A new study published in BMC Medical Education by Christina Meade and colleagues at Brigham and Women’s Hospital and Harvard Medical School examines this problem from an unusual angle: rather than simply accepting the churn as inevitable, the researchers analyzed what happens when an academic primary care practice builds a formal system for moving select patients from resident physicians to attending physicians before the annual handoff even begins. Their findings, drawn from a retrospective chart review and a survey of resident attitudes, offer a practical template that other academic clinics could adapt.

The setting was the Phyllis Jen Center for Primary Care at Brigham and Women’s Hospital, an academic resident and faculty practice in Boston. In this model, internal medicine residents serve as primary care physicians for their own panels of patients, supervised by attending physicians who also carry their own panels. Every year, the resident physicians review their entire panels and can recommend that particular patients be transferred to an attending primary care physician. The researchers wanted to understand which demographic and clinical factors were associated with a transfer recommendation, and to describe the workflow so that other practices could adopt it.

The results were striking in one respect above all: the funnel is narrow. In 2024, only 63 of 4,332 patients, or 1.5 percent, were recommended for transfer from a resident physician to an attending physician. That small fraction matters for feasibility. Attending physicians in academic practices have limited panel capacity, and a system that required transferring large numbers of patients would quickly overwhelm them. By demonstrating that a structured annual review identifies only a small group of patients, the study suggests that the approach could work even in clinics where attending panel space is tight.

What characterized the patients who were recommended for transfer? Three demographic and clinical factors stood out. Patients were more likely to be recommended for transfer if they had Medicare as their insurer, if they were older, and if they were medically complex. These factors cluster together in an intuitive way: older, sicker patients on Medicare often carry multiple chronic conditions, take complicated medication regimens, and require coordinated care across specialties. When the resident who knows them best graduates, the loss of continuity is not just inconvenient; it can be clinically dangerous.

Perhaps the strongest single predictor, however, was subjective. Resident physicians’ perception that a patient was high-risk was more strongly associated with a transfer recommendation than any single demographic or clinical variable. In other words, the residents’ clinical gestalt, their overall sense of which patients were most vulnerable to a disrupted transition, drove the recommendations more than a checklist of diagnoses. That finding is a double-edged sword. Clinical judgment can capture nuances that coded data miss, but it also introduces variability, and the study found reason for caution on that front.

That caution comes from the survey results. When the researchers asked resident physicians about their attitudes toward the transfer process, they found that overall confidence in their own recommendations was low. Residents were identifying patients for attending transfer without being sure they were making the right call. The authors interpret this as a signal about education: resident physicians need more guidance and training in considering which patients may genuinely benefit from transfer to an attending physician. A transfer system, in other words, is not self-executing. It depends on the judgment of trainees who are, by definition, still learning.

The study also revealed a second pathway into the transfer process that had gone underappreciated. Almost half of the transfer requests, 29 of 63, were initiated by patients themselves rather than by their resident physicians. Patient-initiated requests were common, yet they made up a lower proportion of high-risk patients than the requests initiated by residents. This distinction carries an equity implication that the authors highlight. If the only patients who get moved to an attending physician are those who know to ask, the system may favor patients who are more assertive, more health literate, or more familiar with how academic medicine works, potentially leaving the most vulnerable patients behind.

From this, the authors draw a policy conclusion with implications well beyond one Boston clinic. A standardized process that gives every patient the explicit opportunity to request a transfer, rather than relying on patients to invent that option themselves, may offer a more equitable approach to the annual transition. Combined with the finding that only about 1.5 percent of patients need attending transfer, the model looks scalable: an annual panel review, a structured recommendation step, an open door for patient-initiated requests, and educational support to help residents judge which patients truly need the continuity that a permanent attending physician can provide.

The study arrives at a moment when continuity of care is under pressure from many directions, including physician burnout, panel sizes, and the relentless turnover built into graduate medical education. For the 600,000 patients who change resident physicians each year, the difference between an abrupt, unstructured handoff and a thoughtful, standardized one may shape their health for years. This research does not solve the turnover problem inherent to training the next generation of doctors, but it demonstrates that the disruption can be engineered to be smaller, fairer, and better matched to clinical risk, one carefully reviewed panel at a time.

Subject of Research: Annual transfer of primary care patients from graduating resident physicians to attending physicians at an academic medical center

Article Title: Transitioning primary care from residents to attendings – an approach to address challenges in care during the academic year transition

Article References: Meade, C., Berling, A., Solomon, S., Southworth, B., BS, M. W., Aagaard, E. M., Chheda, S., & J Atalay, A. (2026). Transitioning primary care from residents to attendings – an approach to address challenges in care during the academic year transition. BMC Medical Education. https://doi.org/10.1186/s12909-026-10349-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10349-w

Keywords: primary care, internal medicine residency, care transitions, attending physicians, resident physicians, academic medical center, continuity of care, health equity, medical education, patient panels, Medicare, high-risk patients