1. 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

2. Office of Statewide Initiatives
Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

3. Office of Statewide Initiatives
Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

4. 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
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 and these are the true primary care rates.
Methods
Residency match data from UNR Med was used to identify graduates from 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
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5. Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

6. Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

7. Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

8. Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

9. Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

10. Office of Statewide Initiatives
Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

11. Office of Statewide Initiatives
Office of Statewide Initiatives
University of Nevada, Reno School of Medicine

12. 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
Office of Statewide Initiatives
University of Nevada, Reno School of Medicine