Transitioning Primary Care From Residents to Attendings – A Possible Solution to Address Inequities in Care at Resident Clinics Running Title: Improving Resident PCP Transitions of Care

Why It Matters

Standardizing resident‑to‑attending transfers could reduce care gaps for high‑complexity patients and improve continuity, ultimately enhancing clinical outcomes across teaching hospitals.

Key Takeaways

• 1.5% of patients recommended for attending transfer
• 46% of transfer requests initiated by patients
• Medicare coverage and complexity drive transfer recommendations
• High‑risk patients less likely to request transfer
• Resident confidence in transfer decisions remains low

Pulse Analysis

The annual turnover of resident primary‑care physicians creates a hidden churn in outpatient continuity, exposing up to 600,000 patients to fragmented care. While teaching hospitals excel at training, the hand‑off process often lacks a systematic safety net, leading to measurable declines in preventive screening, medication adherence, and chronic disease control. By introducing a structured pathway that flags patients for attending‑physician oversight, institutions can proactively address the inequities that arise when inexperienced clinicians inherit complex panels without adequate support.

The pilot study from a large academic clinic reveals that only a modest 1.5% of the resident panel was earmarked for attending transfer in 2024, yet nearly half of those moves were patient‑driven. Medicare enrollment and higher medical complexity emerged as the strongest predictors, suggesting that financial risk and clinical burden motivate both patients and residents to seek more seasoned oversight. Conversely, the most high‑risk individuals were less likely to request a change, underscoring a paradox where those who might benefit most remain under‑served. Residents also expressed limited confidence in their referral judgments, pointing to gaps in training and decision‑making frameworks.

These findings signal an urgent call for standardized education and decision‑support tools that help residents identify candidates who would gain from attending continuity. Implementing clear criteria—such as comorbidity scores, social determinants, and insurance status—could streamline referrals and ensure equitable access to experienced primary‑care providers. As teaching hospitals adopt such models, they stand to improve patient outcomes, reduce readmissions, and set a benchmark for nationwide primary‑care transition practices.