Why Resident Physicians’ Patients Miss Out on Breast Cancer Screening

When a woman sees her primary care doctor for a routine visit, the conversation often turns to preventive care: cholesterol checks, colonoscopy scheduling, and mammograms. But who that doctor is — a seasoned faculty physician or a physician still in residency training — may shape whether that mammogram actually happens. A new study published in the Journal of General Internal Medicine by Saul N. Weingart and colleagues at Tufts Medical Center finds that patients cared for by resident physicians were substantially less likely to be up to date on breast cancer screening than patients cared for by faculty physicians, even in a primary care practice with unusually robust support systems.

The research team measured breast cancer screening compliance during calendar year 2025 using tools embedded in the EPIC electronic health record system. Patients were counted as compliant if they were women aged 40 to 74 who had received a mammogram within the previous two years and had no disqualifying characteristics, such as a prior bilateral mastectomy. The investigators then abstracted detailed patient data from the medical record and collected information about each physician, including gender, language facility, and years in practice. Using both bivariate comparisons and multivariable logistic regression, they teased apart how much of the screening gap could be explained by patient characteristics, clinical and utilization patterns, and physician attributes.

The headline numbers are striking. Of the 8,825 patients eligible for breast cancer screening at the practice, 1,024 — about 12 percent — were cared for by residents. Faculty physicians achieved a screening rate of 83 percent among their eligible patients, while residents reached only 66 percent, a difference that was highly statistically significant. In the unadjusted analysis, a resident’s patient had just 0.41 times the odds of being up to date on screening compared with a faculty patient — a 95 percent confidence interval of 0.35 to 0.47, meaning resident-panel patients were roughly 60 percent less likely to have a current mammogram.

But the raw gap tells only part of the story, and this is where the study becomes technically interesting. The resident and faculty panels were not comparable populations to begin with. Faculty panels included a higher percentage of patients who were white, spoke English, and carried commercial insurance, along with more medical comorbidities. The resident panel, by contrast, contained more patients with serious mental illness and had fewer primary care encounters overall. These differences matter enormously, because decades of research have shown that screening mammography rates vary systematically with race, ethnicity, socioeconomic status, language, and engagement with the health care system.

To account for this, the researchers built a series of progressively more rigorous statistical models. In the first model, adjusting only for patient sociodemographic characteristics, the odds ratio for a resident patient being screened improved from 0.41 to 0.50. When clinical and utilization variables were added in the second model, the odds ratio rose further to 0.59. And in the third model, which incorporated physician attributes such as gender, language facility, and years in practice, the odds ratio climbed to 0.73 — with a confidence interval of 0.54 to 0.98 that only barely excludes the null. In other words, most of the apparent screening deficit attributable to being a resident’s patient dissolved once the underlying differences between patient populations were taken into account, though a meaningful residual gap remained.

This pattern of attenuation carries an important message about how quality disparities in teaching practices should be interpreted. Earlier studies comparing resident and faculty care have often reported that trainees achieve poorer cancer screening rates, and some have framed this as a conflict between training and equity. A 2019 study in the same journal documented disparities in quality of primary care by resident and staff physicians, and a multi-center study published in 2025 confirmed differences in ambulatory care outcomes between trainees and faculty across institutions. But those studies, like this one, must grapple with the fact that resident panels are not random samples of the practice population. Residents often inherit panels of patients with the greatest social and medical complexity — patients who are harder to reach, less likely to attend appointments, and more likely to face logistical barriers to preventive care.

The setting of the new study makes its findings particularly notable. The authors deliberately chose to examine this question in an academic primary care practice with robust practice support, reasoning that if residents’ disadvantages in experience and continuity could be overcome anywhere, it would be in a high-functioning environment. Teaching practices like this one typically offer embedded care managers, screening outreach programs, and structured panel management — infrastructure that should, in theory, buffer less experienced clinicians from their own limitations. The fact that a gap persisted even under these favorable conditions suggests that the problem is not simply one of inadequate support, but may be woven into the structure of residency training itself.

One structural feature looms large: the annual turnover inherent in residency. Residents graduate and hand their panels to incoming trainees every year, creating what researchers have called the revolving door of resident continuity practice. Prior work has identified gaps in transitions of care during these year-end handoffs, and a 2009 commentary in JAMA described the academic year-end transfer of outpatients as an unaddressed patient safety issue. Patients who lose their trusted physician at a moment of transition may be less likely to follow through on screening recommendations, particularly if the handoff is poorly executed. The lower number of primary care encounters observed in the resident panel in this study may reflect both patient disengagement and the discontinuity that comes with annual rotations.

The study’s conclusion is measured but pointed: while rigorous statistical adjustment substantially improved the apparent performance of resident physicians, residency training programs may need to be redesigned to eliminate the remaining disparities in care. Possible redesigns discussed in the broader literature include longer continuous blocks in continuity clinic, structured year-end sign-out programs, and X-plus-Y scheduling models that cluster ambulatory time to protect continuity. Quality improvement efforts targeting specific screening gaps — such as a 2025 initiative addressing colorectal cancer screening disparities between faculty and residents — offer a template for how practices might close the mammography gap as well.

For patients, the practical takeaway is not to avoid resident physicians, whose care is supervised by attending faculty and whose patients often have the greatest need. Rather, the findings highlight where the health care system should direct its attention: toward the patients of trainees, who are disproportionately likely to face barriers to preventive care, and toward the design of the training programs that will produce the next generation of physicians. Breast cancer screening saves lives, and the US Preventive Services Task Force recommends biennial screening for women aged 40 to 74. Ensuring that every eligible woman — regardless of whether her physician is a first-year resident or a twenty-year veteran — receives that recommendation in time is a test of whether academic medicine can align its training mission with its equity obligations.

Subject of Research: Disparities in breast cancer screening rates between resident and faculty physicians in an academic primary care practice

Article Title: Understanding Low Breast Cancer Screening Rates by Resident Physicians

Article References: Understanding Low Breast Cancer Screening Rates by Resident Physicians. (n.d.). https://doi.org/10.1007/s11606-026-10899-1

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10899-1

Keywords: breast cancer screening, mammography, resident physicians, primary care, health disparities, graduate medical education, residency training, quality of care, continuity of care, academic medicine, preventive care, logistic regression