ABSTRACT
A group of senior leaders from the early generation of academic family medicine reflect on the meaning of being a personal physician, based on their own clinical experiences and as teachers of residents and students in academic health centers. Recognizing that changes in clinical care and education at national and local systems levels have added extraordinary demands to the role of the personal physician, the senior group offers examples of how the discipline might go forward in changing times. Differently organized care such as the Family Health Team model in Ontario, Canada; value-based payment for populations in large health systems; and federal changes in reimbursement for populations can have positive effects on physician satisfaction. These changes and examples of changes in medical student and residency education also have the potential to positively affect the primary care workforce. The authors conclude that, without substantive educational and health system reform, the ability to truly serve as a personal physician and adhere to the values of continuity, responsibility, and accountability will continue to be threatened.
Subject(s)
Delivery of Health Care/trends , Family Practice/trends , Personal Satisfaction , Physician-Patient Relations , Physicians, Family/psychology , Primary Health Care/trends , Academic Medical Centers/trends , Delivery of Health Care/methods , Family Practice/education , Family Practice/methods , Health Care Reform , Humans , Internship and Residency , Leadership , Patient Protection and Affordable Care Act , Physicians, Family/education , Primary Health Care/methods , Students, Medical , United StatesABSTRACT
Ontario's Family Health Team (FHT) model, implemented in 2005, may be North America's largest example of a patient-centered medical home. The model, based on multidisciplinary teams and an innovative incentive-based funding system, has been developed primarily from fee-for-service primary care practices. Nearly 2 million Ontarians are served by 170 FHTs. Preliminary observations suggest high satisfaction among patients, higher income and more gratification for family physicians, and trends for more medical students to select careers in family medicine. Popular demand is resulting in expansion to 200 FHTs. We describe the development, implementation, reimbursement plan, and current status of this multidisciplinary model, relating it to the principles of the patient-centered medical home. We also identify its potential to provide an understanding of many aspects of primary care.
Subject(s)
Health Promotion/methods , Models, Organizational , Patient-Centered Care/methods , Quality of Health Care/standards , Delivery of Health Care/organization & administration , Humans , Ontario , Program Development , Program EvaluationSubject(s)
Family Practice/organization & administration , Patient Care Team , Patient-Centered Care , Primary Health Care/organization & administration , Reimbursement Mechanisms , Age Factors , Capitation Fee , Female , Humans , Male , National Health Programs , Ontario , Primary Health Care/legislation & jurisprudence , WorkforceABSTRACT
We predict that population growth and aging will increase family physicians' and general internists' workloads by 29 percent between 2005 and 2025. We expect a 13 percent increased workload for care of children by pediatricians and family physicians. However, the supply of generalists for adult care, adjusted for age and sex, will increase 7 percent, or only 2 percent if the number of graduates continues to decline through 2008. We expect deficits of 35,000-44,000 adult care generalists, although the supply for care of children should be adequate. These forces threaten the nation's foundation of primary care for adults.
Subject(s)
Health Services Needs and Demand/trends , Internship and Residency , Physicians, Family/supply & distribution , Adult , Forecasting , Humans , Internal Medicine/trends , Pediatrics/trends , Physicians, Family/trends , Population Growth , United States , Workforce , WorkloadSubject(s)
Family Practice , Medically Underserved Area , Physicians, Family/supply & distribution , Professional Practice Location , Rural Health Services , Career Choice , Family Practice/education , Gynecology/education , Humans , Internal Medicine/education , Obstetrics/education , Pediatrics/education , Personnel Loyalty , Personnel Turnover , Practice Management, Medical , United States , Utah , WorkforceABSTRACT
Throughout the past century rural health care has been dependent upon general practitioners (GPs) and their successors, family physicians (FPs). Only FPs and GPs have practiced in rural areas in proportion to the population, then and now. As specialization occurred, numbers of GPs declined and physician shortages developed in rural areas. The creation of family practice residencies in the 1970s halted this decline, but rural shortages persist today. During the 1990s the number of allopathic and osteopathic FP residency graduates rose 54 percent. At the same time, the percentage of women enrolled in these residencies increased to 46 percent, and women have been less likely than men to select rural practice. We project that if current numbers of graduates continue, the nonmetropolitan FP/GP-to-population ratio will increase 17 percent by the year 2020. However, today, medical students' interest in primary care residencies (including family practice) is declining precipitously. If numbers of FP graduates return to 1993 levels, the density of FPs in rural America and in the nation as a whole will decline after 2010.
