Click on this icon to go directly to online-only
content.
The death was sudden. Virtually no symptoms appeared until just before the end. By then, Renee Miskimmin, M.D., and the 33 family medicine residents she oversaw could do nothing to prevent the demise.
Citing a decision to focus on cardiology care, leaders of Hamot Medical Center of Erie, Pa., withdrew life support from the Hamot Family Practice Residency.
News of its demise jolted Pennsylvania family medicine. Waning medical student interest had haunted the specialty for a half-decade. Now the institutions that trained future family physicians seemed to be deserting the specialty.
To shut down in June 2004, the Hamot Family Practice Residency program is the state's third to close in two years. The program at Geisinger Health System, Danville, Pa., has already closed; the Meadville Medical Center Family Practice Residency will close soon.
Taking action, making plans
But Pennsylvania's family physicians are acting to stem the losses. The Pennsylvania AFP convened a statewide summit Oct. 10 in Harrisburg. There, family medicine educators reviewed challenges to the specialty and possible ways to recruit students to family medicine and enhance the specialty's prestige.
Any recruitment plan, they said, must address perceptions that family medicine is too broad and too difficult, or too broad and too superficial; that it is a research-poor specialty that rarely uses technology; or that family physicians are plagued with uncontrollable work hours filled with paperwork and reimbursement hassles.
Strong research is key
Some solutions, said summit participants, lie in primary care research initiatives.
Speakers urged colleagues to seek increased research funding from the NIH and other sources. Research opportunities abound, said speakers, in issues family physicians address on a daily basis. Programs with a strong research presence see an increase in prestige and student interest, said Jeannette South-Paul, M.D., chair of the family medicine department at the University of Pittsburgh School of Medicine.
Participants also agreed that early, positive exposure to family medicine could be a key to a medical student's decision to select the specialty.
Linda Kanzleiter, associate program director for the Pennsylvania Area Health Education Center in Hershey, suggested stronger alliances between AHECs and family medicine programs. The two share medical schools' workforce development goals, focus on primary care and offer ideal locations for student rotations, she said. As such, AHECs provide excellent exposure to the joys of family medicine, she suggested. Moreover, the Pennsylvania AHEC program, which traditionally has served rural areas, could shift focus to include urban sites, she said.
Hospitals determine programs' futures
Academic medical leaders have long acknowledged that the end of the residency programs demonstrated a fact of medical education life: The continued existence of many family residencies depends on the interest of community hospitals in serving as the residencies' educational homes.
"Family practice residency programs are particularly vulnerable" as a result of economic changes, said Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, in the June 2000 Family Practice Management. "More than 80 percent are based in community hospitals. … They typically serve disenfranchised patient populations and have little access to revenues from 'high-reimbursement' surgical procedures and specialty consultations that, for example, are available to surgical residency programs."
Because they don't generate as much income as residencies for high-tech specialties, family medicine programs may be seen as cost centers to hospitals. The danger: Hospital boards may opt to cut family medicine residencies in order to add or increase subspecialty slots, said John Jordan, chapter executive of the Pennsylvania AFP in Harrisburg.
"Hospitals may have different ideas, decide to go in different directions and develop different goals," he said. "In order to increase their residency slots in cardiology, they had to delete another program."
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.