Publication Date



hiring, physicians, residency, training, quality, health care


Background: Several studies have compared international graduates on measures of performance, quality and satisfaction. No studies have compared internally versus externally hired graduates in relation to these measures.

Purpose: To identify if there is a difference in hiring patterns and care management (CM)/patient satisfaction (PS) scores between internal and external graduate hires.

Methods: We conducted a quality improvement study on graduates hired by Aurora Health Care from Jan. 1, 2006, to Dec. 14, 2015. CM scores were determined based on hire date. PS scores were calculated based on the calendar year, regardless of exact hire date. PS scales for scoring changed in mid-2010. Hired graduates with no CM and PS scores, as well as those with less than one year of employment, were excluded. Means were compared using two-sample t-tests and regression analysis. Categorical variables were analyzed using chi-squared and Fisher’s exact test, as appropriate.

Results: Study population (N = 108) characteristics included: mean age 38.0 years, 62.0% female gender and 56.5% white race. The majority of those hired (mean starting FTE 0.99) were external graduates (70.4%) and family medicine physicians (50.9%). Of those hired since 2006, 71.3% are still employed (mean longevity 3.5 years). There was no difference in age, sex, race or employment status between internally and externally hired graduates. Family medicine hires were significantly more likely to be internal graduates compared to internal medicine (40.0% vs 13.6%, P = 0.03) and all other physician specialties combined (40.0% vs 18.9%, P = 0.03). First-year CM scores did not differ by age, sex, race, year offer accepted, or external versus internal residency. Family medicine hires had significantly lower initial CM scores (2.76 vs 3.14, P = 0.009) when compared to other physician specialties. However, second-year CM scores showed no difference between family medicine and other physicians. First-year PS (scale one) scores were significantly higher with younger age (P = 0.03), female sex (P = 0.04) and internal graduates (P = 0.04). Younger age and female sex remained predictors of higher PS for second-year scores. No statistical difference was noted with use of scale two for PS scoring.

Conclusion: Care management scores do not differ between internally and externally hired graduates; patient satisfaction scores differed based on scale used. Further study is needed to determine internal hiring disparities between specialties and if CM scores are lower in those hires with more items to be scored.