Responses to questions about family practice as a career.
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Career Choice↗
Biomedical subjects
N B Kahn
Publications and source records attributed to N B Kahn.
Support services for family practice residents.
BACKGROUND: Internship and residency are stressful experiences for physicians in training. Residency programs vary in their provision of supportive services for residents. METHODS: A random sample of 50% of the nation's family practice residency programs was surveyed to determine the prevalence of 19 support services, 10 of which were assessed a decade previously. Programs were also asked about on-call frequency, vacation benefits, and program size. RESULTS: Approximately 91% of the programs responded. The surveys indicated that residents were on call an average of once every four nights, a 10% decrease from a decade ago. The prevalence of three support services had increased over the last decade: seminars and speakers on the stresses and conflicts of being a physician, support groups for residents, and child care services. "Night-float" rotations and part-time residencies are the least offered support services of those studied. CONCLUSIONS: Support for family practice residents is increasing, yet in many cases remains inadequate.
Family Practice↗
Obstetric care, Medicaid, and family physicians. How policy changes affect physicians' attitudes.
Recent expansion of Medicaid eligibility for pregnant women and increased reimbursement to physicians who provide perinatal services were designed to improve access to care. Family physicians provide a relatively high proportion of care to pregnant women on Medicaid, especially in rural areas. We surveyed all family physicians who provide obstetric services in 26 northern California counties regarding these changes and perceived barriers to providing obstetric care to women on Medicaid. Of surveyed physicians who limited the number of their Medicaid obstetric patients, 58% stated that recent Medicaid policy changes had increased their willingness to accept new Medicaid obstetric patients. Despite these policy changes, administrative issues and poor reimbursement were cited as the two most notable barriers to providing obstetric care to women on Medicaid. Fear of being sued by Medicaid patients is still seen as a barrier by physicians who have recently discontinued practicing obstetrics and by those who continue to care for a large number of Medicaid obstetric patients.
Attitude of Health Personnel↗
Congratulations, family practice residency graduates.
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Delivery of Health Care↗
Cost-benefit analyses of California family practice residencies.
Several national commissions have recommended that family practice residency training be subsidized, but without stating how much support is needed. Financial studies of graduate medical education have used the methods of cost allocation or joint-products cost analysis. Previous cost-allocation studies indicate that one third of family practice residency costs are met by extramural subsidy. Cost reports of eight California public hospitals with a single family practice residency program were evaluated for the 1984-85 fiscal year. Discrepancies in the education costs reported to Medicare and those reported in state hospital disclosure reports demonstrate the arbitrary nature of the cost-allocation method. The Medicare medical education reimbursement was an average of $20,444 per resident. State and federal grants provided an average of $5,190 per resident. The Medicare payments and grants met an average of 35.7% of the education costs reported to Medicare. A joint-products cost analysis was used to estimate the pure cost of education in an 18-resident family practice residency. Replacing the residency with salaried physicians would have decreased the hospital's net return by $143,534. If neither grants nor Medicare education payments had been received, elimination of the program would have increased hospital net return by $428,083.
California↗
A comparison of university-based and community-based family practice residency programs.
The issue of differences between university-hospital-based and community-hospital-based family practice residency programs was studied in a network that included five community programs and one large university program. American Board of Family Practice (ABFP) Intraining Examination scores and ABFP board certification scores indicated comparative cognitive knowledge. A graduate follow-up study compared post-residency experience of the graduates of both types of programs. Conclusions from the study showed little difference between subjects trained in the two types of programs. Differences in examination scores were not significant. Small differences in graduate perception of adequacy of preparation for content areas and in postresidency practice characteristics seemed equally insignificant, but were not amenable to statistical testing.
California↗
A process group approach to stress reduction and personal growth in a family practice residency program.
A family practice residency experience presents both stress and the opportunity for personal growth. One approach to focusing on these issues is a process oriented group. This paper describes the evolution of such a group. Content areas that emerged in the group are discussed in terms of the variety of stresses experienced by residents, especially those engendered by changing and conflicting role expectations. Changes in group process over time are described. Outcome is discussed in terms of individual stress reduction, personal growth, improved interpersonal relationships, increased ability to comfortably interact with patients, and knowledge gained about dynamics relevant to the treatment of families as groups.
Family Practice↗
Entry of US medical school graduates into family practice residencies: 1991-1992 and 11-year summary.
This is the 11th report prepared by the American Academy of Family Physicians on the percentage of each medical school's graduates entering family practice residency programs. Approximately 10.3% of the 15,499 graduates of US medical schools between July 1990 and June 1991 were first-year residents in family practice in October 1991. This compares to 10.7% the previous year. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1991 at 15.3%; the Middle Atlantic and New England regions continued with the lowest percentages. Graduates from publicly funded medical schools were more than twice as likely as those from privately funded schools to be first-year residents in family practice in October 1991, 12.9% compared to 6.2%. Approximately half of medical school graduates entering their first year of family practice residency training in October 1991 selected a program in the same state as their medical schools. This report includes the average percentage for each medical school for the last 11 years, as well as the number and percentage of graduates from osteopathic schools who entered ACGME-accredited family practice residency programs.
Family Practice↗
Results of the 1992 National Resident Matching Program.
After 4 years of declining fill rates through the National Resident Matching Program (NRMP), 74 more positions in family practice residencies were filled in 1992 than in 1991, including 24 more filled with US seniors. The March fill rate (67.5%) increased for the first time since 1987, while the July fill rate (90.7%) increased for the first time since 1984. The Mountain and Pacific regions had the highest fill rates (89.1% and 88.5%, respectively) through the NRMP. Community-based, unaffiliated and university-affiliated programs filled 71.0% and 70.3% of positions offered through the NRMP. University-based and community-based, university administered programs filled 63.8% and 61.0% of positions offered through the NRMP. The other commonly defined primary care specialties of internal medicine and pediatrics also filled increased numbers of positions offered through the NRMP. This is the first year since 1984 in which all three primary care specialties matched more positions than in the previous year. The demand for family physicians in the United States is increasing. Evidence presented here suggests that 1992 may mark the beginning of a new trend toward increased interest in careers in family practice.
Family Practice↗
Risk factors and recommendations for 230 adult primary care patients, based on U.S. Preventive Services Task Force guidelines.
We used a computer program based on the U.S. Preventive Services Task Force guidelines to identify recommendations for 230 adult patients who presented to an ambulatory family practice residency clinic. We entered risk factors into the computer program from sex-specific questionnaires that patients completed. On average, patients had 15.4 risk factors and 24.5 recommendations for preventive services (13.0 recommendations for screening, 10.5 for counseling, and 1.1 for immunizations). We noted a significant increase in the number of risk factors and recommendations with increasing age, except for counseling recommendations. The average patient incurs a large number of recommendations, which depend on many different risk factors, making the task of complete clinician compliance with the U.S. Preventive Services Task Force guidelines difficult. Many of these recommendations include counseling, which may take more time and require skills that clinicians may think they lack. Complete adherence may require several visits for the physician to address all recommendations. Measures to increase patient responsibility for health maintenance and innovations using comprehensive, interactive, and educational computer programs may help solve these problems.
Adult↗
Transferring hospital sponsorship of a family practice residency: financial implications.
Family practice residency programs close each year, many in which there is a perception by the sponsoring institution that the program was too costly. Upon the imminent closure of a program's sponsoring hospital, we analyzed and projected the residency's budget and revenues to convince another community hospital to accept transfer of the sponsorship of the program. Revenues directly attributable to the residency (family practice center, grants, Medicare graduate medical education reimbursement) were identified. In addition, we identified that portion of new inpatient revenues necessary to offset the balance of the residency budget. We found that the program could account for reimbursement of 51.8% of its budget through patient care services, requiring 5.2% to be subsidized through state grants and 43.1% through federal graduate medical education reimbursement. Consistent with studies by several authors, family practice residency programs continue to require financial subsidy to balance their budgets. The nation's need for family physicians can only be ensured if state and federal priorities for needed primary health manpower are translated into continued and enhanced financial support.
California↗
Obstetric privileges for family physicians: a national study.
BACKGROUND: We surveyed family physicians in the US to determine how many include obstetric services in their practices and to compare trends over time. METHODS: In the 1993 Practice Profile Survey, the American Academy of Family Physicians (AAFP) surveyed a random sample of active members whose mailing address was in one of the 50 states or the District of Columbia. The sample was stratified by nine census divisions; after two mailings 2460 responses were received from the 4400 physicians in the sample (56 percent response). RESULTS: Eighty-seven percent of active members had hospital admission privileges. Although there were regional disparities in the proportion of family physicians with various hospital privileges, overall 94 percent perceived that the privileges afforded them were appropriate. Approximately 26 percent of AAFP active members in 1993, compared with 29 percent in 1988, included routine obstetric care in their hospital practices. A higher proportion of family physicians in the West North Central census division had privileges at various levels of obstetric care than did family physicians in other census divisions; for example, while 57 percent of family physicians in the West North Central census division had privileges in routine obstetric care, only 9 percent of family physicians in the East South Central division had these privileges. For those family physicians who did not have privileges for any obstetric care, most indicated that they chose not to include obstetric care in their hospital practices. Family physicians most likely to have had obstetric privileges included those who practiced in nonmetropolitan areas (39 percent of family physicians had privileges in routine obstetric care compared with 21 percent in an urban setting) and those who completed a family practice residency program (33 percent with routine obstetric privileges compared with 13 percent who did not complete a 3-year residency in family practice.
Curriculum↗
Twenty years of consulting for excellence: the Residency Assistance Program.
BACKGROUND AND OBJECTIVES: The Residency Assistance Program (RAP) in family practice was established in 1975 to provide consultative assistance to family practice residency program directors interested in enhancing the quality of their training programs. Since its inception, RAP activities have been monitored and policies approved by a project board, with representation from all the national family medicine/practice organizations. The voluntary, confidential, nonpunitive, collaborative problem-solving process has provided more than 800 RAP consultations in RAP's 20 years of operation. This paper reviews the historical development, current status, and future directions of the program.
Consultants↗