Inpatient experience of family practice residents in a community hospital.

Decisions regarding residency training require repeated reevaluation of organization and curriculum. Developing an autonomous inpatient teaching service may become necessary in many community hospitals because of a new competitive environment. To predict the impact of this possible change in one community program, we performed a retrospective analysis of 2,735 admissions to a community hospital during a one-year period. Residents' cases were compared with those of practicing family physicians and general internists. If family practice residents in this hospital were limited to an autonomous service, their overall experience and management of patients would be comparable to practicing primary care physicians in the same community hospital. However, volume would be inadequate and exposure to certain types of problems and situations would be limited. In multivariable analysis age, payment status, total consultation rate, many diagnostic categories, and some specific diagnoses separate residents from practicing physicians. As a particular example, internists have a concentration of geriatric patients and patients with cardiovascular disease. In order to utilize this experience, family practice residents in this hospital cannot rely solely on an autonomous teaching service.