Preparing for their presentation "Primary Health Care Access: Does it ameliorate health disparities" at the 11th National Conference on Primary Health Care Access in Kaua'i. From Left to Right: V. I. Chetty, Ph.D., Manuel Idrogo, M.D., John E. Midlting, M.D., M.S., and B. Bruce Zellner, M.A.. Doctor Idrogo is from the University of Minnesota, the other three represented the University of Illinois at Rockford.

National Grand Rounds

Lead Person:
Samuel C. Matheny, MD
Chairman, Department of Family Practice
University of Kentucky

The idea of National Grand Rounds was proposed by Dr. Matheny, the Chair of the Policy Analysis Committee of the Coastal Research Group. (The Policy Analysis Committee is assigned oversight of the National Grand Rounds. The current membership of that committee is displayed below.)

National Grand Rounds: The Family Physician and Continuity of Care: Ideas, Realities and Possibilities.

Has the concept of a "personal physician" providing continuity of care to the physician's patients, one of the ideas that underlie family medicine, been overtaken by other developments in "health care delivery"? In the "classical model", what constitutes continuity of care? Do there exist current exemplary models of "classic" continuity of care that meet the family physician ideal? Will the function of continuity of care to lower income persons be assumed by, say, community health centers with sophisticated information systems or by Medicaid managed care plans? Or will the only continuity for the poor be the continued forced choice of episodic or categorical interventions?

A team presented an introduction to the subject at National Grand Rounds in Bethesda in 1999.

National Grand Rounds: Can "strategic" programs really influence the geographic location of family physicians?

Doctor Donald Pathman of the University of North Carolina has challenged some of the assumptions behind certain kinds of "strategic programs" -- community rotations and programs designed to retain physicians in underserved communities. In cooperation with Dr. Pathman, participants in the National Project on the Outcomes of Family Practice Residency Training presented sessions defining the issues to be included in a National Grand Rounds on Physician Recruitment and Retention in plenary sessions at the Tenth National Conference in Bethesda in March 25-27, 1999.

Donald L. Weaver, M.D., Director of the National Health Service Corps, participated in National Grand Rounds on the geographic distribution of physicians at the 10th National Conference in Bethesda, Maryland.

National Grand Rounds: Physician "Supply" and "Workforce": Should there be and who should determine a national policy on numbers of physicians trained and in practice?

The work of the U.S. Public Health Service Council on Graduate Medical Education [COGME] and general issues relating to physician supply and workforce have been highlighted by a series of presentations at previous National Conferences on Primary Health Care Access: Marc Rivo, MD and Norman Kahn, MD (Williamsburg, 1992), David Satcher, MD (Monterey, 1993); Jack Colwill (Beaver Creek, Colorado, 1995). David Sundwall, MD, Robert Avant, MD, Norman Kahn, MD and Perry A. Pugno, MD. (San Diego, 1998).

COGME continues to contemplate its projections of an increasing "oversupply" of physicians in future years. Meanwhile, Touro University, a brand new medical school, was opened in Fall, 1998 -- in San Francisco! -- and nurse practitioner and physician assistant programs are expanding throughout the nation. A team will be formed to prepare for a National Grand Rounds on physician supply and workforce issues at the 11th National Conference in Kaua'i in 2000. It will also plan and develop a Policy Analysis paper on this issue.

National Grand Rounds: Primary Health Care Access and the Behavioral Sciences: Ideas, Realities and Possibilities.

One of the antecedents of the family medicine movement was the community mental health movement. An outgrowth of community mental health activities in the 1950s was the perception that family physicians of the future should have an intensive knowledge of the behavioral sciences. Thus the emphasis on behavioral science has been a core component of family residency training from its beginnings. How has this core value impacted family practice over time? A team will be formed to discuss this subject and define the questions to be presented as National Grand Rounds at the Eleventh National Conference in Kaua'i in 2000.

Members
Coastal Research Group
Policy Analysis Committee

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