Identifying Gaps in Care Between a Fellow and Faculty Pulmonary Practice.

Area of Science:

• Academic Medicine
• Health Disparities Research
• Pulmonary Medicine

Background:

• Academic medical centers balance clinical training, patient care for underserved populations, and financial viability, which can perpetuate health disparities.
• While differences in care quality exist between trainee and faculty primary care clinics, such disparities in subspecialty clinics remain understudied.

Purpose of the Study:

• To compare quality of care metrics between fellow-run and attending-run pulmonary clinics at an academic medical center.
• To investigate patient satisfaction and access to care in these distinct clinical settings.

Main Methods:

• An observational, mixed-methods study with balanced sampling across fellow and faculty clinics.
• Patient surveys assessed satisfaction, social desirability, treatment access, and experiences.
• Electronic health records provided data on vaccination rates, smoking cessation counseling, and lung cancer screening.

Main Results:

• Both fellow and faculty clinics demonstrated high patient satisfaction and comparable adherence to quality metrics.
• No significant differences in satisfaction were found based on clinic type or race.
• Hispanic patients, especially primary Spanish speakers, reported greater difficulty accessing care (P=.02).

Conclusions:

• Trainee and faculty pulmonary clinics offer comparable standards of care and patient satisfaction, despite potential infrastructure differences.
• Systemic barriers and challenges in care access, particularly for specific linguistic and ethnic groups, warrant further investigation.
• Future research should focus on patient and clinician-reported experiences to identify and address care delivery gaps.