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Family Medicine (Important and It’s Future)

R.AskariPh.D. Student in Health Services ManagementEmail: r.asqari@yahoo.com

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Your Future is Family Your Future is Family MedicineMedicine

Information, facts and answers to frequently asked questions about

family medicine

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Why is primary care Why is primary care important?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 hospital use better preventive care reduced health disparities

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What do family physicians What do family physicians do?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

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Family physicians Family physicians provideprovide 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

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What FP attributes are What FP attributes are valued?valued?

Deep understanding of the whole person

Act as a partner to patients over many years

Talent for humanizing health care

A command of complexitySource: 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 collaborative project of the family medicine community. Ann Fam Med. 2004 Mar-Apri; 2 Suppl 1:53-32Mar-Apri; 2 Suppl 1:53-32 8

Family physicians’ whole-person Family physicians’ whole-person orientation and training ensures orientation and training ensures that FPs…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

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Family physicians have a Family physicians have a unique influence on unique influence on patients’ livespatients’ lives

Serving as partner with patients to maintain well-being 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 10

Family physicians are Family physicians are relationship-oriented, which relationship-oriented, which ensures… 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.

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Family physicians have a Family physicians have a natural command of natural command of complexity andcomplexity 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

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How are family physicians How are family physicians trained?trained?

3 years More than 400 family medicine residencies Community-based Medical school-based Military Inner-city Urban Suburban Rural Innovative Training Models

Family medicine residencyFamily medicine residency clinical clinical curriculum curriculum

Adult medicine Critical care medicine

Maternity care Gynecologic care

General surgery Orthopedics

Emergency care Care of children

Skin care Human behavior

Women’s health Newborn care

Continuity Patient Care – all 3 years

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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

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What distinguishes family What distinguishes family physicians from general physicians from general internists?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 gender of patients seen by family physicians and general internists

Source:

National Center for Health Statistics: Chart book on Trends in the health of Americans: 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

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What’s a typical week in What’s a typical week in primary care?primary 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

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People rely on primary care People rely on primary care physicians to care for complex physicians to care for complex diseasedisease

Source: 2002 National Health Interview Survey

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%

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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

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Lifestyle of Family Lifestyle of Family Physicians?Physicians? 39.7 hours per week in direct patient

care1 50 hours per week in patient related

activities Avg. wks worked – 46.9 weeks 1

5 weeks for vacation/CME 1

Avg. Income for 2006: $161,000 2

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.

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Are family physicians in Are family physicians in demand?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

11 Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting Merritt Hawkins & Assoc. 2007 Review of Physician and CRNA Recruiting Incentives. Oct 2007Incentives. 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.

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The WHO framework The WHO framework statementstatement

General Continuous Comprehensive Coordinated Collaborative Family orientated Community orientated

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The principles of the The principles of the discipline as suggested by discipline as suggested by GayGay• Patient centered approach • Orientation on family and

community context • Field of activities determined by

patient needs and requests • Unselected and complex health

problems • Low incidence of serious diseases • Diseases at early stage • Continuing management • Coordinated care • Efficiency

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The WONCA 1991 statement The WONCA 1991 statement includes the followingincludes the following

Comprehensive care Orientation to the patient Family focus Doctor/patient relationship Co-ordination with other

services Advocacy Accessibility resource management.

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What’s the future of family What’s the future of family medicine?medicine?

Electronic health record (EHR)

Online appointments

Web-based patient education

E-visits

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Innovations in family Innovations in family medicinemedicine

Group visits

Team approach to care

Systematic approach to care

Chronic disease management

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Future of family Future of family medicinemedicine Market research

Six task forces

Family medicine’s new model of care

Personal medical home

Continuous relationship

Basket of services

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