The Organization of Academic General Internal Medicine Practice at the Top Primary Care Schools

Lisa Rotenstein; Jeanette Wong; Stacie Schmidt; Nancy LaVine; Julie Oyler; Urmimala Sarkar

doi:10.1007/s11606-024-09013-0

The Organization of Academic General Internal Medicine Practice at the Top Primary Care Schools

J Gen Intern Med. 2024 Oct 2. doi: 10.1007/s11606-024-09013-0. Online ahead of print.

Authors

Lisa Rotenstein¹, Jeanette Wong¹, Stacie Schmidt², Nancy LaVine³, Julie Oyler⁴, Urmimala Sarkar⁵

Affiliations

¹ University of California San Francisco, San Francisco, CA, USA.
² Emory University, Atlanta, GA, USA.
³ Northwell Health, New Hyde Park, NY, USA.
⁴ University of Chicago, Chicago, IL, USA.
⁵ University of California San Francisco, San Francisco, CA, USA. Urmimala.Sarkar@ucsf.edu.

PMID: 39356449
DOI: 10.1007/s11606-024-09013-0

Abstract

Background: While prior studies have explored staffing infrastructure for primary care practices in general, little is known about the range of academic primary care practice models and supports available for academic general internists.

Objective: To characterize the range of practice arrangements and expectations for attending academic physicians in general internal medicine (GIM) practices at the top 22 medical schools across the USA.

Design: Cross-sectional survey administered electronically between October 30, 2022, and December 28, 2022.

Participants: Clinical leaders in GIM at the top 22 primary care medical schools, as identified by the 2023 US News and World Report Rankings.

Main measures: Clinical load, productivity expectations, cross-coverage, and team-based care models.

Key results: Twenty-two leaders responded, representing 68% (15/22) of medical schools surveyed. The practices were mostly in urban locations (18/22, 82%) and 86% (19/22) included residents. Practices ranged from 7 to 200 PCPs and from 3 to 112 clinical FTEs. A full-time (1.0 FTE) clinical role for academic attending GIM physicians entailed a median of 9 (IQR 8, 10) weekly half-day clinic sessions, with a median panel size expectation of 1600 (IQR 1450, 1850) patients and a median yearly RVU expectation of 5200 (IQR 4161, 5891) yearly RVUs generated. Staff support was most commonly present for prescription refills and patient portal message checks. It was less commonly available for time sensitive form completion. Occasional clinical coverage for other physicians was an expectation at all practices.

Conclusions: In this study, we characterize the organization of and supports available in academic GIM practices affiliated with the top primary care medical schools. Our findings provide comparative information for leaders of academic GIM practices seeking to enhance primary care delivery for their faculty and trainees. They also highlight areas where standardization may be beneficial across academic GIM.

Keywords: Academic general internal medicine; Cross coverage; Practice models; Productivity expectations; Team-based care.