Despite the widespread belief that the U.S. medical education system produces superbly skilled clinicians, a recent survey of department chiefs from Kaiser Permanente reveals some surprising insights into challenges new doctors face in providing office-based care.

For the study, published in the November issue of Health Affairs, lead author Francis J. Crosson, senior fellow at the Kaiser Permanente Institute for Health Policy and director of public policy at the Permanente Medical Group, in Oakland, Ca., and colleagues asked heads of four clinical departments of the group, "If you had to name one characteristic missing in the average newly hired physician in your department in knowledge, skills, and professionalism (that is, values, attitudes, work habits), what would it be?"

Although most of the chiefs' reported shortcomings of new doctors, such as trouble coordinating care and managing patients' chronic conditions, came as little surprise to study authors, the most common concern they received via the email survey and follow-up interviews was one they did not expect, according to the report. "By far the most common concern ... was that newly trained physicians, especially those in pediatrics and obstetrics/gynecology, lacked certain technical skills that all physicians had if they had completed their residency 10 or more years ago," they wrote. In particular, new pediatricians were less adept at performing circumcisions, lumbar punctures, and placing difficult intravenous access lines, while OB/GYNs struggled with complex vaginal surgeries.

As with many of the competencies reported to be weak among new physicians, chiefs attributed part of the decline in this skill set to reduced resident work hours, leading to fewer opportunities for physicians to learn and practice such procedures during training. But when it came to technical skills, chiefs also blamed changes in technology for diminished skills among newer physicians in performing "open" (versus laparoscopic) procedures.

Those interviewed also blamed a growing emphasis on work-life balance on what they called a "shift work attitude" toward practicing medicine. According to one respondent, "Lifestyle is definitely a primary focus, and some view work as shift work with less of an interest in their patient as a whole."

According to study authors, most of the deficiencies reported by respondents can be mitigated though more group-practice experience for doctors as well as one-on-one mentoring with more experienced doctors. Difficulties that stem from generational differences in mindsets, however, may be more difficult to address, they wrote.

To learn more:
- read the study abstract from Health Affairs

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