Coastal Research Group — Policy Statements

Title : Public Health Impact of Family Medicine Residency Programs

Keywords

Public health impact

Public health benefits

Community

Community context of care

School health

Population-based health

Policy/Position Statement

In an environment of economic constraints, declining resources, and increasing public health needs, support for a collaborative relationship between family medicine residency programs and their communities’ public health infrastructure will ultimately benefit the public and protect the health of the community.

Practice styles and techniques taught in family medicine residency programs, including comprehensiveness, community-orientation, and coordination of resources for their patients, should be used to advance federal, state and local public health priorities.

Background

Introduction to the National Project

Since 2000, the Coastal Research Group National Project on the Community Benefits of Family Medicine Residency Programs has amassed a robust database on the services provided by a diverse sample of family medicine programs.  That sample reflects the distribution of residency program characteristics nationally.  From this database has been derived a detailed taxonomy of the services delivered to the patient populations served by those programs.  In addition, in collaboration with the University of Louisville School of Public Health and Information Sciences, the taxonomy and data set are undergoing detailed analysis to demonstrate the relationship between family medicine residency programs’ clinical contributions to their communities and the meeting of local public health needs.

Pertinent Data

Data from this project support the observation that family medicine residency programs contribute to the public health priorities of communities in:

The “sentinel” physician role (community health assessment and protecting the health of the public)

Care of special populations (school-based health, low-income elderly)

High-quality disease prevention services

Training of a professional workforce in appropriate models of care

Curriculum in breadth of care

Curriculum in public health and epidemiology

Care in the context of community

“Community” as part of FMRP mission statements

Conclusions

Family medicine residency programs make material and substantive contributions to meeting the public health needs of the communities they serve through the training of generalist physicians with an “adaptive skill set”.

Future Considerations

Physician workforce issues including numbers, training and distribution.

The benefits of community partnerships with health systems.

The use of family medicine residency programs as sentinel practices.

The integration of school health in residency curricula.

References

1.      Starfield B, Shi L, Macinko C — Contribution of Primary Care to Health Systems and Health.  The Milbank Quarterly 83(3):457-502 (2005)

2.      IOM Report — Crossing the Quality Chasm — (http://www.iom.edu/CMS/8089.aspx)

3.      Goldberg W, Goldfrank L, Smith PC, Green LA, Lanier D, Yawn BP – The Ecology of Medical Care Revisited.  N Engl J Med 345:1211-1212 (2001)

4.      Green LA, Fryer GE — The Development and Goals of the AAFP Center for Policy Studies in Family Practice and Primary Care.  JFP 48:905-908 (1999)

5.      IOM Report — The Future of Public Health in the 21st Century – http://www.iom.edu/?id=15246

6.      Gerberding J — 10 priorities

Glossary

Comprehensive care — Care of women, men, and children that meets all of their health care needs.

Adaptive skill set — The clinical skills of a physician that can be applied to a variety of medical problems through the extrapolation of current training.

Sentinel physician — That member of the medical community most likely to have early/initial contact with a threat to the public health.

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This policy statement is a product of the Coastal Research Group (CRG) Policy Analysis Committee, Task Force on Family Medicine Center Benefits

Chair, Working Group on Public Health Impact of FMRPs: Richard Clover, MD

Last Updated (18 May 2006 07:51)

Coastal Research Group – Policy Statements

Title: Family Medicine Residency Impact on the Medical Community

Keywords

Physician workforce

Quality of care

Quality assurance

Standard of care

Patient safety

Medical community

Distribution / Mal-distribution

Policy/Position Statement

Family medicine residency programs generate favorable impacts in their medical communities, including the raising of quality standards and the rejuvenation/replenishment of the physician workforce.

Background

Introduction to the National Project

Since 2000, the Coastal Research Group National Project on the Community Benefits of Family Medicine Residency Programs has amassed a robust database on the services provided by a diverse sample of family medicine programs.  That sample reflects the distribution of residency program characteristics nationally.  From this database has been derived a detailed taxonomy of the services delivered to the patient populations served by those programs.

Pertinent Data

Data from this project supports the observation that the impacts of a family medicine residency program on their local medical community include:

o       Residency programs have increased the number of family physicians in their communities.

o       Graduates have established practices in these communities, and replaced older and retired GPs with board-certified family physicians.

o       Impact on the composition of…

o       Impact on the demographics of…

o       Impact on the systems-based proficiencies of…

o       Impact on the recruitment of…

A.     Hospital’s medical staff

B.     Community physician workforce

o       Workforce multiplier effect (call schedule coverage, admission of unassigned patients, obstetrical deliveries “feeding” pediatrics, etc.)

o       Family medicine programs and their graduates differentiate themselves to meet unique community needs.

o       Expands local/regional primary care base.

o       Introduces and maintains evidence-based medicine and enhanced standard of care.

Conclusions

Family medicine residencies benefit both the physicians and patients of their communities.

Future Considerations

Physician workforce issues including numbers, training and distribution.

The benefits of community partnerships with health systems.

The use of family medicine residency programs as sentinel innovators for health care delivery.

References

1.      Starfield B, Shi L, Macinko C — Contribution of Primary Care to Health Systems and Health.  The Milbank Quarterly 83(3):457-502 (2005)

2.      IOM Report — Crossing the Quality Chasm — (http://www.iom.edu/CMS/8089.aspx)

3.      Goldberg W, Goldfrank L, Smith PC, Green LA, Lanier D, Yawn BP – The Ecology of Medical Care Revisited.  N Engl J Med 345:1211-1212 (2001)

4.      Green LA, Fryer GE — The Development and Goals of the AAFP Center for Policy Studies in Family Practice and Primary Care.  JFP 48:905-908 (1999)

5.      25+ Years: Oklahoma Physician Manpower Training Commission — Oct. 2001

Glossary

Medical community — The medical environment in which health care professionals work, in both ambulatory or inpatient settings.

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This policy statement is a product of the Coastal Research Group (CRG) Policy Analysis Committee, Task Force on Family Medicine Center Benefits

Chair, Working Group on FMRP Impact on Medical Community: Charles Henley, DO

Last Updated (18 May 2006 07:40)

Coastal Research Group — Policy Statements

Title: Care of Underserved Populations

Keywords

Underserved

Uninsured

Underinsured

Publicly funded

Safety-net

Special populations

Disenfranchised

Policy/Position Statement

The range of services delivered in family medicine residency programs provides comprehensiveness and continuity of care for “safety net” populations.

Background

Introduction to the National Project

Since 2000, the Coastal Research Group National Project on the Community Benefits of Family Medicine Residency Programs has amassed a robust database on the services provided by a diverse sample of family medicine programs.  That sample reflects the distribution of residency program characteristics nationally.  From this database has been derived a detailed taxonomy of the services delivered to the patient populations served by those programs.

Pertinent Data

Data from this project supports the observation that the benefits of family medicine residency programs to safety-net populations include:

High-quality fundamental medical services

High-quality disease prevention services

Appropriate access to needed specialty services

Coordination of social services that complement care

Multidisciplinary team care

Training of a professional workforce in appropriate models of care

Conclusions

Comprehensiveness and continuity of care delivered to underserved populations provide a roadmap to an efficient and effective system of care that benefits society in general.

Future Considerations

Physician workforce issues including numbers, training and distribution.

The benefits of community partnerships with health systems.

The use of family medicine residency programs as sentinel innovators for health care delivery.

References

1.      Starfield B, Shi L, Macinko C — Contribution of Primary Care to Health Systems and Health.  The Milbank Quarterly 83(3):457-502 (2005)

2.      IOM Report — Crossing the Quality Chasm — (http://www.iom.edu/CMS/8089.aspx)

3.      IOM Reports (6 during 2001-2004) on the Consequences of Uninsurance —  (http://www.iom.edu/CMS/3809/4660/4356.aspx)

4.      Goldberg W, Goldfrank L, Smith PC, Green LA, Lanier D, Yawn BP – The Ecology of Medical Care Revisited.  N Engl J Med 345:1211-1212 (2001)

5.      Green LA, Fryer GE — The Development and Goals of the AAFP Center for Policy Studies in Family Practice and Primary Care.  JFP 48:905-908 (1999)

Glossary

Safety-net population — Segment of the US population that includes recipients of Medicaid health coverage, the, publicly-subsidized medically indigent, the uninsured, and those under-insured who would be financially decimated by catastrophic health care costs … those whose access and means to care is either discontinuous, insufficient or non-existent.

Comprehensive care — Care of women, men and children that meets all of their health care needs.

Continuity of care — Health care to an individual by a specific medical professional or team over an extended period of time.

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This policy statement is a product of the Coastal Research Group (CRG) Policy Analysis Committee, Task Force on Family Medicine Center Benefits

Chair, Working Group on Care of Underserved Populations: Peter Nalin, MD

Last Updated (18 May 2006 07:41)