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Family Medicine

Family Medicine. Special People Providing Special Health Care. Overview. History Core Values Who are Family Physicians Options and Opportunities Questions. History. Early 1900’s – formalization of medical training 1930-1950- advances in therapeutics

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Family Medicine

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  1. Family Medicine Special People Providing Special Health Care David M. Deci, M.D.

  2. Overview • History • Core Values • Who are Family Physicians • Options and Opportunities • Questions David M. Deci, M.D.

  3. History • Early 1900’s – formalization of medical training • 1930-1950- advances in therapeutics • 1950-1965- Post WWII focus on technology • 1965-1975- consumer movements • 1985-2000- managed care • 2014 – Family Medicine for America’s Health -Future of Family Medicine 2.0 David M. Deci, M.D.

  4. Core Values of Family Medicine • Respect- recognizing the value of all persons as unique individuals and deserving of quality care • Integrity– utilizing critical thinking and intellectual curiosity honestly and within acknowledged limits to balance conflicting medical, psychosocial, and spiritual priorities David M. Deci, M.D.

  5. Core Values of Family Medicine • Integration- implementing comprehensive care for the whole person within the context of family, community, and culture • Collaboration- actively engaging the skills, talent and resources of medical colleagues, other healthcare professionals and community organizations in a patient-centered environment David M. Deci, M.D.

  6. The New Practice ModelAAFP 2014 • Patient-centered team approach • Elimination of barriers to access • Advanced information systems, including electronic health records • Redesigned, more functional offices • Focus on quality and outcomes • Enhanced practice finance David M. Deci, M.D.

  7. The Real Story… • Nice people • Value relationships • Manage complexity • See both the forest and the trees • Integrated within the community • Patient centered • Health promotion and advocacy David M. Deci, M.D.

  8. Who are US Family Physicians ?Figures from AAFP April 2015 • 135,000 members AAFP • Worldwide spread of specialty • Direct patient care 90% • Administration 11% • Teaching 5% • Research 1% David M. Deci, M.D.

  9. Who are US Family Physicians ?Figures from AAFP 12.31.16 • Clinical practice • Inpatient 36.2% • ICU 16.6% • Hospice 31.1% • Pediatrics 73.1% • Obstetrics 17.1%% • Sports med 38.7% photo courtesy of shutterstock.com David M. Deci, M.D.

  10. Who are US Family Physicians?Figures from AAFP 12.31.16 • Practice location • Office 83.0% • Hospital 3.7% • ER 3.0% • Urgent Care 3.5% Urban 83.6% photo courtesy of shutterstock.com Rural 16.4% David M. Deci, M.D.

  11. Who are US Family Physicians?Figures from AAFP 2014 • Practice Type • Solo 14.9% • Group 21.9% • Comm Health Ctr 8.3% • ER 3.3% • Urgent Care 3.3% • Hospital 3.1% David M. Deci, M.D.

  12. Typical Practice Hours(AAFP December 2014) • Worked average of 47 weeks per year • 34 hours per week direct patient care • 16 hours per week indirect patient care • Per week: • 78 office visits • 4 hospital visits • 2 nursing home visits • 2 e-visits David M. Deci, M.D.

  13. Family Physician Procedures(AAFP 12.31.16 • Dermatological procedures 73.4% • Vasectomy 7.6% • Colposcopy 16.1% • Cardiac Stress Test 6.7% • Colonoscopy 2.4% • Ultrasound 13.6% David M. Deci, M.D.

  14. In Wisconsin • 2,500 Family Physicians • 23 % rural • 77 % urban • 57% do deliveries • 96% treat children • 59% men • 41 % women Figures courtesy of WAFP 2010 Photo courtesy of dustydavis.com David M. Deci, M.D.

  15. Impact of Family Medicine Family Physicians Contribute Significantly to Emergency Care of Medicare Patients in Urban and Suburban Areas Family Physicians provide 12% of ER care – in urban settings One Pagers | Sep 15, 2015 Gerald Banks, MD, MS; Peter Wingrove, BS; Stephen Petterson, PhD; and Kathleen Klink, MD David M. Deci, M.D.

  16. Impact of Family Medicine Over half (55.3%) of (rural) hospitals have family physicians doing deliveries; in 32% of hospitals, family physicians perform cesarean deliveries. The Rural Obstetric Workforce in US Hospitals: Challenges and Opportunities Katy B. Kozhimannil PhD, et. al. First published: 23 March 2015 David M. Deci, M.D.

  17. Impact of Family Medicine Patients With High-Cost Chronic Conditions Rely Heavily on Primary Care Physicians However, a majority of patients seeking care for most of 14 high-cost chronic conditions, for example hypertension, were more likely to see a primary care physician than a specialist physician (69% vs. 24%, respectively). From the Evergreen Health Cooperative, Baltimore, MD (MAS); the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (NC, MM, MC, AWB). David M. Deci, M.D.

  18. Impact of Family Medicine FPs Lower Hospital Readmission Rates and Costs Adding one FP per 1,000 population, or 100 per 100,000 (adjusted for mortality, sociodemographics, and hospital characteristics), reduces readmission odds for these three conditions (pneumonia, heart attack, heart failure) by 7 percent, 5 percent, and 8 percent. One Pagers | May 01, 2011Veerappa K. Chetty, PhD; Larry Culpepper, MD, MPH; Robert L. Phillips, Jr., MD, MSPH; Jennifer Rankin, PhD, MPH, MS, MHA; Imam Xierali, PhD; Sean Finnegan, BS; and Brian Jack, MD David M. Deci, M.D.

  19. Getting from Here to There… • Seek out mentor relationships • Seek out community based experiences • Talk to students, residents, faculty • Spend time finding the “real you” • Consider practice location, family needs, potential for growth • Be an empowered graduate applicant David M. Deci, M.D.

  20. Residency Training in Family Medicine • Three years – 580+ programs! • Outpatient based – your own practice • Skill development in: • Prenatal care and vaginal deliveries • Minor surgical procedures • Acute care including minor trauma/ortho • Chronic disease management • Behavioral health • Community health David M. Deci, M.D.

  21. Follow Your Passion with a Fellowship • Adolescent Medicine • Emergency Medicine • Faculty Development • Geriatrics • Hospice/Palliative Care • International • Obstetrics • Preventive Medicine • Research • Rural Medicine • Sports Medicine • Substance Abuse • Women’s Health David M. Deci, M.D.

  22. Family Medicine in demand David M. Deci, M.D.

  23. This Year’s Family Medicine WI Graduates • 80% found “easy to secure a job” • 60 % received debt reduction package • Average salary offer $210,000 David M. Deci, M.D.

  24. Options and Opportunities • Traditional comprehensive practice model • Office based care only • Urgent Care • Emergency Room Care • Public Health • Underserved communities with Federal Clinics David M. Deci, M.D.

  25. Options and Opportunities • Global health/mission based care • Part-time work with job sharing • Home based care/hospice • Medical consultation/public education • Academic medicine • Military medicine David M. Deci, M.D.

  26. Are YOU Family Medicine Material? • Do you value relationships? • Do you enjoy patient stories? • Do you appreciate the influence of psychosocial and spiritual factors upon personal well being? • Do you feel comfortable with uncertainty? David M. Deci, M.D.

  27. Are YOU Family Medicine Material? • Do you feel comfortable measuring success in weeks, months or years? • Do you enjoy using your brain, your hands and your heart? • Do you desire connection with community? • Do you enjoy health promotion and public health? David M. Deci, M.D.

  28. Do you desire to make a profound difference in the lives of those you serve? Are YOU Family Medicine Material? David M. Deci, M.D.

  29. My Own Journey In Family Medicine • Making a difference in the lives of others – (sometimes delayed) • Developing long term therapeutic relationships • Walking beside my patients • Community engagement David M. Deci, M.D.

  30. Questions? David M. Deci, M.D.

  31. Current Focus for American Academy of Family Physicians • Patient-Centered Medical Home (? All things new – again ?) • Payment Reform • Quality Improvement • Electronic Medical Records • Access to Care • Workforce Development David M. Deci, M.D.

  32. Physician Salary ComparisonsUS Median Pre-Tax IncomeAmerican Medical Group Association 2013 Compensation and Financial Survey • FM $223,258 • Peds 222,827 • GIM 226,833 • ER 302,000 • OB 312,541 • Gen Surg $373,478 • Derm 411,499 • Diag Rad IR 504,722 • Ortho 525,00 • Card IV 547,112 David M. Deci, M.D.

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