American Academy of Family Physicians

Educational debt among physicians is growing and contributes to burnout symptoms. Work hours have been associated with burnout symptoms among medical learners and early-career physicians. It is not known if medical debt is directly associated with increasing work hours among early-career family physicians. We created a longitudinal cohort of family physicians who were 3 years into their career using data from the American Board of Family Medicine. We assessed whether educational debt at the time of residency graduation was correlated with hours worked and with burnout symptoms at this career stage. Logistic regression analysis was used to determine if educational debt level and hours worked per week were independently associated with burnout symptoms. Among 4,905 early-career family physicians,17.8% had no educational debt while 16.2% had more than $350,000 of debt. Educational debt was positively correlated with mean hours worked per week (P = .002) and with burnout symptoms (P <.001). Also, mean hours worked per week were positively correlated with burnout symptoms (P <.001). In adjusted logistic regression analysis, family physicians had elevated odds of burnout if they had educational debt of $250,000 to $350,000 (adjusted odds ratio = 1.24; 95% CI, 1.01-1.51) and greater than $350,000 (adjusted odds ratio = 1.47; 95% CI, 1.19-1.82) as compared with no debt. Their odds of burnout symptoms also increased with work hours (adjusted odds ratio = 2.87; CI, 2.40-3.44 for ≥60 hours vs <40 hours weekly). Among early-career family physicians, those with higher educational debt worked more hours. Both educational debt and work hours were independently associated with symptoms of burnout. Reducing educational debt may help prevent burnout symptoms and their downstream consequences.

The Women's Preventive Services Initiative (WPSI) expanded its previous breast cancer screening recommendation-initiate annual or biennial mammography screening for women at average risk of breast cancer between the ages of 40 and 50 years-by including additional imaging and pathology evaluation as part of the screening process if needed. Consistent with the previous recommendation, screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. To increase utilization of screening recommendations, the WPSI also issued a new recommendation to provide patient navigation services for breast and cervical cancer screening. To update its 2016 breast cancer screening recommendation, the WPSI found no new evidence of benefits and harms of screening. However, additional studies reported that gaps in insurance coverage contributed to incomplete follow-up after an initial abnormal mammogram for many women. For its new patient navigation recommendation, the WPSI evaluated 42 randomized controlled trials of patient navigation services for breast and cervical cancer screening and follow-up that showed increased rates compared with usual care. Patient navigation services involve person-to-person contact and are individualized to the patient's specific needs. Services include but are not limited to person-centered assessment and planning, health care access and health system navigation, referrals to support services, and patient education. The new recommendations are intended to expand breast cancer screening follow-up and to improve access and equity for cancer screening. Beginning in 2026, under the Affordable Care Act, these services will be covered without copay or deductible charges for most eligible women.

International medical graduates (IMGs) are a quarter of US practicing physicians and residents, with higher numbers in family medicine. Our objective was to determine whether the progression of milestone ratings varies between IMGs and US medical graduates based on a residency's historical percentage of IMGs. Data, which were all from the American Board of Family Medicine, included milestone ratings of each family medicine graduate from 2018 to 2020. We calculated the mean milestone rating for each core competency at each assessment. The main exposure was the 10-year percentage of residency graduates who were IMGs: very low (&lt;10%), low (10%-33%), medium (34%-66%), and high (67%-100%). We used repeated measures multilevel regression to test for adjusted associations of resident and residency characteristics with milestone performance. Interactions between IMG status and historical percentage of IMGs tested for differential milestone growth. Our sample included 12,302 residents from 538 residencies. Of the family medicine residencies, 41.8% had less than 10% IMGs. Across milestones, mean growth between rating periods ranged from 0.46 to 0.54. In adjusted regression analysis, both being an IMG (β=-0.003 to -0.07) and training in a higher historical IMG residency (β=-0.01 to -0.08) were associated with lower milestone ratings. IMGs in high IMG programs had higher ratings for medical knowledge and professionalism (β=0.07). We found comparable milestone ratings between IMGs and US medical graduates, with IMGs getting a small boost if they were trained in a program with a higher percentage of IMGs. Our results demonstrate that the performance of IMGs may be enhanced in residencies with a history of acculturating them.

Physician workforce shortages are expected to reach 48,000 primary care physicians by 2034 with burnout, discrimination (gender, race, and others), and harassment as contributors. Physicians experience discrimination and harassment on a daily basis and continue to work with patients who routinely discriminate against them, which can be directly related to burnout. The American Academy of Family Physicians (AAFP) created the Leading Physician Well-Being Certificate Program to combat these issues. Surveys were sent to cohorts at multiple time points - beginning, middle, and end. Multiple evaluation instruments were included in these surveys, but for this analysis, we focused on the Everyday Discrimination Scale (EDS). For Cohort 1 (n = 88, 2021), they received the EDS midway through their cohort. For Cohort 2 (n = 62, 2022), they received the EDS at each time point, but received a Privilege Assessment midway through their cohort due to their answers on the EDS. Cohort 1 consistently rated the questions with higher levels of discrimination than Cohort 2 scholars. In general, Asian women from Cohort 1 experienced the most discrimination of all the groups (7 statements). For the Privilege Assessment, Asian and other women of color were more likely to indicate less privilege than other groups. Physicians taking the AAFP Leading Physician Well-Being Certificate Program reported have experienced discrimination and harassment. Certain physician groups experience higher levels of discrimination and harassment, and concurrent lower levels of privilege. While unfortunate, discrimination and harassment will continue to play a large role in physicians' lives.

Chronic cough is a common concern in primary care, with an estimated prevalence of 16% in Canada.[1][1] Guidelines recommend deprescribing medications such as sitagliptin and angiotensin-converting enzyme inhibitors in patients with chronic cough, as it may be a side effect of these medications.[2][