In a recent study, researchers set out to determine whether medical residents in family medicine are getting proper Medicare education and learning enough about the population to treat Medicare patients.

Changing geriatric population

The 2017 census indicates that by the year 2030, the number of people age 65 and older will be higher than the number below age 18 – 78 million versus 76.7 – for the first time ever. This change in demographics means so many things, but relevant to this discussion it means that the medical system must meet the new changes and be ready for them. The system will have to have in place more geriatricians, and more doctors and residents who are able to deal with the senior community. Hospitals will have to be updated with equipment that deals with heart attacks and strokes more than incubators and nurseries. And since this population is generally covered by Medicare, doctors, residents and other hospital faculty will have to be updated with Medicare education.

Are residents currently getting Medicare education?

A research team headed by Eric Poulin, MD, of the Mayo Clinic healthcare system in Minnesota, tackled the question in a study published in the medical journal Family Medicine in May 2019, entitled  “Essential Office Procedures for Medicare Patients in Primary Care: Comparison With Family Medicine Residency Training.”

Dr. Poulin explained that previous studies have sought to determine the level of Medicare education residents have through a typical question and answer format, but have not gone into checking the information on the ground. In this study, the authors compared procedures done in healthcare clinics to procedures done in family medicine residencies, with the study group and the control group demographically similar. They found that of 10 procedures measures, 8 of them were done at a lower rate in the residency clinics. This indicates that residents are not, in fact, getting the Medicare education that they should be getting to be prepared for the influx of seniors that they are likely to be seeing as patients when they finish residency.

The researchers studied all of the cases for the 10 procedures done and billed for, and found that in the healthcare system these procedures were performed and billed to Medicare, whereas in the residency clinics they were not performed nearly as frequently. Some of the procedures checked were wound debridement of skin; destruction of benign skin lesions; large joint injection; and insertion of bladder catheter. The only procedure equal in both groups was large joint injection, and skin excision was done at a higher rate in the residency clinic. In the 8 procedures, the rate was much lower than the control group – for example, nail care in the healthcare system group was 32.6, and in the residency group was 1.4.

The study authors suggest that the residents are not receiving Medicare education, and present some thoughts as to why. Dr Poulin asserts that “We’ve been in this slow slide toward training our residents to be coordinators of care rather than comprehensive providers of care – and some residents only know the former.” he also posits that this causes a shortage of doctors in rural areas, since being a doctor in a rural area requires the physician to be a comprehensive provider of care, and residents, who haven’t been trained that way, are fearful of making the jump.

He notes that during the residency, residents are focused on completing their coursework, and to get them to focus on learning all of the how-to, the residency program coordinators need to re-work their training. “Creating a learning environment where comprehensive care is encouraged and modeled will likely result in graduates who are able and willing to deliver this type of care.”

 

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