"Who's on Backup?"-Exploring Internal Medicine Residency Backup Coverage Systems: Findings from a National Survey

Area of Science:

• Medical Education
• Healthcare Administration
• Physician Workforce Management

Background:

• Backup coverage systems for resident physicians during acute absences are not well understood.
• Internal Medicine (IM) residency programs rely on these systems for continuity of care.

Purpose of the Study:

• To determine the prevalence and characteristics of backup coverage systems in US IM residency programs.
• To explore the challenges faced by program directors (PDs) in managing these systems.

Main Methods:

• A national cross-sectional survey was distributed to US IM program directors.
• Data were collected from 266 program directors and analyzed using inferential statistics and thematic analysis.

Main Results:

• Formal backup systems are utilized by over 90% of IM programs, with increased usage noted post-COVID-19.
• Coverage is prioritized for inpatient and ICU services, with less emphasis on primary care clinics.
• Key challenges include resource allocation, cultural shifts in absence reporting, and administrative burden.

Conclusions:

• Backup coverage systems are nearly universal in IM residency but are under significant strain.
• Program directors report issues including workload imbalances and prioritization of inpatient over primary care.
• System-level improvements are necessary to enhance the effectiveness and sustainability of backup coverage.