Presented at the 2012 AAPM Annual Meeting « Back

Patient Satisfaction with Residents Versus Attending Physician Following Fluoroscopy-Guided Pain Injections

Mohammed A. Issa, MD, drissa80@hotmail.com, Yale School of Medicine, Morgantown, West Virginia

Introduction: Patient satisfaction has been the object of interest in health care for some time, and is now increasingly used as the basis for quality management and improvement. Design: Retrospective Cohort Study Setting: University-based Pain Management Center. Methods: Study was approved by West Virginia University IRB. Injections were performed over a 3-month period by one staff physician and three senior residents. Results: A total of 242 patients underwent fluoroscopy-guided injections; 125 (52%) performed by an attending physician and 117 (48%) by resident physicians. Of the resident performed procedures, 48% reported "as expected," 31% "better," and 21% "worse" than expected. Of the attending performed procedures, 50% reported "as expected," 42% "better," and 8% "worse." Residents had longer mean table time (2.95 min versus 1.92 min) and fluoroscopy time (30.2 sec versus 21.7 sec) compared to attendings (p<0.0001). Patients of attending physician were more likely to be satisfied than patients of residents (likelihood ratio [LR], 9.9; p=0.007). However, further analysis showed similar average attending and resident mean table and fluoroscopy times in patients reporting "worse" or "better" perception of their performed procedure. Conclusions: Patient satisfaction is lower with residents as compared to attending physician. Patient perception correlated with table time regardless of the performing physician. The fluoroscopy time likely represents the skills of the performing physician as well as the difficulty of the procedure and correlated proportionally with the overall table time. References: 1)Matthews DA, Sledge WH, Lieberman PB. Evaluation of intern performance by medical inpatients. Am J Med 1987;83: 938–944 2)Sheets KJ, Caruthers BS, Schwenk TL. Patients satisfaction with gynecologic care provided by family practice resident physicians. Fam Pract Res J1991;11:421–428. 3)Tamblyn R, Benaroya S, Snell L, et al. The feasibility and value of using patient satisfaction ratings to evaluate internal medicine residents. J Gen Intern Med 1994;9:146–152 4)Bialor BD, Gimotty PA, Poses RM, Fagan MJ. The effect of primary care training on patient satisfaction ratings. J Gen Intern Med 1997;12:776–780 5)O’Malley PG,Omori DM, Landry FJ, et al. A prospective study to assess the effect of ambulatory teaching on patient satisfaction. Acad Med 1997;72:1015–1017 6)Wachter RM, Katz P, Showstack J, et al. Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education. JAMA 1998;279:1560–1565 7)Wells RD,Dahl B,Nilson B. Comparison of the levels of quality of inpatient care delivered by pediatrics residents and by private community pediatricians at one hospital.AcadMed 1998;73: 192–197 8)Frank SH, Stange KC, Langa D, et al. Direct observation of community-based ambulatory encounters involving medical students. JAMA 1997;278:712– 6 9)Kirz HL, Larsen C. Costs and benefits of medical student training to a health maintenance organization. JAMA 1986; 256:734 –9 10)MacGregor, F. C. Patient dissatisfaction with results of technically satisfactory surgery. Aesthetic Plast. Surg. 5: 27, 1981

Funding: None