A Five Year Plan for Resident Clinic Transformation

There is a looming shortage of primary care doctors in the United States; a June 2021 AAMC report estimates a shortfall of at least 17,800 by 2034. To catch up, multiple points in the workforce pipeline must be targeted, including medical school admission, residency selection, and GME. But any viable solution must include attracting more internists to outpatient general medicine.

Internal medicine program directors have a huge influence on the general medicine workforce, because the quality of resident outpatient experience is a major factor in graduates choosing primary care. (Of course, for those residents who are fellowship-bound, excellent primary care training also lays the foundation for their office-based subspecialty careers.)

At our large community-academic hospital, we have substantially invested in our resident outpatient experience. We made deep changes to clinic structure, staffing, and scheduling, which has led to a revolution in the quality of patient care, resident experience, and staff morale.

Our work has had profound results: in 2017, we had 7% graduate entry into primary care, compared with 35% of graduates in 2021. Achieving this increase required a longer time horizon than most program innovations. We present a "five-year plan" for reimagining and reshaping a residency's outpatient internal medicine experience, using our institution as a model.