In an era of transition, family medicine residency programs must teach residents to provide the medical care of the future before that future has arrived.
It’s a challenge that about 715 directors, faculty and staff grappled with during the 30th annual Residency Assistance Program Workshop for Faculty and Staff of Family Medicine Residencies April 3 - 5. And while they learned more about the new model of care for which they are training tomorrow's family physicians, they also pondered how to prepare residents for the current world of medical practice.
"You are the source of tomorrow's family physicians, and our members are out there waiting for them to join their practices and help make that new model a reality," said John Bucholtz, D.O., program director of the Columbus Family Practice Residency in Columbus, Ga., and past president of the Association of Family Medicine Residency Directors. Referring to recommendations in The Future of Family Medicine report, which includes a new model of care, he said, "Our challenge is how we're going to put these into our residency programs."
Bucholtz reviewed components of the new model within the context of residency training during "Implementing the New Model of Family Medicine Into Family Practice Residencies: Challenges and Opportunities."
Adoption of electronic health records -- "the central nervous system of the new model of care" -- represents a prime example of residency programs spurting ahead of the practicing medical community.
Incoming residents expect training programs to use EHRs, according to Steven Waldren, M.D., assistant director of the AAFP Center for Health Information Technology.
“By 2006, your residency program will be at a substantial recruiting disadvantage if you don’t have at least plans to move to electronic health records,” he said during “Migrating a Residency to EMR: ChiT-Facilitated Panel Discussion."
One in three family medicine residency programs has heard the message and implemented EHRs, dwarfing the rate for community-based physicians, said Bucholtz. Those programs' graduates will pave the way for private practices that want someone with hands-on expertise to help them implement paperless patient care.
The real-world lag emphasizes the importance of teaching advanced practice management. Such programs train residents to connect clinical activities such as charting and note-taking to business operations activities such as billing, scheduling, making and tracking referrals, and writing prescriptions, said Bucholtz.
Likewise, residency programs must instill commitment to a team approach to care and a full basket of services, regardless of whether the graduates will provide all those services within their own practices.
Family medicine residencies will continue to teach maternity care, hospital-based care and other elements in the new model's full basket of services, said Bucholtz. But new graduates may not be able to provide all those services themselves.
"We have to train full-service family doctors so they can at least structure their practices to provide the new model's full basket of services," said Bucholtz. "When they graduate into a one- or two-person practice, they aren't going to have that many people on the bench."
The answer to securing the full range of services for patients, he said, lies in teaching the residents how to "work harmoniously within the community among those who provide the services you don't and who will ensure your patients come back to their medical home."
Family medicine residency programs are “the tip of the spear” in making the new model of care a reality, said Bucholtz. Residents who graduate with skills to implement the new model of care can realize a 26 percent increase in physician compensation over current practice systems, according to the FFM Task Force Six Report on Financing the New Model of Family Medicine. Moreover, said the report, if all primary care physicians adopted the new model of practice, and every American received care from them, the nation would see a 5.6 percent reduction in health care costs, or $67 billion per year in savings.
