Transcript Family Medicine - University of Pittsburgh

Your Future is Family
Medicine
Information, facts and answers to
frequently asked questions about
family medicine
What are the primary care
specialties?
The Primary Care Physician
Number of Office Visits to Primary Care Physicians vs. Other Specialists
Millions
573
600
500
390
400
300
216
200
168
129
100
0
Family
Medicine
Internal
Medicine
Pediatrics
All Primary
Care
Other
Specialists
Source: DA, Cherry DK. National Ambulatory Medical Care Survey: 2005 Summary. Advance
Data from Vital and Health Statistics; No. 346, Hyattsville, Maryland: National Center for Health
Statistics. 2004. http://www.cdc.gov/nchs/about/major/ahcd/officevisitcharts.htm .
What’s a typical week in primary
care?
Major Reasons for Visits to Primary Care Specialists
Reasons for Visits
Preventive
87
Acute Condition
32.6
34.7
Chronic Condition
11.5
Injury Related
0
20
40
60
80
100
Percentage
Source: National Ambulatory Medical Care Survey: 2004 Summary. National Center for
Health Statistics
Why is primary care important?
 longer life spans and fewer deaths due to heart
and lung disease
 fewer cases and deaths due to colon and
cervical cancer
 better detection of breast cancer
 less ER and hospital use
 better preventive care
 reduced health disparities
People rely on primary care physicians
to care for complex disease
Condition
Saw a PC physician in the last year
Asthma
80%
Congestive Heart Failure
88%
Coronary Heart Disease
88%
Depression/Anxiety
81%
Diabetes
88%
Hypertension
88%
Multiple Sclerosis
77%
Parkinson’s
90%
Source: 2002 National Health Interview Survey
What do family physicians do?
Family physicians provide comprehensive and
continuous primary care health care to:
 individuals and families
 women and men regardless of age or disease
 infants, children and adolescents regardless of
disease
Family physicians provide
 Prevention & management of acute injuries and
illnesses
 Health promotion
 Hospital care for acute medical illnesses
 Chronic disease management
 Maternity care
 Well-child care and child development
 Primary mental health care
 Rehabilitation
 Supportive and end-of-life care
Procedures performed by family
physicians
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Arterial lines
Audiometry
Casting
Central lines
Colonoscopy
Colposcopy/LEEP
EKG
Excisions of moles, nevi,
cysts, warts, skin tags
 Endoscopy
 Intubation
 Joint Injections
 Paracentesis
 Pap Smears
 Pulmonary function
testing
 Punch biopsies
 Skin biopsies
 Spirometry
 Suturing lacerations
 Thoracentesis
 Ultrasound imaging
 Tympanometry
 Vasectomy
What distinguishes family physicians
from general internists?
Visits by men to primary care physicians -2006
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
Family Medicine
Internal Medicine
5.0%
0.0%
Under 18
18-44 years 45-64 years 65 year and
over
Visits by women to primary care physicians - 2006
Ages and
gender of
patients seen
by family
physicians and
general
internists
30.0%
25.0%
20.0%
Fam ily Medicine
15.0%
Internal Medicine
10.0%
5.0%
0.0%
Under 18
18-44
years
45-64
years
65 year
and over
Source:
National Center for
Health Statistics:
Chart book on Trends
in the health of
Americans: 2006
Percentage of Children’s Office Visits
by Specialty
Sources:
National Ambulatory Medical Care Surveys, 1992-2002
AAFP Task Force On the Care of Children, 2005
What FP attributes are valued?
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Deep understanding of the whole person
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Act as a partner to patients over many years
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Talent for humanizing health care
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A command of complexity
Source:
Martin JC, Avant RF, Bowman MA, et al. The Future of Family Medicine: A
collaborative project of the family medicine community. Ann Fam Med. 2004 MarApri; 2 Suppl 1:53-32
Family physicians’ whole-person orientation
and training ensures that FPs…
 Consider all of the influences on a person’s
health
 Know and understand peoples’ limitations,
problems and personal beliefs when deciding
on a treatment
 Are appropriate and efficient in proposing
therapies and interventions
 Develop rewarding relationships with patients
Family physicians have a unique
influence on patients’ lives
 Serving as partner with patients to maintain wellbeing over time
 Empowering with information and guidance that
are needed to maintain health over time
 Providing care that includes long-term
behavioral change interventions that lead to
better health
 Developing ongoing communication between
patient and physician
Family physicians are
relationship-oriented,
which ensures…
 Good relationships with other physicians and
health care providers.
 Better patient understanding of complex
medical issues and improved participation in
the care process.
 Less expensive and better healthcare
experience for patient.
Family physicians have a natural
command of complexity and
 Thrive on managing complex medical
problems
 Integrate all of the medical and personal
issues facing an individual
 Break down medical terms and complex
medical issues to make it easier for patients
to understand
How are family physicians trained?
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3 years
More than 400 family medicine residencies
Community-based
Medical school-based
Military
Inner-city
Urban
Suburban
Rural
Innovative Training Models
Family medicine residency
clinical curriculum
Continuity Patient Care – all 3 years
Adult medicine
Maternity care
Critical care medicine
Gynecologic care
General surgery
Orthopedics
Emergency care
Care of children
Skin care
Human behavior
Women’s health
Newborn care
LifeLong
Learning
What’s a typical week in family
medicine?
Reasons for visits to Family Physicians
Acute problem
33.1
Reasons
Chronic routine problem
30.2
Chronic flare-up
9.3
Pre or post surgery
follow up
7.3
Non-Illness (preventive)
18.1
Not Reported
2
0
5
10
15
20
25
30
Percentage
Source: National Ambulatory Medical Care Survey: 2005 Summary. National Center for
Health Statistics
35
A typical month of health care
in the United States
Source: N England Journal of Medicine 2001;344:2021-25]:
Hospital practice of family
physicians - 2006
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83.2% provide inpatient care
78.8 have hospital admission privileges
22.6% do routine OB
22.8% surgical-assist
28.4% perform minor surgical procedures
38.8% delivered care in the CCU
41.1% delivered care in the ICU
44.9% deliver care in hospital ER
57.4% reported delivering newborn care
Source – AAFP Facts About Family Medicine. Oct 2006 http://www.aafp.org/facts.xml
Lifestyle of Family Physicians?
 39.7 hours per week in direct patient care1
 50 hours per week in patient related activities 1
 Avg. wks worked – 46.9 weeks 1
 5 weeks for vacation/CME 1
 Avg. Income for 2006: $161,000 2
1 AAFP
Facts About Family Medicine. 2006 http://www.aafp.org/facts.xml
2 Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting
Incentives. Oct 2007.
Where do family physicians
practice?
Current PCHPSAs
Without FPs
Source: Robert Graham Center for Policy Studies in Family Practice and
Primary Care. http://www.graham-center.org/
Are family physicians in demand?
 The Number One most recruited specialty in 2006
 The primary care specialty most in demand
 35% increase in recruitment of family physicians in
2004
1
Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting Incentives. Oct 2007
J. Encouraging news about family physician recruitment.
Family Practice Management. 2005 Apr; 12(4); 56-8.
2 Hawkins,
What loan repayment options are
available for family physicians?
What’s the future of family
medicine?
 Electronic health record (EHR)
 Online appointments
 Web-based patient education
 E-visits
Innovations in family medicine
 Group visits
 Team approach to care
 Systematic approach to care
 Chronic disease management
Future of family medicine
 Market research
 Six task forces
 Family medicine’s new
model of care
 Personal medical home
 Continuous relationship
 Basket of services
More about family medicine
Family medicine
department
Family medicine
clerkship director
Your school’s FMIG
Virtual FMIG at
fmignet.aafp.org
AAFP chapter