1. FAMILY MEDICINE AT ITS PEAK Amy Russell, MD Medical Director MAHEC/MMA Primary Care Asheville, NC FAMILY MEDICINE AT ITS PEAK Amy Russell. MD Medical Director MAHEC/MMA Primary Care April 2015

2. Presentation Goals  Why Primary Care is Important  Why recruit Family Medicine  How to recruit Family Medicine

3. Primary Care Vital to Health Care Future

4. How are we doing?

5. 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.

6. Personal physician: primary care vs specialist  33% lower cost of care  19% less likely to die Frank et al. J Fam Pract 1998;47:105-9

7. Why is Primary Care Important  Primary Care Physicians are Comprehensive  Common symptoms –dizziness, fatigue  As our population ages more people have multiple problems  Primary Care providers have flexible skills to meet the needs of the population  Focus on population needs  Focus on Prevention

8. Why Family Medicine  Approximately 90% of Internal Medicine subspecialize  Approximately 50% of Pediatrics subspecialize  Affordable Care Act  In Western North Carolina needs 140 primary care physicians

9. How are we doing?  American Association of Medical Colleges  Projects a shortage of 124,000 physicians by 2020  37 % or 46,000 should be primary care doctors.  16 -32 million newly insured  Greatest crisis in rural areas  WNC 142 Primary Care physicians short

10. 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]

11. Designing the Primary Care Practice of the Future  Different patents have different needs  Routine preventative services  Same-day acute care  One or two chronic conditions  Multiple illnesses and complex healthcare needs.  Mental health and substance abuse needs.  Complex social circumstances  Others require palliative care and end-of –life care.

12. Determinants of Health in US: 5% Environmental Health Care 10% 15% Social Circumstances 30% Genetic predisposition Behavioral Patterns 40% Schroeder, NEJM 2007;357:1221-8

13. Pyramid of Care <1 5 9 250 750 1000 Adapted from White KL, et al. N Engl 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

14. Designing the primary care practice of the future  Designing care for patients in the clinic  Clinical guidelines  Team based care  BH integration  Pharmacy integration  Group visits  Self-management support  Designing care for patients who are not in the clinic  Outreach  Phone and e-mail care  Transitions of care  Coordinating care across the continuum

15. Team Based Care -The Model of the Future 4 FTEs of Provider 8 FTEs of Medical Assistant/Scribe 1 Nurse Team Manager 1 Care Coordinator 1 Behavioral Health Professional ½ Pharmacist 2 Office Technicians/ Front Desk 1 IT Support ½ Referral Case Manager ½ Dental Hygienist

16. Recruit and Retain  What do you need?  For what positions are you being asked to recruit?  Outpatient adult medicine  Geriatrics  Outpatient Family Medicine  Inpatient and outpatient  OB

17. What do you think the family doctors want?  Money  Lifestyle  Control  Not to be dumped on  Not to have to worry about the business side

18. What do you think the family doctors want?  See varied groups of patients  Do a variety of things  Loan Repayment  Money

19. To Recruit, you (and your hospital system) have to be creative FQHC model Encourage/allow newborns and kids Prenatal care Procedures Teaching – Need time and money Colleagues HPSA score Spouse Potential spouse

20. To Recruit, you (and your hospital system) have to be creative  Sponsor a rotation  Sponsor an extra resident  Critical Access Hospitals

21. The Product is Heterogeneous  455 family medicine residency programs  Areas of the country of different strengths  Programs have different strengths  Individual physicians have different strengths

22. Summary  You know why you need to recruit  Hopefully you learned something about how to recruit