Identifying Gaps in Care Between a Fellow and Faculty Pulmonary Practice

RATIONALE: Academic medical centers have concurrent responsibilities to train clinicians and provide patient care, particularly for underserved populations, while remaining financially solvent. These priorities are not easily aligned and can incentivize workflows that perpetuate health disparities. While there are documented discrepancies in care delivery and patient satisfaction among trainee and faculty primary care clinics, it is unknown whether these disparities are present in medical subspecialty clinics. OBJECTIVES: We aim to analyze the quality of care metrics in a fellow-run and attending-run pulmonary clinic at a large academic medical center. METHODS: This is an observational mixed-methods study with balanced sampling between fellow and faculty clinics to ensure representation of marginalized populations. Patients completed a multi-component survey probing patient satisfaction and social desirability, as well as open-ended survey questions on treatment access and experience. Clinic metrics on vaccination rates, smoking cessation counseling, and lung cancer screening were abstracted from the electronic medical record. MEASUREMENTS & MAIN RESULTS: Both clinics delivered high patient satisfaction and clinical outcomes related to provider care and facility infrastructure. We note comparable adherence to quality metrics between fellow and faculty clinics. Patient satisfaction with clinic infrastructure and provider interactions did not differ by clinic or by race (P > .05 for all tests); however, Latiné participants, particularly primary Spanish speakers, reported more difficulty accessing their respective clinic (average = 4.83 out of 5; versus 4.33, P = .02). Qualitative analyses revealed three response themes: systemic barriers to care, minimization of lived experiences, and supportive or positive encounters. CONCLUSIONS: Despite infrastructure limitations in our trainee clinic, there were no significant differences in standards of care and patient satisfaction among fellow and faculty clinics were comparable. Further studies may elucidate gaps in patient experience and care delivery as experienced by patients and clinicians.