FAMILY MEDICINE AT ITS PEAK

Amy Russell, MD

Medical Director MAHEC/MMA Primary Care

Asheville, NC

FAMILY MEDICINE AT ITS PEAK

Amy Russell. MDMedical Director MAHEC/MMA Primary CareApril 2015

Presentation Goals

Why Primary Care is Important Why recruit Family Medicine How to recruit Family Medicine

Primary Care Vital to Health Care Future

How are we doing?

Mortality Outcomes

Primary care physicians: 1 per 10,000 (20%) more primary care physicians decreases mortality by 40 per 100,000 (5% fewer deaths).

Family Physicians: 1 per 10,000 (33%) more family physicians results decreases mortality by 70 per 100,000 (9% fewer deaths).

Specialists: 1 per 10,000 (8%) more specialists increases mortality by 16 per 100,000 (2% more deaths).

Shi. J Am Board Fam Pract 2003;16:412-22.

Personal physician: primary care vs specialist

33% lower cost of care 19% less likely to die

Frank et al. J Fam Pract 1998;47:105-9

Why is Primary Care Important Primary Care Physicians are

Comprehensive Common symptoms –dizziness, fatigue As our population ages more people have

multiple problems Primary Care providers have flexible skills

to meet the needs of the population Focus on population needs Focus on Prevention

Why Family Medicine

Approximately 90% of Internal Medicine subspecialize

Approximately 50% of Pediatrics subspecialize

Affordable Care Act

In Western North Carolina needs 140 primary care physicians

How are we doing?

American Association of Medical Colleges Projects a shortage of 124,000 physicians

by 2020 37 % or 46,000 should be primary care

doctors. 16 -32 million newly insured Greatest crisis in rural areas WNC 142 Primary Care physicians short

How are we doing?

A PCP with a panel of 2500 will spend 7.4 hours per day doing recommended preventative care. [Yarnell et al. Am J Public Health 2003;93:635]

A PCP with a panel of 2500 will spend 10.6 hours a day doing recommended chronic care [ Ostbye et al. Annals of Family Med 2005;3:209]

National study of physician performance for 30 medical conditions plus preventative care: physicians provided only 55% of recommended care. [McGlynn et al. NEJM 2003; 348:2635]

Designing the Primary Care Practice of the Future

Different patents have different needs Routine preventative services Same-day acute care One or two chronic conditions Multiple illnesses and complex

healthcare needs. Mental health and substance abuse

needs. Complex social circumstances Others require palliative care and end-

of –life care.

Determinants of Health in US:

5%

Environmental Health Care 10%

15% Social Circumstances

30% Genetic predisposition

Behavioral

Patterns

40%

Schroeder, NEJM 2007;357:1221-8

Pyramid of Care

<1

5

9

250

750

1000

Adapted from White KL, et al. N Engl J Med 1961;265:885-92 and Green LR, et al. N Engl J Med 2001;344:2021-25.

Have symptoms

Visit usual source of care

Admit to community hospital

Refer to community consultant

Admit to academic hospital

Community size

Designing the primary care practice of the future

Designing care for patients in the clinic Clinical guidelines Team based care BH integration Pharmacy integration Group visits Self-management support

Designing care for patients who are not in the clinic Outreach Phone and e-mail care Transitions of care Coordinating care across the continuum

Team Based Care -The Model of the Future

4 FTEs of Provider8 FTEs of Medical Assistant/Scribe1 Nurse Team Manager1 Care Coordinator1 Behavioral Health Professional½ Pharmacist2 Office Technicians/ Front Desk1 IT Support ½ Referral Case Manager½ Dental Hygienist

Recruit and Retain

What do you need? For what positions are you being asked to

recruit? Outpatient adult medicine Geriatrics Outpatient Family Medicine Inpatient and outpatient OB

What do you think the family doctors want?

Money Lifestyle Control Not to be dumped on Not to have to worry about the business

side

What do you think the family doctors want?

See varied groups of patients Do a variety of things Loan Repayment Money

To Recruit, you (and your hospital system) have to be creative

• FQHC model• Encourage/allow newborns and kids• Prenatal care• Procedures• Teaching

– Need time and money• Colleagues • HPSA score• Spouse• Potential spouse

To Recruit, you (and your hospital system) have to be creative

Sponsor a rotation Sponsor an extra resident Critical Access Hospitals

The Product is Heterogeneous 455 family medicine residency programs Areas of the country of different

strengths Programs have different strengths Individual physicians have different

strengths

Summary

You know why you need to recruit Hopefully you learned something about

how to recruit