Transitioning primary care from residents to attendings – an approach to address challenges in care during the academic year transition

Abstract

Internal medicine residents provide primary care to a panel of patients. Annually, 600,000 patients are assigned new resident primary care physicians (rPCPs) when their current rPCP graduates. At our academic resident and faculty primary care practice, all rPCPs review their panels annually and can recommend transfer of patients to aPCPs. We sought to understand demographic and clinical factors associated with patients recommended for aPCP transfer and disseminate a workflow for other academic practices. We conducted a retrospective chart review of patients recommended for aPCP transfer in 2024 to understand characteristics associated with transfer recommendation. We conducted a survey of rPCP attitudes regarding transfer. A small amount ( n = 63/4332, 1.5%) of patients were recommended for attending transfer. Almost half ( n = 29/63, 46%) of the transfer requests were patient-initiated. Patients were more likely to be recommended for transfer to an aPCP based on Medicare insurer, older age, and medical complexity. rPCP perceived “high-risk” status was most strongly associated with transfer recommendation. Overall, rPCP confidence in their recommendations was low. rPCPs identified a small number of high complexity patients for aPCP transfer, which may make this process feasible for clinics with limited capacity on aPCP panels. Patient-initiated transfer requests were common yet comprised a lower proportion of high-risk patients than rPCP initiated requests. A standardized process providing patients the opportunity to request transfer may offer a more equitable approach. rPCP confidence in these recommendations was low, emphasizing the importance of rPCP education and guidance in considering who may benefit from aPCP transfer.