University of Nevada, Reno School of Medicine Office of Statewide Initiatives M. Tabor Griswold, PhD Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives https://med.unr.edu/statewide Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives https://med.unr.edu/statewide/reports Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Who Really Goes Into Primary WHO Really Goes Into Primary Care Who Really Goes Into Primary WHO Really Goes Into Primary Care? Study of University of Nevada, Reno School of Medicine Graduates 2005-2014 M. Tabor Griswold, PhD, Victoria M. Young , BS Location of Providers Active Licenses Background Nevada has a shortage of primary care physicians; medical schools often publicize their primary care graduation rate based on the residency choice of their graduates rather than their actual career upon entry into practice. Because so many physicians subspecialize during their residency, only using entry to residency rates dramatically overestimates a school’s primary care production. The University of Nevada, Reno School of Medicine (UNR Med) was asked to join in a multi-state study and these are the results of UNR Med nominal primary care residencies in 2005-2014 and these are the true primary care rates. Methods Residency match data from UNR Med was used to identify graduates from 2005-2014 who entered nominal primary care residencies. The residency choices used for primary care are Family Medicine, General Internal Medicine, and Pediatrics. This is consistent with the Institute of Medicine’s definition of primary care. From the match data it was determined that 98% of the nominal primary care graduates could be found via internet search three or more years after medical school graduation. We assessed their current practice environment or training status and re-classified them as either primary care or non-primary care. Results The UNR Med nominal primary care rate at time of graduation is 40.9 %. Upon completion of residency and entry into practice, 26.8 % actually practice primary care. The rate of actual entry into primary care practice ranges from 83.8% for Family Medicine graduates to 53.8 % for Internal Medicine graduates. The percentage of primary care graduates currently practicing in Nevada is 48.6% . Nominal Primary Care Output Based on Residency Program and Actual Entry into Primary Care Practice After Residency Completion Year Total Grads Number Percentage *Nominal *Actual Nominal Actual 2005 51 23 12 45.1 % 23.5 % 2006 53 17 9 32.1 % 17.0 % 2007 52 20 14 38.5 % 26.9 % 2008 48 11 41.7 % 22.9 % 2009 50 19 13 38.0 % 26.0 % 2010 54 35.2 % 20.4 % 2011 37.0 % 2012 55 31 24 56.4 % 43.6 % 2013 59 25 42.4 % 32.2 % 2014 18 42.6 % 33.3 % Total 530 217 142 40.9 % 26.8 % Conclusion & Future Direction Using residency choice over estimates UNR Med primary care output. At residency choice 40.9% of UNR Med of graduates report primary care as career choice, however, only 26.8% actually remain in primary care. The number of graduates from the UNR med who eventually enter careers in primary care is lower than residency choice at graduation. There is a clear difference between choice of a nominal primary care residency at medical school graduation and actual entry into primary care practice upon completion of residency. Recommendation for Medical Schools Use applicant characteristics known to predict future primary care to recruit and admit a larger portion of each incoming medical school class. Involve community based primary care providers early in the curriculum, including pre-clinical years as role models. Shift more clinical training into nonhospital outpatient clinics that demonstrate the value of primary care. Develop more primary care provider tracks within internal and pediatric programs. Recommendation for Graduate Medical Education Target more resources and training positions to Family Medicine which is the specialty most likely to produce primary care physicians in meaningful numbers. Develop Internal Medicine and Pediatrics programs that emphasize primary care. Advocate for state and federal graduate medical education funding to expand primary care residency in Nevada. Allocate more funds for loan forgiveness for primary care providers in Nevada. Primary Care Retention by Residency Program Residency Number Percentage Retained *Nominal *Actual Internal Medicine 93 50 53.8 % Family Medicine 74 62 83.8 % Pediatrics 30 60.0 % Total 217 142 65.4% *Nominal is residency choice *Actual is career upon entry into practice “Nominal” Primary Care definitions Included Excluded Family Medicine Transitional Year Internal Medicine Medicine-Emergency Internal Med Primary Medicine - Preliminary Pediatrics State of Residency and Retention in Nevada “Actual” Primary Care definitions Included Excluded Family Medicine Hospice/Palliative Care General Internal Medicine Hospitalists with >50% of time in hospital General Pediatrics Urgent Care Geriatrics Emergency Medicine Any Specialty of Internal Medicine Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide Contact: tgriswold@med.unr.edu or victoriay@nevada.unr.edu
Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives https://med.unr.edu/statewide/instant-atlas Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Office of Statewide Initiatives http://urbanobservatory.maps.arcgis.com/apps/Cascade/index.html?appid=f86499d99e4340b68229eaccfb02b29f Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide
Health Services Research Analyst Contact Information: M. Tabor Griswold, PhD Health Services Research Analyst University of Nevada, Reno School of Medicine Office of Statewide Initiatives Tgriswold@med.unr.edu 775.682.8475 Office of Statewide Initiatives University of Nevada, Reno School of Medicine https://med.unr.edu/statewide