Effect of number of clinics and panel size on patient continuity for medical residents

Abstract

Background: Accreditation Council for Graduate Medical Education program requirements for internal medicine residency training include a longitudinal, continuity experience with a panel of patients.

Objective: To determine whether the number of resident clinics, the resident panel size, and the supervising attending physician affect patient continuity. To determine the number of clinics and the panel size necessary to maximize patient continuity.

Design: We used linear regression modeling to assess the effect of number of attended clinics, the panel size, and the attending physician on patient continuity.

Participants: Forty medicine residents in an academic medicine clinic.

Measurements: Percent patient continuity by the usual provider of care method.

Results: Unadjusted linear regression analysis showed that patient continuity increased 2.3% ± 0.7% for each additional clinic per 9 weeks or 0.4% ± 0.1% for each additional clinic per year (P = .003). Conversely, patient continuity decreased 0.7% ± 0.4% for every additional 10 patients in the panel (P = .04). When simultaneously controlling for number of clinics, panel size, and attending physician, multivariable linear regression analysis showed that patient continuity increased 3.3% ± 0.5% for each additional clinic per 9 weeks or 0.6% ± 0.1% for each additional clinic per year (P < .001). Conversely, patient continuity decreased 2.2% ± 0.4% for every additional 10 patients in the panel (P < .001). Thus, residents who actually attend at least 1 clinic per week with a panel size less than 106 patients can achieve 50% patient continuity. Interestingly, the attending physician accounted for most of the variability in patient continuity (51%).

Conclusions: Patient continuity for residents significantly increased with increasing numbers of clinics and decreasing panel size and was significantly influenced by the attending physician.