The Joys Of Family Medicine

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The Joys Of Family Medicine

• OCFP Presentation to FMIGs
• Ontario Medical Faculties
• 2008

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Four Principles

• The family physician is a skilled clinician.
• Family Medicine is a community-based discipline.
• The Family physician is a resource to a defined
  practice population.
• The patient-physician relationship is central to
  the role of the family physician.

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The Family Physician is a Skilled Physician
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Four Principles

• The family physician is a skilled clinician.
• Family Medicine is a community-based discipline.
• The Family physician is a resource to a defined
  practice population.
• The patient-physician relationship is central to
  the role of the family physician.

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Family Medicine is Community Based
6
Four Principles

• The family physician is a skilled clinician.
• Family Medicine is a community-based discipline.
• The Family physician is a resource to a defined
  practice population.
• The patient-physician relationship is central to
  the role of the family physician.

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Resource to a defined practice population
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Four Principles

• The family physician is a skilled clinician.
• Family Medicine is a community-based discipline.
• The Family physician is a resource to a defined
  practice population.
• The patient-physician relationship is central to
  the role of the family physician.

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The patient-doctor relationship

• The essence of general practice is an
  unconditional and open-ended commitment to ones
  patients.
• - Ian McWhinney A Celebration of General
  Practice, 2003

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Family Medicine Comprehensive Care

• McWhinney (1989)
• Family physicians are committed to the person
  rather than a particular body of knowledge, group
  of diseases or special technique
• it is not limited by the type of health problem
• the commitment has no defined end point
• Family medicine defines itself in terms of
  relationships

McWhinney I.. A Textbook of Family Medicine.
Oxford University Press. 1989. P.12.
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The 12 Medical Services of the Comprehensiveness
Score

• Anesthesia
• Chronic disease Management
• Emergency Medicine
• Home for the aged/nursing home visits
• House calls
• In-patient hospital care
• Palliative care
• Preventive medicine
• Coordination of patients use of other healthcare
  services
• Mental health care (psychotherapy/counseling/other
  )
• Surgical services (major surgery, assisting,
  minor surgical procedures)
• Maternity care (antenatal, intrapartum care, or
  postpartum care)

Wong, E. P 26
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Unique features of family medicine

• Only 2 year residency
• Many fellowship opportunities
• Broad knowledge base
• Never boring
• Procedural skills involved
• Variety of settings
• Not hospital-dependant

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Fellowships
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Family Medicine is NEVER boring!

• Depression
• Anxiety
• Substance Abuse
• Ischemic Heart Disease
• Diabetes
• Hypertension
• Pregnancy
• Headache
• Periodic Health/Screening
• Palliative Care

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Expertise

• Generalist
• Family model
• Biopsychosocial model of illness
• IQ vs. EQ
• Evidence-based medicine
• Self-directed learning

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Renumeration

• OprahMarch 2008 O magazine
• If you can get paid for doing what you love,
  every paycheck is a bonus

Salary per annum
350,000
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Renumeration
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Remuneration
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Primary Care ModelsBlended Models
0
FHG
FHN
CHC
100
FFS
FHO
CAP
FFS Only 30 are working as Solo Physicians,
FHG 4,292 Physicians FHG, FHN, FHO are enrolling
their patients 24 are working as
inter-professional FHN 990 Physicians practice
(Jan 2008) FHO 800 Physicians CHC 202
Physicians CAP 17 Physicians 6,772 Family
Doctors are working in primary care enrolled
models
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Family Health Groups

• Bill FFS based on the SOB-100
• Comprehensive care premium of 10 on codes
• After hour premium 20
• Senior care 15
• Bonus and Premiums
• Palliative care, mental health problems, diabetes
  management
• Comprehensive care management fee
• Approximately 1.80 / patient / month
• Preventative Care bonuses
• Mammograms, pap streaks, childhood immunization,
  vaccinations, colorectal screening reach 11,000
  per year

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Family Health Networks

• Base rate 112.94/patient/year
• Age and sex adjusted
• Base rate is paid at 50 beyond 2,400 patients
  per physicians
• Long Term Care Cap Rate 941.16
• 10 shadow billing on 57 codes
• FFS limit of 47,500 per year per physician for
  non-rostered patient
• No FFS limit for excluded codes
• Access bonus of 20.65
• CME Funding of 100/hour up to 24 hours
• IT subsidy of 28,000 over 3 years

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Family Health Organization

• Very similar to a FHN
• Basket of services is larger 119 codes vs 57
• Hospital, ED, obstetricals codes excluded
• Cap rate is larger 124.63 vs. 110.01
• Access bonus is maximum of 18.59
• Paid monthly on an estimate
• Reconciled q 6 months
• Better cash flow

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Family Health Team

• 150 FHTs in Ontario 50 announced
• Only FNH or FHO are eligible
• Funding for AHPs including expenses (space, etc)
• Collaborative care model in Ontario exception
  of the 6 FHG shared care pilot sites
• Governance Physician-led, community-led mixed

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Unique

• Team work
• intra and inter-disciplinary
• Flexibility (career evolves)
• Lifestyle
• Teaching

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Team-work
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Flexible
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Balance
Average hours of work per week Men 53 Women
47 Women with children under 5 42
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Teaching Research
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Continuing Education
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1 million Adults are without a Family Doctor