Overview

To support physician wellness, an academic medical center created a concierge scheduling service with telehealth options for medical trainees, improving their perception of  healthcare access and providing a convenient solution for receiving medical care.

Organization Name

Duke Graduate Medical Education, in partnership with Duke Primary Care

Organization Type

• Academic Medical Center

National/Policy Context

• Improving Trainee Wellbeing: 
  • The unpredictable hours, challenging demands, and overall intensity of residency training programs deleteriously impact trainee wellbeing. 
  • Moreover, burnout leads to increased rates of medical error, drug abuse, and suicidal ideation amongst physicians and physician trainees. 
  • As a result, the Accreditation Council for Graduate Medical Education (GME) identified physician wellness as a critical component to its Common Program Requirements. 
    • The requirements increase emphasis on behavioral and mental health.
  • Physician trainees still comment on the difficulty in obtaining routine primary care. 
    • Their most commonly identified barriers to care include challenging work schedules, privacy issues, and a perceived lack of support from residency programs.  
• Simplifying points of entry to primary care: 
  • The demands of GME training inhibit residents from accessing primary care.
  • Telehealth was recognized as a possible solution for simplifying points of entry to care. 
    • While research supports that telehealth improves patient experiences and decreases time spent seeking and receiving care, there is no data that considers the impact of telehealth on medical trainees.

Local/Organizational Context

• The institution long recognized the need to improve access through broadened care options for trainees, their children, and spouses. 

Patient Population Served and Payor Information

• Duke Medical Center is an academic medical center located in central North Carolina. It has more than 160 residency and fellowship training programs, with over 1000 trainees:
  • Male: 54%; Female: 46%
  • Married: 42%; Single: 58%

Leadership

• Primary care clinical leaders
• GME leaders

Funding

• Duke Institute for Health Innovation (DIHI) – 2018 Innovation Award

Research + Planning

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Tools or Products Developed

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Training

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Tech Involved

• Electronic medical record
• Redcap
• Video conferencing

Team Members Involved

• Administrative Assistant
• Physicians
• Primary Care Physicians
• Program staff
• Support Staff

Workflow Steps

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Budget Details

• Operating and developing a concierge scheduling line
• Opening up PCP schedules to allow for video visits
• Setting up a telehealth platform set up
• Salary for an administrative fellow/support staff

Where We Are

• The scheduling line remains open and now trainees are able to schedule appointments with specialty providers (i.e., pediatrics and OB/GYN). The COVID-19 pandemic accelerated the use of telehealth.

Outcomes

• While there was a statistically significant increase in the number of trainees requesting more access to primary care, there was no statistically appreciable change in the proportion of trainees who actually sought out and received care. 
• Trainees reported decreased barriers and delays to accessing care.
• A total of 142 calls to the concierge line were available for analysis and 111 appointments were scheduled, of which 0.1% (11) were for family members.
  • 87% of callers (127) requested an appointment; of these, 10% (15) of callers requested a video appointment. Of those requesting a clinic appointment only, 80% (99) were actually scheduled. 
    • Most often, if a call didn’t result in an appointment it was because trainees called seeking care outside of primary care.

Future Outcomes

• The innovators aim to increase access to specialty care clinics (see “Current Status”), and continue identifying and addressing other perceived barriers to care access. 

Benefits

• Approximately 15% of all trainees accessed the concierge scheduling line, demonstrating that the service met a large demand.
• Trainees’ perception of care access improved even though the amount of care they sought did not significantly increase. Just knowing that there is enhanced access to primary care can enhance overall trainee mindset and morale, which are critical to wellbeing. 
  • Additionally, the single point of entry for scheduling an appointment simplified the process for attaining primary care.
• At this time, there are no other institutions in the country that offer comparable programs.

Unique Challenges

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Glossary

• REDCap: secure web application for building and managing online surveys and databases.

Sources

• Tan, C., Kuhn, C., Anderson, J., Borun, A., Turner, D. A., Whalen, K., & Shah, K. (2020). Improving Well-Being Among Trainees: A Partnership to Reduce Barriers to Primary Care Services. Journal of Graduate Medical Education, 12(2), 203-207.
• About Us. Duke Graduate Medical Education. Retrieved May 16, 2020 from: https://gme.duke.edu/about