Geriatric education and practice of family practice graduates: An alumni survey

Background: The goal of this research was to study the relationship between family practice residency training in geriatrics and subsequent postresidency geriatric practice patterns. Methods: We surveyed all graduates of the University of Maryland Family Practice Residency Program through 1990 to determine their attitudes toward their geriatric training and the extent of their geriatric practice. Logistic regression analysis was used to identify factors associated with 1) making house calls, 2) making weekly nursing home visits, and 3) having a practice in which more than 25% of patients were older than age 65. Results: The responses of 143 graduates were analyzed. Most respondents (58.8%) made house calls, and the majority (51%) saw nursing home patients weekly. Older respondents and those possessing Certificates of Added Qualifications in Geriatric Medicine (CAQGMs) were more likely to treat patients older than age 65. Respondents with larger nursing home practices rated their geriatric training more favorably. Multivariate logistic regression analysis found that the following factors were associated with making house calls: working in a group family practice (odds ratio [OR] = 3.88, 95% confidence interval [CI] = 2.58-5.84) and a rural practice location (OR = 2.71, 95% CI = 1.77-4.17). Physicians who had additional training after residency (OR = 0.16, 95% CI = 0.10-0.25) were less likely to make house calls. Factors associated with making weekly nursing home visits were: additional training after residency (OR = 0.31, 95% CI = 0.19-0.50) and working in a group family practice (OR = 2.43, 95% CI = 1.63-3.65). Attainment of a CAQGM was the only factor associated with having more than 25% geriatric patients in the office practice (OR = 6.00, 95% CI = 2.72- 13.24). Conclusions: Most graduates of the University of Maryland Family Practice Residency Program maintain significant geriatric practices and value geriatric training, but whether favorable training experiences influence graduates' practices is unknown. Prospective studies of family practice residents are needed to clarify the influence of geriatric curricula on residents' future clinical practices.