Association of Family Medicine Milestone Ratings With Early-Career Patient Retention: A US National Insurance Claims Study.

Background: US family medicine (FM) residency training emphasizes the development of patient-physician relationships, which are associated with patient satisfaction, improved health outcomes, cost containment, and retention. It is important to examine whether this emphasis translates into observable performance during physicians' early years of independent practice. Objective: To assess the association between residency Milestone ratings related to patient-physician relationships and patient retention in early clinical practice. Methods: We analyzed data from 2375 FM residents across 435 programs who completed training in June 2016, linked to 416 249 patients in a commercial health insurance claims dataset. The dataset included patients seen for evaluation and management services and chronic disease visits within 2 years after resident graduation. Subject matter experts identified, a priori, Milestone subcompetencies relevant to patient-physician relationships and retention. A logistic regression model was used to evaluate the association between composite Milestone ratings and patient retention. Results: After adjusting for each patient's total visit count to any primary care physician, FM graduates with higher Milestone ratings than their program peers were associated with greater patient retention (OR, 1.19; 95% CI, 1.16-1.22). This association was stronger among graduates from programs with higher composite program-level Milestone performance (OR, 1.30; 95% CI, 1.26-1.35). Conclusions: Higher ratings in patient-physician relationship subcompetencies were associated with increased patient retention among early-career FM physicians, with stronger associations in programs with higher program mean ratings.