Family medicine is a model of care that focuses on caring for patients of all ages throughout their lives, with an emphasis on understanding the whole person and the communities where they live. Today, family physicians are in high demand due to the increased awareness of the importance of primary care in realigning our health care system to support the triple aims of the Accountable Care Act (ACA); better health care for individuals, better health outcomes in the community, and lower health care costs.
Family medicine has always relied on the same core principles as the ACA: comprehensive, coordinated and continuous primary care; preventive care; and the sophisticated implementation of health information technology designed to promote communication between health care providers, enhance care coordination, minimize duplication of services, and support reporting on quality. Family Medicine is uniquely positioned to provide a leadership role in health-reform efforts that are accelerating across the country, including the patient-centered medical home model, health homes, and accountable care organizations.
The History of Family Medicine
In 1930, 80% of physicians were general practitioners. By 2011, only 32% of physicians were in general practice, a category that includes family medicine, general internal medicine, and general pediatrics.1 This decrease can be attributed to medical discoveries and advancement of medical technology throughout the 20th century, as well as a trend toward specialization in the physician community that began during World War II when medical students who pursued specialty residency training, were given military exemptions.2
To increase the number of generalists, the American Academy of General Practice was established in 1947. In 1969, the AAGP was replaced by The American Board of Family Practice, and in 1970, the first family-medicine certifying exam was offered. Some hoped this would spur a rebuilding of a health care model in which every American had a personal physician. Yet despite an increase of health care activism, including the creation of the federal Medicare and Medicaid programs and the community health center (CHC) movement, the proportion of physicians in general practice continued to decline as older general practitioners retired and were not yet replaced. Recently, family-medicine residency programs have experienced an increase in both the number of positions offered and the number of residents recruited.3,4 The widespread acknowledgement of a broken health care system and the developing vision for reform are influencing these trends.
Trained to Care for Communities
The centerpiece of family medicine training is a three-year residency in an ambulatory setting caring for pediatric, adult, and geriatric patients, which includes prenatal care, delivery, and postpartum care, as well as care for chronic illnesses. Training also incorporates robust experience in human behavior and mental health under the direction of interdisciplinary teams that include family physicians, psychiatrists, and behavioral scientists. Residents coordinate preventive care and treatment, as well as referrals, consultations, and psychosocial needs with a multidisciplinary team; manage inpatient care for patients requiring hospitalization; and conduct group and home visits.
Family physicians are often drawn to practice in underserved rural and urban communities. Many work at federally designated health centers, which provide services to more than 20 million Americans.5 These centers are ideally suited to family physicians’ ability to provide a broad range of services to patients of all ages based on a patient-centered approach, and their interest in working with community resources.
Health Care Reform and Family Medicine
The need to reform the delivery of health care in the United States is widely recognized, with the often-stated goals of improving health care outcomes, increasing the quality and safety of care, improving patient satisfaction, and decreasing costs. Equally important is increasing access to care for people in medically underserved urban communities and rural areas, as well as those who are uninsured and underinsured. These goals will undoubtedly be achieved through more coordinated, continuous, patient-centered care.
As providers who can care for patients of all ages, family physicians are an especially important component of the health-reform goals of increasing access to care. Family physicians are primed for this role, as they are taught to serve as partners to patients to help them maintain well being, empower them with information and guidance needed to self-manage, provide care that promotes behavior change that leads to better health within the context of their social and economic circumstances, and cultivate ongoing communication.
With its broad scope of training, emphasis on preventive care and care coordination, and use of community-based resources, family medicine is well positioned to lead the way toward change.
Mount Sinai, and its family medicine partner, the Institute for Family Health, will celebrate our collaborative efforts to expand care in underserved areas on Monday, June 9, 2014 at the Primary Care Development Corporation’s Annual Spring Gala. Dr. Arthur A. Klein, President of The Mount Sinai Health Network, and I are honored to be recognized at the prestigious event. We hope you will join us.
Click here for more information about the 2014 Gala.
Neil S. Calman, MD
Professor and Chair
Department of Family Medicine and Community Health,
Icahn School of Medicine at Mount Sinai
President of CEO
The Institute for Family Health
References:
1. Council on Graduate Medical Education. Twentieth Report: Advancing Primary Care. Rockville, MD: U.S. Department of Health and Human Services; 2010.
2. Stanard JR. Caring for America: The Story of Family Practice. Virginia Beach, VA: Donning Co. Publishers; 1997.
3. Biggs WS, Bieck AD, Pugno PA, et al. Results of the 2011 National Residency Matching Program. Fam Med 2011; 43: 619–624.
4. American Academy of Family Physicians. 2012 match summary and analysis. http://www.aafp.org/online/en/home/residents/match/summary.html#Parsys68643. Accessed May 27, 2012.
5. Rosenblatt RA, Andrilla CH, Curtin T, et al. Shortages of medical personnel at community health centers: implications for planned expansion. JAMA 2006; 295: 1042–1049.