Introduction to Family Medicine
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1 Introduction to Family Medicine RADE N. PEJIC, M.D. ASSOCIATE PROFESSOR OF FAMILY MEDICINE
2 Academic Background Tulane University: BS in cell & molecular biology Tulane University: MD UCLA-Santa Monica: Residency in FM UNC-Chapel Hill: Faculty development fellowship Tulane University: Masters of medical management
3 Professional Background Malibu Urgent Care Center Lallie Kemp-LSU ER Riverside Medical Center ER Westbank Urgent Care Rivard Juvenile Detention Center TMC Touro Kindred LTAC Nursing homes
4 I know what family medicine doctors do. A. Strongly Agree B. Agree C. Somewhat Agree D. Neutral E. Somewhat Disagree F. Disagree G. Strongly Disagree 14% 14% 14% 14% 14% 14% 14%
5 I want to be a family medicine doctor A. Yes, of course I do B. Not sure yet C. No D. Definitely not E. What s family medicine? 20% 20% 20% 20% 20%
6 What is Family Medicine We specialize in YOU!
7 What is family medicine? Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.
8 History of Family Medicine 1946: AMA establishes section on general practice 1966: Millis, Folsom, and Willard reports recognizes value of family medicine 1969: American Board of Family Medicine established as the 20 th medical specialty
9 Principles of family medicine Biopsychosocial model of care Comprehensive: all ages/stages Contextual and community based Continuous care over time Coordination of complex care
10 Spectrum of Care Adults/Elderly Children/Infants Women/Maternity care
11 Spectrum of Care Clinic Hospital ER Urgent care Nursing home Student health center
12 Care Triad Acute Chronic Preventive *Problems encountered in the practice reflect the patterns of illness which exists in the community
13 Specialists in Common Problems Common problems are common Uncommon presentations of common problems are common Common problems are frequently the most important health issue to patients
14 Uncertainty Point of first contact Vague, undifferentiated complaints Large differential Mostly low-risk problems but laced with landmines
15 Top 25
16 Why choose family medicine Job satisfaction/flexibility Professionally challenging Personally rewarding Job security/ability to practice anywhere Important to society
17 Societal impact Lower cost of care Lower mortality Increased patient satisfaction
18 Residency training 480 FM programs (as of 2015) Offering 3260 PGY-1 slots 3 to 4 years Train in multiple settings Outpatient continuity clinic Learn most office-based procedures
19 CAQ Sports medicine Geriatrics Adolescent medicine Sleep medicine Hospice/palliative care
20 Other fellowships Emergency medicine Faculty development Integrative health Headache HIV International OB Preventive medicine Research Rural Substance abuse Women s health
21 Types of residencies University based University affiliated Community Military
22 Types of residencies Opposed Un-opposed
23 Income Average 1 st year salary: $150, ,000 Average salary: $227,541
24 FM vs. IM??? Family Medicine Internal Medicine Primary care emphasis Womb to tomb care Well-woman care Basic OB care Behavioral health Office based? Procedural Specialty emphasis Adult care Not too much gyn No OB Behavioral heatlh +/- Hospital based? Procedures +/-
25 FM vs. ER??? Family Medicine Emergency Medicine Clinic setting Regular business hours Call Continuity of care Responsible for patient all of the time ER Shift-work No call Acute/episodic care Only responsible for patient while in the ER
26 FM vs. Med-Peds??? Family Medicine Medicine-Pediatrics Primary care OB/Gyn More procedural Clear job description Easy to find job Many specialize No OB, some gyn? Less procedural Less clear job description Usually have to join FM group or pick IM vs Peds
27 Patient-Centered Medical Home The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." Medical homes can lead to higher quality and lower costs, and can improve patients and providers experience of care.
28 Patient-Centered Medical Home Personal physician Physician-directed medical practice/team Whole-person orientation Care that is coordinated/integrated Quality/safety Enhanced access New payment model
29 Final thoughts Family medicine is primary care Increased access to primary care results in better health outcomes and lower cost Family medicine is leading the way for how care is delivered, e.g. PCMH Advocates for health equity
30 Resources AAFP: ABFM: Robert Graham Center: Tulane department of family medicine
31
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