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COMMENTS AND OPINIONS
Even More to Do and Even Less Time: Resident Education and the Future of Primary Care—Reply
Kevin Fiscella, MD, MPH;
Ronald M. Epstein, MD
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In reply
Kleczek and Baumert make 2 related and important points. They argue that residency work environment affects trainees' decisions to enter primary care and that residency training should reflect future practice. We agree on both counts. Residency training sites serve large numbers of poor, minority, and uninsured patients, and faculty are dedicated to insuring high-quality care. Yet, despite increasingly early exposure to patients and faculty, fewer students and residents pursue careers in primary care and even fewer work with underserved patients.1
This paradox may result from a hidden curriculum that undermines the very skills and values that faculty aspire to teach. Trainees often witness 2-tier systems of care where affluent patients are cared for by faculty in "private" practices, while patients with Medicaid or no insurance are seen in crowded, understaffed resident clinics. Time and resource constraints force trainees to "make . . . [Full Text of this Article]
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RELATED ARTICLE
So Much to Do, So Little Time: Care for the Socially Disadvantaged and the 15-Minute Visit
Kevin Fiscella and Ronald M. Epstein
Arch Intern Med. 2008;168(17):1843-1852.
ABSTRACT
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RELATED LETTER
Even More to Do and Even Less Time: Resident Education and the Future of Primary Care
Julie Kleczek and Heidi Baumert
Arch Intern Med. 2009;169(13):1244.
EXTRACT
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