Family Medicine at its Peak
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Family Medicine at its Peak

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Family Medicine at its Peak

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Family Medicine at its Peak

Amy Russell, MDMedical Director MAHEC/MMA Primary Care Asheville, NC

Family Medicine at Its Peak

Amy Russell. MD

Medical Director MAHEC/MMA Primary Care

April 2015


Presentation Goals

Why Primary Care is ImportantWhy recruit Family MedicineHow 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 specialist33% lower cost of care19% less likely to die

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


Why is Primary Care Important

Primary Care Physicians are ComprehensiveCommon symptoms –dizziness, fatigueAs our population ages more people have multiple problemsPrimary Care providers have flexible skills to meet the needs of the population Focus on population needsFocus on Prevention


Why Family Medicine

Approximately 90% of Internal Medicine subspecializeApproximately 50% of Pediatrics subspecializeAffordable Care ActIn Western North Carolina needs 140 primary care physicians


How are we doing?

American Association of Medical CollegesProjects a shortage of 124,000 physicians by 202037 % or 46,000 should be primary care doctors. 16 -32 million newly insuredGreatest crisis in rural areasWNC 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 needsRoutine preventative servicesSame-day acute careOne or two chronic conditionsMultiple 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:



Health Care 10%

15% Social Circumstances

30% Genetic predisposition

Behavioral Patterns 40%

Schroeder, NEJM 2007;357:1221-8


Pyramid of Care







Adapted from

White KL, et al. N


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 clinicClinical guidelinesTeam based careBH integrationPharmacy integrationGroup visits Self-management support

Designing care for patients who are not in the clinicOutreachPhone and e-mail careTransitions of careCoordinating care across the continuum


Team Based Care -The Model of the Future


FTEs of Provider


FTEs of Medical


1 Nurse Team Manager

1 Care Coordinator

1 Behavioral



½ Pharmacist

2 Office Technicians/ Front Desk


IT Support

½ Referral Case Manager

½ Dental



Recruit and Retain

What do you need?For what positions are you being asked to recruit?Outpatient adult medicineGeriatricsOutpatient Family MedicineInpatient and outpatientOB


What do you think the family doctors want?

MoneyLifestyleControlNot to be dumped onNot to have to worry about the business side


What do you think the family doctors want?

See varied groups of patientsDo a variety of things Loan RepaymentMoney


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

FQHC modelEncourage/allow newborns and kidsPrenatal care

ProceduresTeaching Need time and moneyColleagues HPSA score

SpousePotential spouse


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

Sponsor a rotationSponsor an extra residentCritical Access Hospitals


The Product is Heterogeneous

455 family medicine residency programsAreas of the country of different strengthsPrograms have different strengthsIndividual physicians have different strengths



You know why you need to recruitHopefully you learned something about how to recruit