The Future of Family Medicine: Increasing Interest

1
The Future of Family MedicineIncreasing Interest

• Sara M. Kass, CDR/MC/USN
• Assistant Professor, USU
• Faculty Advisor, USU Family Medicine Interest
  Group

2
(No Transcript)
3
AHLTA Training
4
Objectives

• Review recent trends in interest in Family
  Medicine
• Review potential impact of a decreasing workforce
  on the nations health
• Highlight selected FOFM research findings
• Identify ways that we, as Family Physicians, can
  impact student interest in our specialty.

5
Family Medicine Positions Offered Filled
March 1993-2005
Source www.aafp.org/match/nrmpinfo.html
6
Family Medicine Positions filled with US Seniors
Source www.aafp.org/match/nrmpinfo.html
7
Other Match Data

• American Osteopathic Association
• 43.6 Family Medicine Fill Rate in 2005
• 51.6 in 2003 and 53.2 in 2004
• Canadian Residency Match
• 25.5 made Family Medicine their 1st Choice
• gt50 ten years ago

Source www.aafp.org/match/nrmpinfo.html
8
Medicine as I imagined it is embodied by Family
Physicians-Student, USU, Class of 2006
9
The Good News USU Trends
10
Does the Workforce Crisis Matter?

• US Primary Care physicians provide most of the
  care to most of the patients for most of the
  conditions most of the time

11
Does the Workforce Crisis Matter?

• Evidence of Effectiveness
• Reduced mortality
• Reduced ER use
• Better prevention, cancer detection
• Evidence of Efficiency
• Fewer tests, medication and costs
• Higher satisfaction
• Evidence of Equity
• Reduced health disparities

12
A Call for Change

• The system is broken and cant be fixed. A new
  system must be created.
• 2001 IOM
  Chasm Report

13
Future of Family Medicine ProjectResearch
Findings

• Five characteristics required of a Family
  Physician
• Be in their insurance plan
• Easy access to appointments
• Convenient location
• Good Communication skills
• Reasonable clinical experience
• Beyond these criteria, patients value the
  relationship with their physician above all else

14
Future of Family Medicine ProjectResearch
Findings

• Family Physicians are not recognized by the
  public for what they are and what they do.
• Patients are skeptical that one doctor can know
  it all.
• Patients are enamored with science and technology
  and dont associate Family Physicians with it.
• Family Physicians are satisfied in their jobs

15
Future of Family Medicine ProjectResearch
Findings

• Top Three Benefits to Family Medicine
• Students
• Relationship with patient
• Continuity of Care
• Patient Diversity
• Family Physicians
• Make a difference
• Bond with patients
• Continuity of care

• Top Three Drawbacks to Family Medicine
• Students
• Pay/income
• Breadth but not depth of knowledge
• Lack of prestige
• Family Physicians
• Pay/income
• Lack of prestige
• Managed Care (was 4th item for students)

16
So, to Summarize

• We really like what we do
• Patients like us, but dont seem to understand us
  very well
• We provide good, efficient care
• And, We see the pros and cons pretty similarly to
  medical students
• That said, what can we do to get more, or better
  students, interested in Family Medicine?

17
Opportunities

• Meet the Health Care needs of the nation with
  High Quality, Efficient Care
• New Model of Care
• Educational Initiatives
• Address the drawbacks to our specialty
• Salary
• Respect/Prestige
• Lifestyle
• Communicate what we do, including science and
  technology, to public and students

18
High Quality, Efficient CareFOFM The New Model

• We will be able to attract more students to
  Family Medicine if we show them how we address
  the whole person, including the physical,
  emotional, and spiritual aspects of the human.
  - 2LT Adam Soto, USU MSIV

19
High Quality, Efficient CareFOFM The New Model

• Personal Medical Home
• Patient-centered care
• Team Approach
• Elimination of Barriers to access
• Advanced information systems
• Redesigned Offices

• Whole Person orientation
• Care provided within a community context
• Emphasis on Quality and Safety
• Enhance practice finance
• Commitment to provide family medicines basket of
  services

20
High Quality, Efficient CareFOFM The New Model

• National Demonstration Project
• 20 or so practices, various size and location
• 2 year project
• Data available in 2007
• TransforMED
• Support for the implementation

21
High Quality, Efficient CareFOFM Education

• If I could change one thing about Family
  Medicine, I would add a 4th year to the training
  to allow people to focus on OB, Geriatrics,
  surgical skills or any of the other areas that
  Family Medicine has to offer.
• 
  -2LT Sean Wherry, USU MSIV

22
High Quality, Efficient CareFOFM Education

• Residency
• Flexible
• Reflect typical practice
• Patient centered, evidence based
• Medical School
• Clerkship/PC Experience
• Clinical Demands on Family Medicine Faculty

23
Call to Action High Quality, Efficient Care

• Know, understand, and spread the word about the
  new model.
• Pay attention to the NDP and implement changes
  consistent with model as you are able.
• Review curricula and plan for changes
• Implement IT curriculum
• Think flexibly OB/Inpatient, female friendly
  policies

24
DrawbacksPrestige/Respect

• The thing that really sold me on Family
  Medicine was the fact that I felt most
  comfortable with Family Physicians that I worked
  with. They are the physicians that I look up to
  the most.
• 
  -2Lt Katrina Ferguson, USU MSIV

25
DrawbacksPrestige

• Family Medicine Reputation with Peers
• Academic environment vs elsewhere
• Negative comments about Family Medicine
• University AZ Study
• 25 Often vs 10 for Other PC Specialties
• Residents are worst offenders
• Didnt seem to impact specialty choice
• Lack of Harmony

26
Call to Action Prestige/Respect

• Address reputation issue head on with students,
  how do you handle it
• Educate students that respect issue is less
  significant away from academic environment
• Accept role as an advocate for the specialty
• Professionalism Policies

27
DrawbacksFinancial

• More money
• They have to fix the pay issues
• Altruism will only last so long. We will either
  need to decrease work or increase the
  compensation.

28
DrawbacksFinancial

• Increase Production gt Increased Compensation
• Lewin Group Report New model with new
  efficiencies
• Increase time spent with patients
• Decrease workday by 12
• Increase reimbursement by 26

29
DrawbacksFinancial

• Reorient the Nation to Primary Care
• Reimbursement that facilitates and rewards
  continuous, patient-centered, comprehensive,
  compassionate, and coordinated care
• Subsidies for training programs that produce
  primary care physicians.
• Loan forgiveness for primary care physicians

30
Call to Action Financial

• Pay attention to Pay for Performance and other
  reimbursement issues
• Follow financial results of NDP
• Celebrate recent bonus increases
• Listen to Capt Nichols finance lecture and share
  it with students

31
DrawbacksLifestyle

• When I was on my Family Medicine rotation, it
  was the only time I felt like a normal human
  being, both at work and in the real world.
  Family Physicians seem down to earth and know how
  to balance their career and the other things in
  life that matter.
• 
  -Student, USU, Class of 2006

32
DrawbacksLifestyle
33
DrawbacksLifestyle

• Students choosing specialties with
• Fewer work hours per week
• Fewer nights on call
• Time for avocational activities
• Schwartz et al, Academic Medicine 199065207-210
• In other words they value a Controllable
  Lifestyle
• Personal time (leisure, family, avocation)
• Control of weekly hours (work and call)

34
DrawbacksLifestyle

• Controllable
• Anesthesiology
• Dermatology
• Emergency Medicine
• Neurology
• Ophthalmology
• Otolaryngology
• Pathology
• Psychiatry
• Radiology

• Uncontrollable
• Family Medicine
• Internal Medicine
• OB/GYN
• Orthopedics
• Pediatrics
• Surgery
• Urology

35
DrawbacksLifestyle

• Controllable Lifestyle may mean limited Practice
  Options
• Flexibility in Primary Care
• Locations
• Scope of Practice
• Hours

36
DrawbacksLifestyle

• Selection based on self, colleagues, and content
• Look to faculty to dispel negative images
• Trying on of various selves
• Want to see the balance to see what life is like.
  They need to see more than just work.
• 4/5 factors for site selection have to do with
  residents

37
Call to Action Lifestyle

• Think about what it is that makes you satisfied
  in your joband talk about it openly.
• Share your lifestyle with students and let them
  see how you live as a Family Physician
• Get involved with local schools, shadowing
  programs, TARWARSstart early
• Encourage and reward residents for doing the
  samethat is how you perpetuate good residencies.

38
CommunicationFOFM Identity Statement

• Family Physicians are committed to fostering
  health and integrating health care for the whole
  person by humanizing medicine and providing
  science-based high-quality care

39
CommunicationFMIG

• Active FMIG with increased match rates
• Beyond recruiting students into Family Medicine
• Variety, Opportunities, Accomplishments, Passions
• USU, Your Alma Mater, Local Schools

40
Call to Action Communication

• Know our identity
• Know what Jazzes you up
• Know that patients want and need us
• Know that healthcare in our nation needs us
• SHARE THAT KNOWLEDGE

41
CommunicationRole Models

• I had a fantastic mentor at Camp Lejeune
  Patients loved him, he really focused on
  procedures and most of all he loved to teach. He
  had such passion for what he did, how could I not
  be sold on the specialty of Family Medicine.
• -2Lt Jodie
  Rappe, USU MSIV

42
Summary

• The recent decline in interest has hit a plateau
• Family Physicians are vital to a changing health
  care system
• Family Physicians enjoy patient relationships and
  delivering high quality, efficient care
• Students and Family Physicians see the pros and
  cons of Family Medicine similarly
• Student interest can be influenced at many
  different levels

43
Summary

• Individually you can impact student interest
  through
• Demonstrating clinical excellence in the New
  Model of Family Medicine
• Embracing technology
• Raising public awareness of what Family
  Physicians do
• Sharing your enthusiasm and life as a Family
  Physician with students of all ages

44
Questions?