Journal of General Internal Medicine

, Volume 34, Issue 7, pp 1184–1191 | Cite as

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

  • Utibe R. EssienEmail author
  • Wei He
  • Alaka Ray
  • Yuchiao Chang
  • Jonathan R. Abraham
  • Daniel E. Singer
  • Steven J. Atlas
Original Research



Outpatient primary care experience is vital to internal medicine resident training but may impact quality and equity of care delivered in practices that include resident physicians. Understanding whether quality differences exist among resident and staff primary care physicians (PCPs) may present an opportunity to address health disparities within academic medical centers.


To determine whether there are differences in the quality of primary care provided by resident PCPs compared to staff PCPs.


A retrospective cohort study with a propensity-matched analysis.


143,274 patients, including 10,870 patients managed by resident PCPs, seen in 16 primary care practices affiliated with an academic medical center.

Main Measures

Guideline-concordant chronic disease management of diabetes (HbA1c, LDL) and coronary artery disease (LDL), preventive breast, cervical, and colorectal cancer screening, and resource utilization measures including emergency department (ED) visits, hospitalizations, high-cost imaging, and patient-reported health experience.

Key Results

At baseline, there were significant differences in sociodemographic and clinical characteristics between resident and staff physician patients. Resident patients were less likely to achieve chronic disease and preventive cancer screening outcome measures including LDL at goal (adjusted OR [aOR] 0.77 [95% CI 0.65, 0.92]) for patients with coronary artery disease; HbA1c at goal (aOR 0.73 [95% CI 0.62, 0.85]) for patients with diabetes; breast (aOR 0.56 [95% CI 0.49, 0.63]), cervical (aOR 0.66 [95% CI 0.60, 0.74]), and colorectal (aOR 0.72 [95% CI 0.65, 0.79] cancer screening. Additionally, resident patients had higher rates of ED visits and hospitalizations but lower rates of high-cost imaging. Resident patients reported lower rates of satisfaction with certain access to care and communication measures. Similar outcomes were noted in propensity-matched sensitivity analyses.


After controlling for differences in sociodemographic and clinical factors, resident patients were less likely to achieve chronic disease and preventive cancer screening outcomes compared to staff patients. Further efforts to address ambulatory trainee education and primary care quality along with novel approaches to the management of the disproportionately disadvantaged resident patient panels are needed.


resident primary care quality racial and ethnic disparities medical education 



The authors would like to thank Ethan Lennox, MA, for his assistance in the preparation of this manuscript.


Utibe R. Essien’s role in the research reported in this publication was supported by the National Research Service award grant T32 HP10251.

Compliance with Ethical Standards

The Institutional Review Board at Partners Healthcare approved this study.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_4960_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 23.4 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Utibe R. Essien
    • 1
    • 2
    Email author
  • Wei He
    • 3
  • Alaka Ray
    • 4
    • 5
  • Yuchiao Chang
    • 3
    • 5
  • Jonathan R. Abraham
    • 3
  • Daniel E. Singer
    • 3
    • 5
  • Steven J. Atlas
    • 3
    • 5
  1. 1.Division of General Internal Medicine University of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA
  3. 3.Division of General Internal MedicineMassachusetts General HospitalBostonUSA
  4. 4.Department of MedicineMassachusetts General HospitalBostonUSA
  5. 5.Harvard Medical SchoolBostonUSA

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