Correlation of Milestone Ratings and Family Physicians' Early Diabetes Management

Family physicians manage the treatment of patients with chronic illnesses like type 2 diabetes mellitus (T2DM). During residency, trainees are assessed on their management of chronic disease under the Accreditation Council for Graduate Medical Education patient care (PC) milestone. Residency programs are expected to ensure that trainees are prepared to meet patients' needs; however, evidence is mixed as to whether milestone evaluations predict how well a physician will perform in early unsupervised practice. This study tested whether higher PC milestone evaluations predict greater adherence to T2DM guidelines for early-career family physicians.

Using national provider identification numbers, we linked family medicine trainees' penultimate PC milestones with commercial insurance claims for T2DM patients. We associated doctors with patients by identifying the doctors who performed the evaluation and maintenance exams and observing the extent to which those patients received HbA1c, retinal, and renal functioning exams. We followed doctors who graduated in June 2016 through the first 18 months of unsupervised practice.

Milestones were not significantly associated with screening outcomes: HbA1c (OR=0.963, 95% CI [0.840, 1.104]), nephropathy (OR=0.983, 95% CI [0.901, 1.072]), or eye exam (OR=1.001, 95% CI [0.936, 1.070]). Rather, for every additional diabetes patient a family physician saw, administration of standard tests increased: HbA1c (OR=1.005, 95% CI [1.002, 1.009]) and nephropathy (OR=1.004, 95% CI [1.002, 1.006]).

Milestones for chronic disease management were not correlated with diabetes management for early career family physicians. The volume of diabetic patients under a doctor's care was positively correlated with levels of expected screenings.