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Your Future is Family Your Future is Family MedicineMedicine
Information, facts and answers to Information, facts and answers to frequently asked questions about frequently asked questions about
family medicinefamily medicine
What are the primary care What are the primary care specialties?specialties?
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 .
216
168129
573
390
0
100
200
300
400
500
600
Millions
FamilyMedicine
InternalMedicine
Pediatrics All PrimaryCare
OtherSpecialists
The Primary Care Physician Number of Office Visits to Primary Care Physicians vs. Other Specialists
What’s a typical week in primary What’s a typical week in primary care?care?
Source: National Ambulatory Medical Care Survey: 2004 Summary. National Center for Health Statistics
Major Reasons for Visits to Primary Care Specialists
11.5
34.7
32.6
87
0 20 40 60 80 100
Injury Related
Chronic Condition
Acute Condition
Preventive
Rea
son
s fo
r V
isit
s
Percentage
Why is primary care important?Why is primary care important?
longer life spans and fewer deaths due to heart longer life spans and fewer deaths due to heart and lung diseaseand lung disease
fewer cases and deaths due to colon and fewer cases and deaths due to colon and cervical cancercervical cancer
better detection of breast cancer better detection of breast cancer less ER and hospital useless ER and hospital use better preventive carebetter preventive care reduced health disparitiesreduced health disparities
People rely on primary care physicians People rely on primary care physicians to care for complex diseaseto care for complex disease
Source: 2002 National Health Interview SurveySource: 2002 National Health Interview Survey
ConditionCondition Saw a PC physician in the last yearSaw a PC physician in the last year
AsthmaAsthma 80%80%
Congestive Heart FailureCongestive Heart Failure 88%88%
Coronary Heart DiseaseCoronary Heart Disease 88%88%
Depression/AnxietyDepression/Anxiety 81%81%
DiabetesDiabetes 88%88%
HypertensionHypertension 88%88%
Multiple SclerosisMultiple Sclerosis 77%77%
Parkinson’sParkinson’s 90%90%
What do family physicians do?What do family physicians do?
Family physicians provide comprehensive and Family physicians provide comprehensive and continuous primary care health care to:continuous primary care health care to:
individuals and familiesindividuals and families
women and men regardless of age or diseasewomen and men regardless of age or disease
infants, children and adolescents regardless of infants, children and adolescents regardless of diseasedisease
Family physicians provideFamily physicians provide
Prevention & management of acute injuries and Prevention & management of acute injuries and illnessesillnesses
Health promotionHealth promotion Hospital care for acute medical illnessesHospital care for acute medical illnesses Chronic disease managementChronic disease management Maternity careMaternity care Well-child care and child developmentWell-child care and child development Primary mental health carePrimary mental health care Rehabilitation Rehabilitation Supportive and end-of-life careSupportive and end-of-life care
Procedures performed by family Procedures performed by family physiciansphysicians
Arterial linesArterial lines AudiometryAudiometry CastingCasting Central linesCentral lines ColonoscopyColonoscopy Colposcopy/LEEPColposcopy/LEEP EKGEKG Excisions of moles, nevi, Excisions of moles, nevi,
cysts, warts, skin tagscysts, warts, skin tags EndoscopyEndoscopy IntubationIntubation Joint InjectionsJoint Injections
ParacentesisParacentesis Pap SmearsPap Smears Pulmonary function Pulmonary function
testingtesting Punch biopsiesPunch biopsies Skin biopsiesSkin biopsies SpirometrySpirometry Suturing lacerationsSuturing lacerations ThoracentesisThoracentesis Ultrasound imaging Ultrasound imaging TympanometryTympanometry VasectomyVasectomy
What distinguishes family physicians What distinguishes family physicians from general internists?from general internists?
Visits by men to primary care physicians -2006
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Under 18 18-44 years 45-64 years 65 year andover
Family Medicine
Internal Medicine
Ages and Ages and gender of gender of patients seen patients seen by family by family physicians and physicians and general general
internistsinternists
Source: Source:
National Center for National Center for Health Statistics: Health Statistics: Chart book on Trends Chart book on Trends in the health of in the health of Americans: 2006Americans: 2006
Visits by women to primary care physicians - 2006
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Under 18 18-44years
45-64years
65 yearand over
Family Medicine
Internal Medicine
Percentage of Children’s Office Visits Percentage of Children’s Office Visits by Specialtyby Specialty
Sources:
National Ambulatory Medical Care Surveys, 1992-2002
AAFP Task Force On the Care of Children, 2005
What FP attributes are valued?What FP attributes are valued?
Deep understanding of the whole personDeep understanding of the whole person
Act as a partner to patients over many yearsAct as a partner to patients over many years
Talent for humanizing health careTalent for humanizing health care
A command of complexityA command of complexity
Source: Source: Martin JC, Avant RF, Bowman MA, et al. The Future of Family Medicine: A 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 Mar-Apri; collaborative project of the family medicine community. Ann Fam Med. 2004 Mar-Apri; 2 Suppl 1:53-322 Suppl 1:53-32
Family physicians’ whole-person orientation Family physicians’ whole-person orientation and training ensures that FPs…and training ensures that FPs…
Consider Consider allall of the influences on a person’s of the influences on a person’s healthhealth
Know and understand peoples’ limitations, Know and understand peoples’ limitations, problems and personal beliefs when deciding problems and personal beliefs when deciding on a treatmenton a treatment
Are appropriate and efficient in proposing Are appropriate and efficient in proposing therapies and interventionstherapies and interventions
Develop rewarding relationships with patientsDevelop rewarding relationships with patients
Family physicians have a unique Family physicians have a unique influence on patients’ livesinfluence on patients’ lives
Serving as partner with patients to maintain well-Serving as partner with patients to maintain well-being over timebeing over time
Empowering with information and guidance that Empowering with information and guidance that are needed to maintain health over timeare needed to maintain health over time
Providing care that includes long-term Providing care that includes long-term behavioral change interventions that lead to behavioral change interventions that lead to better healthbetter health
Developing ongoing communication between Developing ongoing communication between patient and physicianpatient and physician
Family physicians are Family physicians are relationship-oriented,relationship-oriented,
which ensures…which ensures…
Good relationships with other physicians and Good relationships with other physicians and health care providers.health care providers.
Better patient understanding of complex Better patient understanding of complex medical issues and improved participation in medical issues and improved participation in the care process.the care process.
Less expensive and better healthcare Less expensive and better healthcare experience for patient.experience for patient.
Family physicians have a natural Family physicians have a natural command of complexity andcommand of complexity and
Thrive on managing complex medical Thrive on managing complex medical problemsproblems
Integrate all of the medical and personal Integrate all of the medical and personal issues facing an individualissues facing an individual
Break down medical terms and complex Break down medical terms and complex
medical issues to make it easier for patients medical issues to make it easier for patients to understandto understand
How are family physicians trained?How are family physicians trained?
3 years 3 years More than 400 family medicine residencies More than 400 family medicine residencies Community-basedCommunity-based Medical school-basedMedical school-based MilitaryMilitary Inner-cityInner-city UrbanUrban SuburbanSuburban RuralRural Innovative Training ModelsInnovative Training Models
Family medicine residencyFamily medicine residencyclinical curriculumclinical curriculum
Adult medicineAdult medicine Critical care medicineCritical care medicine
Maternity careMaternity care Gynecologic careGynecologic care
General surgeryGeneral surgery OrthopedicsOrthopedics
Emergency careEmergency care Care of childrenCare of children
Skin careSkin care Human behaviorHuman behavior
Women’s healthWomen’s health Newborn careNewborn care
Continuity Patient Care – all 3 yearsContinuity Patient Care – all 3 yearsLife-
Long
Learning
What’s a typical week in family What’s a typical week in family medicine?medicine?
Reasons for visits to Family Physicians
2
18.1
7.3
9.3
30.2
33.1
0 5 10 15 20 25 30 35
Not Reported
Non-Illness (preventive)
Pre or post surgeryfollow up
Chronic flare-up
Chronic routine problem
Acute problem
Re
as
on
s
Percentage
Source: National Ambulatory Medical Care Survey: 2005 Summary. National Center for Health Statistics
A typical month of health care A typical month of health care in the United Statesin the United States
Source: N England Journal of Medicine 2001;344:2021-25Source: N England Journal of Medicine 2001;344:2021-25]: ]:
Hospital practice of family Hospital practice of family physicians - 2006physicians - 2006
83.2% provide inpatient care83.2% provide inpatient care 78.8 have hospital admission privileges78.8 have hospital admission privileges 22.6% do routine OB22.6% do routine OB 22.8% surgical-assist22.8% surgical-assist 28.4% perform minor surgical procedures28.4% perform minor surgical procedures 38.8% delivered care in the CCU38.8% delivered care in the CCU 41.1% delivered care in the ICU41.1% delivered care in the ICU 44.9% deliver care in hospital ER44.9% deliver care in hospital ER 57.4% reported delivering newborn care57.4% reported delivering newborn care
Source – AAFP Facts About Family Medicine. Oct 2006 http://www.aafp.org/facts.xmlSource – AAFP Facts About Family Medicine. Oct 2006 http://www.aafp.org/facts.xml
Lifestyle of Family Physicians?Lifestyle of Family Physicians?
39.7 hours per week in direct patient care39.7 hours per week in direct patient care11 50 hours per week in patient related activities 50 hours per week in patient related activities 11
Avg. wks worked – 46.9 weeks Avg. wks worked – 46.9 weeks 11
5 weeks for vacation/CME 5 weeks for vacation/CME 11
Avg. Income for 2006: $161,000 Avg. Income for 2006: $161,000 22
1 1 AAFP Facts About Family Medicine. 2006 http://www.aafp.org/facts.xmlAAFP Facts About Family Medicine. 2006 http://www.aafp.org/facts.xml22 Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting Incentives. Oct 2007. Incentives. Oct 2007.
Where do family physicians Where do family physicians practice?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?Are family physicians in demand?
The The Number One Number One most recruited specialty in 2006most recruited specialty in 2006
The primary care specialty most in demandThe primary care specialty most in demand
35% increase in recruitment of family physicians in 35% increase in recruitment of family physicians in 20042004
11 Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting Incentives. Oct 2007Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting Incentives. Oct 2007 2 2 Hawkins, J. Encouraging news about family physician recruitment. Hawkins, J. Encouraging news about family physician recruitment. Family Practice Management. 2005 Apr; 12(4); 56-8.Family Practice Management. 2005 Apr; 12(4); 56-8.
What loan repayment options are What loan repayment options are available for family physicians?available for family physicians?
What’s the future of family What’s the future of family medicine?medicine?
Electronic health record (EHR)Electronic health record (EHR)
Online appointmentsOnline appointments
Web-based patient educationWeb-based patient education
E-visitsE-visits
Innovations in family medicineInnovations in family medicine
Group visitsGroup visits
Team approach to careTeam approach to care
Systematic approach to careSystematic approach to care
Chronic disease managementChronic disease management
Future of family medicineFuture of family medicine Market researchMarket research
Six task forcesSix task forces
Family medicine’s new Family medicine’s new model of caremodel of care
Personal medical homePersonal medical home
Continuous relationshipContinuous relationship
Basket of servicesBasket of services
More about family medicineMore about family medicine
Family medicine Family medicine departmentdepartment
Family medicine Family medicine clerkship directorclerkship director
Your school’s FMIGYour school’s FMIG
Virtual FMIG at Virtual FMIG at fmignet.aafp.orgfmignet.aafp.org
AAFP chapterAAFP chapter