclusion

Medical trainee wellness is impacted by health system factors and individual factors. This initiative created a systemic workflow improvement that provided trainees with access to primary care appointments and prioritized their health and wellness immediately upon arrival to their training program. Survey data, which identified the most relevant barriers to establishing with a PCP, guided the intervention. This initiative showed that trainees may be receptive to opportunities to establish with a PCP in the area of their residency program when barriers are eliminated and access to care is made available. Barriers to establishing care with a PCP such as lack of time, availability of appointments, and work scheduling conflicts are issues that must be addressed on a systemic rather than individual level to optimize outcomes. This intervention resulted in 92% of orientation attendees and 83% of incoming residents overall utilizing the provided scheduling services. Components of the program that we found to be critically important were identification of barriers to appointment scheduling, identifying providers external to the training program, and protecting work time for residents to attend appointments.

References

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