How the learning in Family Medicine can make you better doctors
A World of Family Doctors :
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A World of Family Doctors A World of Family Doctors : : The Global Solution The Global Solution Richard G. Roberts, MD, JD, FAAFP, FCLM Richard G. Roberts, MD, JD, FAAFP, FCLM Professor of Family Medicine Professor of Family Medicine University of Wisconsin School of Medicine & University of Wisconsin School of Medicine & Public Health Public Health 777 South Mills Street, Madison, WI 53715 777 South Mills Street, Madison, WI 53715 TEL: +1 608 263 3598; FAX: +1 608 263 5813 TEL: +1 608 263 3598; FAX: +1 608 263 5813 Email: [email protected] Email: [email protected] The National Conference The National Conference American Academy of Family Physicians American Academy of Family Physicians 30 July 2008 30 July 2008
Transcript of A World of Family Doctors :
- 1. A World of Family DoctorsA World of Family Doctors :: The Global SolutionThe Global Solution Richard G. Roberts, MD, JD, FAAFP, FCLMRichard G. Roberts, MD, JD, FAAFP, FCLM Professor of Family MedicineProfessor of Family Medicine University of Wisconsin School of Medicine & Public HealthUniversity of Wisconsin School of Medicine & Public Health 777 South Mills Street, Madison, WI 53715777 South Mills Street, Madison, WI 53715 TEL: +1 608 263 3598; FAX: +1 608 263 5813TEL: +1 608 263 3598; FAX: +1 608 263 5813 Email: [email protected]: [email protected] The National ConferenceThe National Conference American Academy of Family PhysiciansAmerican Academy of Family Physicians 30 July 200830 July 2008
2. The Global SolutionThe Global Solution The Case for Family MedicineThe Case for Family Medicine AccessAccess OutcomesOutcomes ValueValue People do better with primary carePeople do better with primary care Global medicine opportunitiesGlobal medicine opportunities 3. AccessAccess 4. Current Primary Care HPSAsCurrent Primary Care HPSAs Current Primary Care HPSAsCurrent Primary Care HPSAs 5. Primary Care HPSAs without FP/GPsPrimary Care HPSAs without FP/GPs 6. 0 10 20 30 40 50 60 GP/FP GIM G Ped G Sur GOB Physicians per 100,000 Population (2000)Physicians per 100,000 Population (2000) 00--2,4992,499 2,5002,500-- 4,9994,999 5,0005,000-- 9,9999,999 10,00010,000-- 24,99924,999 25,00025,000-- 49,99949,999 50,00050,000-- 199,999199,999 200,000200,000-- 999,999999,999 1,000,0001,000,000-- 2,999,9992,999,999 3,000,000+3,000,000+ PhysiciansPhysicians perper 100,000100,000 Colwill JW, Cultice J. www.cogme.gov/00_8726.pdfColwill JW, Cultice J. www.cogme.gov/00_8726.pdf 7. Healthcare servicesHealthcare services U.S., 2004U.S., 2004 Physician office visitsPhysician office visits 910,857,000910,857,000 Emergency dept visitsEmergency dept visits 110,216,000110,216,000 Hospital outpatient dept visitsHospital outpatient dept visits 84,994,00084,994,000 Hospital admissionsHospital admissions 36,927,00036,927,000 Source: National Ambulatory Medical Care Survey, 2004Source: National Ambulatory Medical Care Survey, 2004 http://www.cdc.gov/nchs/data/hus/hus06.pdfhttp://www.cdc.gov/nchs/data/hus/hus06.pdf 8. 01/29/15 12:11 U.S. Physician Office Visits 2004U.S. Physician Office Visits 200411 11 Excludes anesthesiology, pathology & radiology.Excludes anesthesiology, pathology & radiology. Source: http://www.cdc.gov/nchs/data/hus/hus06.pdfSource: http://www.cdc.gov/nchs/data/hus/hus06.pdf 0 100 200 300 400 500 Fam Med-GP Internal Medicine Pediatrics All Primary Care Other Specialists 205 Million205 Million 23% 16% 147 Million147 Million 101 Million101 Million 11% 452 Million452 Million 50% 459 Million459 Million 50% 9. OutcomesOutcomes 10. Mortality OutcomesMortality Outcomes Primary care physiciansPrimary care physicians: 1 per 10,000 (20%): 1 per 10,000 (20%) more primary care physiciansmore primary care physicians decreasesdecreases mortality by 40 per 100,000 (mortality by 40 per 100,000 (5% fewer deaths5% fewer deaths).). Family PhysiciansFamily Physicians: 1 per 10,000 (33%) more: 1 per 10,000 (33%) more family physicians resultsfamily physicians results decreasesdecreases mortalitymortality by 70 per 100,000 (by 70 per 100,000 (9% fewer deaths9% fewer deaths).). SpecialistsSpecialists: 1 per 10,000 (8%) more specialists: 1 per 10,000 (8%) more specialists increasesincreases mortality by 16 per 100,000 (mortality by 16 per 100,000 (2% more2% more deathsdeaths).). Shi. J Am Board Fam Pract 2003;16:412-22.Shi. J Am Board Fam Pract 2003;16:412-22. 11. Indonesia Infant MortalityIndonesia Infant Mortality 1996-19971996-1997 1997-19981997-1998 1998-19991998-1999 1999-20001999-2000 PrimaryPrimary care*care* Hospital*Hospital* InfantInfant MortalityMortality 10.310.3 9.69.6 8.58.5 8.28.2 4.14.1 4.14.1 4.64.6 5.35.3 70% improvement in70% improvement in 14% worsening in14% worsening in all provinces 1990-1996all provinces 1990-1996 22 of 28 provinces22 of 28 provinces **constant Indonesian rupiah per capita, in billionsconstant Indonesian rupiah per capita, in billions Simms et al. Lancet 2003;361:1382-5.Simms et al. Lancet 2003;361:1382-5. 12. Value =Value = QualityQuality CostCost 13. Personal physician:Personal physician: primary care vs specialistprimary care vs specialist 33% lower cost of care33% lower cost of care 19% less likely to die19% less likely to die Frank et al. J Fam Pract 1998;47:105-9Frank et al. J Fam Pract 1998;47:105-9 14. Increasing physiciansIncreasing physicians 1 per 10,000 population1 per 10,000 population SpecialistsSpecialists Decrease 9 states in qualityDecrease 9 states in quality Increase costs $526/beneficiaryIncrease costs $526/beneficiary Primary carePrimary care Increase 10 states in qualityIncrease 10 states in quality Decrease costs $684/beneficiaryDecrease costs $684/beneficiary Baicker et al. Health Affairs 2004;W4:184-197Baicker et al. Health Affairs 2004;W4:184-197 15. People do betterPeople do better with primary care.with primary care. Starfield B, Shi L, Grover A, Macinko J.Starfield B, Shi L, Grover A, Macinko J. The Effects of Specialist Supply on PopulationsThe Effects of Specialist Supply on Populations Health: Assessing the Evidence.Health: Assessing the Evidence. http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.97/DC1http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.97/DC1 16. Why do people worse with specialists?Why do people worse with specialists? Outside area of expertise:Outside area of expertise: CAP, AMI, CHF, UGI bleedCAP, AMI, CHF, UGI bleed11 Late stage diagnosis of breastLate stage diagnosis of breast22 or colorectalor colorectal33 cancercancer Excessive utilizationExcessive utilization44 Handoff or communication errorsHandoff or communication errors55 1.1. Weingarten et al. Arch Int Med 2002;162:527-532.Weingarten et al. Arch Int Med 2002;162:527-532. 2.2. Ferrante et a. J Am Board Fam Pract 2000;13:408-414.Ferrante et a. J Am Board Fam Pract 2000;13:408-414. 3.3. Rotezheim et al. J Fam Pract 1999;48:850-858.Rotezheim et al. J Fam Pract 1999;48:850-858. 4.4. Greenfield et al. JAMA 1992;367:1024-1030.Greenfield et al. JAMA 1992;367:1024-1030. 5.5. Skinner et al. Health Affairs 2006;25:w34-w37.Skinner et al. Health Affairs 2006;25:w34-w37. 17. Pyramid of CarePyramid of Care
