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