Family medicine residency programs have begun "talking the talk" of the new model of care described in the Future of Family Medicine report. But "walking the walk" has proved more difficult. That's because the new model of care doesn't exist. Yet.
"The new model of care is just that," said William Mygdal, Ed.D. "It's a model; it's a sketch; and it's very complex with many pieces that are interdependent."
Thus, while family medicine residency programs teach the principles of the new model of care, directors must recognize they can implement that model only in steps. And each of those steps may require long periods of planning, negotiating and collaborating.
Mygdal, president of the Society of Teachers of Family Medicine and director of the Family Practice Faculty Development Center in Waco, Texas, made his comments during "How Do We Prepare to Teach the New Model (When We Haven't Yet Experienced It)?!?!" at the Workshop for Directors of Family Medicine Residencies June 5 - 7 in Kansas City, Mo.
Like their counterparts in private practice, residency program directors grapple with reticent partners in the health care community, conflicting scheduling needs, resistant colleagues (in this case, faculty) and -- always -- limited financial resources. But they can find answers to such challenges by brainstorming, planning, negotiating and collaborating, said Mygdal.
First, he advised, recognize that the new model of care described in the Future of Family Medicine report is a process, not a product, and that it evolves.
"Program directors have to decide what they're going to start with, how to prioritize their goals," said Mygdal.
The first step: "Identify your 'sweet spot,' where there is a convergence of your economic drivers with what you do best and what you are passionate about," said Mygdal. That may be group visits, open-access scheduling, electronic health record systems or multidisciplinary care teams.
By emphasizing the program's strengths, residency directors begin the building process. Early successes justify expansion into additional new model practices.
Step two: Identify barriers to and driving forces for change, then determine which of the barriers can be altered in a way that encourages progress toward meeting a goal of the new model.
Workshop participants agreed barriers begin to fall when office staff, residents, resistant faculty and reticent partners such as hospital leadership join the planning process. Moreover, as planning partners become more involved, they can be converted into driving forces.
Among goals identified by workshop participants:
- Implement EHR systems that can interoperate with systems at hospitals, pharmacies and other partners.
- Provide open-access scheduling that meets residents' educational and experiential needs, as well as patients' needs.
- Offer e-mail and Web-based visit services to patients and receive payment for those services.
- Establish group visits for patients.
- Redesign office workflow to capitalize on the efficiencies of EHRs.
Meeting such goals over time will transform residency training programs into new model practices that teach by example, said Mygdal.
