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The Future of Family Medicine: Increasing Interest

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Title: The Future of Family Medicine: Increasing Interest


1
The Future of Family Medicine Increasing 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 Project Research
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 Project Research
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 Project Research
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 Care FOFM 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 Care FOFM 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 Care FOFM 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 Care FOFM 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 Care FOFM 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
Drawbacks Prestige/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
Drawbacks Prestige
  • 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
Drawbacks Financial
  • 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
Drawbacks Financial
  • 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
Drawbacks Financial
  • 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
Drawbacks Lifestyle
  • 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
Drawbacks Lifestyle
33
Drawbacks Lifestyle
  • 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
Drawbacks Lifestyle
  • Controllable
  • Anesthesiology
  • Dermatology
  • Emergency Medicine
  • Neurology
  • Ophthalmology
  • Otolaryngology
  • Pathology
  • Psychiatry
  • Radiology
  • Uncontrollable
  • Family Medicine
  • Internal Medicine
  • OB/GYN
  • Orthopedics
  • Pediatrics
  • Surgery
  • Urology

35
Drawbacks Lifestyle
  • Controllable Lifestyle may mean limited Practice
    Options
  • Flexibility in Primary Care
  • Locations
  • Scope of Practice
  • Hours

36
Drawbacks Lifestyle
  • 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 job…and 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, TARWARS…start early
  • Encourage and reward residents for doing the
    same…that is how you perpetuate good residencies.

38
Communication FOFM 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
Communication FMIG
  • 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
Communication Role 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?
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