title: Directors Recognize Difficulties in Providing Medical Care to Residents But Few Implement Policies to Address Them.
abstract: OBJECTIVE
  Residents find it difficult to access medical care. Some seek care within their own program. Our objectives were to (1) determine whether family medicine program directors see their own resident physicians as patients, (2) describe whether they perceive the residency culture as actively encouraging of this practice, and (3) assess perceptions about reasons to encourage or discourage this.
  
  
  METHODS
  We used a paper-based self-administered survey November 2013--January 2014. A stratified random sample of family medicine residencies based on administrative type was used. Participants were directors of sampled programs. The main outcome measure was provision of medical care to resident physicians.
  
  
  RESULTS
  A total of 137/250 directors (55%) responded. Thirty (22%) reported seeing residents as patients in their family medicine clinic while 107 did not (78%). Some directors who do see resident patients expressed discomfort in doing so (24%). Participants reported that other faculty physicians were significantly more likely to see residents (56%). Eighty-eight percent (114/129) agreed that "Having a doctor-patient relationship with a resident makes a supervisory relationship more difficult." Significant differences in attitudes were noted between directors who do and do not provide resident medical care. Few directors (10 %) agreed that their residency culture actively encouraged residents to establish doctor-patient relationships with faculty physicians. Only 16 (12%) had created written policies.
  
  
  CONCLUSIONS
  It is uncommon for directors to see residents as patients, but most who do feel comfortable with it. Other faculty physicians provide care more frequently. Directors acknowledge potential difficulties with this practice, but few have addressed these issues by creating specific policies.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Scottsdale, AZ.
authors.forename: Michael
authors.initials: M
authors.lastname: Grover
authors.forename: Frederick
authors.initials: F
authors.lastname: Edwards
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Chang
authors.forename: Michael
authors.initials: M
authors.lastname: Bryan
authors.forename: Kristina
authors.initials: K
authors.lastname: Diaz
authors.forename: Molly
authors.initials: M
authors.lastname: Kresin
authors.forename: Carolyn
authors.initials: C
authors.lastname: Moats
authors.forename: Richard
authors.initials: R
authors.lastname: Engle
mesh_terms: D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D016134:Organizational Policy; D008486:Physician Executives; D011795:Surveys and Questionnaires; D014481:United States