Perceived Access and Appropriateness: Comparison of Teaching and Resident Family Physicians' Patients

Teaching clinics aim to provide patients with care that is comprehensive, high quality, and timely. Since resident presence at the clinic is irregular, timely access to care and continuity remain challenging. The two main objectives of our study were to compare the experience of timely access by patients of family residents vs staff and to determine if there was a difference between resident and staff patients in reported appropriateness and patient-centeredness of the visit.

This cross-sectional survey study was carried out in nine family medicine teaching clinics part of University of Montreal and McGill University Family Medicine Networks. Patients self-administered two anonymous questionnaires, before and after their consultation.

We collected 1,979 preconsultation questionnaires. Teaching physician (staff) patients rated the usual wait time for an appointment as very good or excellent more frequently than resident patients (46% vs 35 %; P=.001). One out of five reported consulting another clinic in the last 12 months. Resident patients consulted elsewhere more often. In postconsultation questionnaires staff patients rated their visit experience better than resident physician patients and patients of second-year residents better than first-year residents.

Although patients generally have a positive perception of access to care and adequacy of the consultations meet their needs, staff also face the challenge of providing better access to their patients. Finally, we found the patients' perceived visit-based patient centeredness was higher for visits of second-year than first-year resident physicians, supporting the impact of training efforts toward patient-centered best practices.