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PubMedDate not supplied

Financial and clinical relationships between family practice and the academic medical center.

The clinical relationship of academic family practice units to their parent tertiary care medical centers was studied. We surveyed the designated family practice contacts in all U.S. medical schools and achieved a response rate of 84%. We found wide variations in the degree to which academic family practice units provide patient care within the walls of the academic medical center. Those departments which perform greater than 50% of their patient care within the academic medical center are more involved in medical center-sponsored alternative health care delivery systems. Residents of these programs receive more than 50% of their training at the academic medical center. These departments are also more likely to teach a required first-year course in the medical school curriculum. Finally, we found a suggestion, not statistically significant, that these departments may be supporting a greater proportion of their total budgets through clinical revenues. We conclude that academic family medicine units may benefit from closer clinical and financial connections to parent academic medical centers.

Academic Medical Centers↗
PubMed2003

Geriatrics in family practice residency education: an unmet challenge.

The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

Aged↗
PubMed1994

Family practice graduate medical education and hospitals' patient care costs in New Jersey.

BACKGROUND: More generalists are needed for the American health care system. Will training these practitioners add to hospital costs? Although graduate medical education has been shown to add to hospital patient care costs, the authors questioned whether this were true for the hospital training of family physicians. METHOD: Based on data supplied by 12 participating New Jersey hospitals with family practice residencies, inpatients in 1991 were separated into three categories by the teaching status of their attending physicians: family practice, other teaching, non-teaching. The hospitals were stratified into two types for analysis: seven community and five multiresidency hospitals. Average cost (per case-mix--neutral case) was found for each category of patients within medical, surgical, pediatric, and obstetrical classes. RESULTS: Among community teaching hospitals, the mean case-mix--adjusted cost per case for inpatients associated with family practice training was 6.3% less than that for inpatients with an equivalent case mix not associated with family practice training. Among multiresidency teaching hospitals, there was no difference between mean costs for inpatients associated with family practice training and non-teaching patients. The mean cost for inpatients associated with graduate medical training other than family practice was 8% higher than that for non-teaching inpatients. CONCLUSION: These findings suggest that family practice residencies do not add to the direct inpatient costs of teaching hospitals, and in certain instances may even reduce hospital patient care costs. In times of increasing cost consciousness in health care and medical education, this provides a further rationale for institutions to sponsor graduate training in family practice.

Diagnosis-Related Groups↗
PubMed2003

The effects of the 1997 Balanced Budget Act on family practice residency training programs.

BACKGROUND AND OBJECTIVES: This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States. METHODS: We surveyed 453 active family practice residency programs, asking about program closures and new program starts (including rural training tracks), changes in the number of residents and faculty, and curriculum changes. Programs were classified according to their urban or rural location, university or community hospital setting, and rural and/or urban underserved mission emphasis. RESULTS: A total of 435 (96%) of the programs responded. Overall, the impact of the BBA was relatively small. In 1998 and 1999, nationwide, there were 11 program closures, a net decrease of only 82 residents, and a net increase of 52 faculty across program settings and mission emphasis. The rate of family practice residency program closures increased from an average of 3.0 per year between 1988-1997 to 4.8 per year in the 4 years following passage of the BBA. CONCLUSIONS: The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue.

Budgets↗
PubMedDate not supplied

Personal stress inventory in the screening and evaluation of family practice patients.

This study of family practice center patients assessed the broad range of their stresses and concerns, their emotional status, and personal adjustment. Two hundred and fourteen patients completed the 69-item Personal Stress Inventory (PSI) questionnaire. PSI results were related to patients' medical diagnoses classified as 1) psychological symptoms, 2) possible psychosomatic problems, 3) physical illness, or 4) well-care. For the total group, PSI concerns about financial matters, energy level, and health of other family members were as great as personal health concerns. About 15% of these patients were seriously concerned about their marriages, sexual problems or personal habits (eating, drinking, smoking, rest, exercise). Moderately high levels of stress and anxiety were reported. Patients with psychological symptoms showed the highest levels of stress, anxiety, depression, anger, and confusion and the lowest levels of emotional support and coping skills. Psychosomatic patients reported more depression, anger, and confusion and less emotional support than their physically ill counterparts.

Adaptation, Psychological↗
PubMed1986

Premenstrual symptoms and associated morbidity in a family practice setting.

Women at two family practice clinics were given questionnaires to determine the nature, severity, and treatment of symptoms experienced premenstrually; the degree to which symptoms affected activities of daily living; the relationship of selected variables to women's perception of their symptoms; and the degree of physician involvement in discussion and/or treatment of symptoms. From the study group of 219 women, 76% reported symptoms severe enough to interfere with daily activities every month. The activity most affected by symptoms was relationship with family and friends, while work activities were affected least. Women's perception of the degree to which their mothers' activities had been affected by premenstrual symptoms was significantly related to their own incapacitation by them. Fifty-eight percent of women experiencing symptoms took medication for their symptoms, with over-the-counter medication being the most frequent treatment. Only 14% of the total sample had discussed these symptoms with their physician. Sixty-nine percent of the sample believed they had premenstrual syndrome (PMS). There was a significant relationship between women's belief that they had PMS and the degree of incapacitation experienced from their symptoms.

Activities of Daily Living↗
PubMed2003

Why we should reduce family practice training to two years.

Family practice (FP) should consider decreasing its residency training from three years to two years. These are troubling times for FP. The number of U.S. medical students choosing FP has declined, FP physicians have difficulty maintaining the broad range of skills they learned in residency, and salaries have flattened. FP provides the best training for physicians who care for undifferentiated or continuity patients of all ages in an ambulatory setting. The author proposes that FP should focus its training on this large health care niche and develop a two-year curriculum that reduces inpatient and specialty rotations while increasing time in the family health center. At the same time, he recommends a third or even a fourth year of training be used to develop skills in any number of specialty areas. FP salaries are unlikely to be affected by these changes, residents would rack up less debt, and savings in society's contribution to graduate medical education would be realized. Reducing the length of FP training to two years will make FP more nimble, adaptable, and cost-effective.

Curriculum↗
PubMed1975

Internal medicine and family practice. Controversies, conflict and compromise.

Internal medicine and family practice have come into conflict because both specialties consider primary care to be part of their "turf". Moreover, in academic medical centers there is competition for scarce resources, including patients and support for residents. Analysis of the number of physicians in practice as well as in training shows clearly that both internists and family physicians, as well as pediatricians and obstetricians, must participate in rendering primary care if the needs for this type of physician are to be met. Internal medicine also has to achieve a better balance between generalists and subspecialists, and family practice must define its limitations, monitor its rapid growth and assure the quality of its training programs. Most of these problems are internal to each speciality rather than between two specialties, and, where there is conflict, compromise is clearly possible.

Delivery of Health Care↗
PubMed1997

Telephone counseling for patients with minor depression: preliminary findings in a family practice setting.

BACKGROUND: Depression is a frequently occurring condition in family practice patients, but time limitations may hamper the physician's ability to it treat effectively. Referrals to mental health professionals are frequently resisted by patients. The need for more effective treatment strategies led to the development and evaluation of a telephone-based, problem-solving intervention. METHODS: Patients in a family practice residency practice were evaluated through the Medical Outcomes Study Depression Screening Scale and the Diagnostic Interview Schedule to identify those with subthreshold or minor depression. Twenty-nine subjects were randomly assigned to either a treatment or comparison group. Initial scores on the Hamilton Depression Rating Scale were equivalent for the groups and were in the mildly depressed range. Six problem-solving therapy sessions were conducted over the telephone by graduate student therapists supervised by a psychiatrist. RESULTS: Treatment group subjects had significantly lower post-intervention scores on the Hamilton Depression Rating Scale compared with their pre-intervention scores (P < .05). Scores did not differ significantly over time in the comparison group. Post-intervention, treatment group subjects also had lower Beck Depression Inventory scores than did the comparison group (P < .02), as well as more positive scores for social health (P < .002), mental health (P < .05), and self-esteem (P < .05) on the Duke Health Profile. CONCLUSIONS: The findings indicate that brief, telephone-based treatment for minor depression in family practice settings may be an efficient and effective method to decrease symptoms of depression and improve functioning. Nurses in these settings with appropriate training and supervision may also be able to provide this treatment.

Counseling↗
PubMed1985

Job stress, psychological health, and social support of family practice residents.

Seventy-nine family practice residents were studied to test the hypotheses that the level of job stress and the level, source, and type of social support affect residents' psychological health. Self-report data were collected on measures of job stress, life stress, social support provided by three sources (supervisors, coworkers, and people outside work), and psychological health symptoms. Analysis of variance showed that high levels of job stress and/or low levels of social support were associated with a high number of reported symptoms of psychological distress. Low levels of problem-solving and of emotional support from people at and outside work also were associated with a high number of reported symptoms. The author concludes that residents who perceive high job stress and/or low social support should be identified early in their residencies so that assistance can be provided.

Anxiety↗
PubMedDate not supplied

Improving consistency in student evaluation at affiliated family practice centers.

The Department of Family Medicine at Jefferson Medical College has since 1974 been successful in administering a required third-year family medicine clerkship, providing students with a structured, didactic, and experiential curriculum in six affiliated family practice centers. Prior analysis (1976-1981) had indicated, however, that variation existed in evaluating similar students, depending on the clerkship training site, i.e., three sites graded students in a significantly different fashion than the three other sites. Utilizing these data to focus on the evaluation process, a comprehensive and specific six-point plan was developed to improve consistency in evaluations at the different training sites. This plan consisted of a yearly meeting of affiliate faculty, assigning predoctoral training administrative responsibility to one faculty member at each training site, increased telephone communication, affiliate-faculty attendance at the university site evaluation session, faculty rotation to spend time at other training sites, and financial reimbursement to the affiliate training sites. After intervention, analysis (1981-1983) indicated that five of the six clerkship sites now grade students in a consistent fashion, with only one affiliate using different grading standards. The intervention was therefore judged to be successful for five of the six training sites, allowing for better communication and more critical and consistent evaluation of medical students.

Clinical Clerkship↗
PubMed1996

The difficult patient: creation of a curriculum by third-year family practice residents.

BACKGROUND AND OBJECTIVES: Family practice residents tend to perceive psychosocial problems as less important than other factual aspects of their curriculum. To address this, we developed a problem-based learning (PBL) approach to the biopsychosocial model of medical care. METHODS: Third-year residents presented current problematic patients at a PBL advanced psychiatry conference. Data were collected on topics generated, resident attendance, and conference evaluation. RESULTS: The residents generated a topic list that closely matched a prior faculty-generated list. Some topics were discussed on multiple occasions; others not on the faculty list were also generated. Topics omitted were mental health in the physician's home, crisis prevention/intervention, and troubled marriages. In 1992-1995, resident attendance ranged from 56%-79%. A minority (0-5 residents) consistently attended fewer than 50% of the conferences. Residents evaluated the conference from "good" to "very good." CONCLUSIONS: By employing a PBL format and allowing residents to present current patients, conferences were better attended and covered almost all topics previously identified as important. PBL promoted efficient use of residents' time since residents were only required to research the literature about group knowledge deficits. This provided good training for the residents and excellent continuing medical education for faculty.

Attitude of Health Personnel↗
PubMed1986

Computerization of family practice.

The primary focus of computer systems for family practice is on patient billing. Primary care physicians should be aware of the many other benefits that can and should be considered when planning a system for their practice. This article describes the type and extent of information that can be stored in a family practice data base and explores some of the applications in areas of practice and patient management, prevention and research.

Electronic Data Processing↗
PubMed2001

Electronic medical records: the family practice resident perspective.

BACKGROUND AND OBJECTIVES: Few studies have included family practice residents' perceptions regarding the use of electronic medical records (EMR) in a residency program. This study determined residents' perceptions of EMR systems and what variables influenced those perceptions. Specifically, we studied how EMR training and previous computer background influenced resident perception of difficulty in EMR implementation, time efficiency, preventive care opportunities, accuracy of medical records, and desired future use of EMR systems. Questions targeted the use of the EMR in the resident continuity clinic. METHODS: Survey questionnaires about the use of EMR systems in the residents' continuity clinic were mailed to residency directors and residents of 219 family practice residency programs. Respondents were given the opportunity to comment on benefits of and concerns about EMR. RESULTS: Resident response rate was 46% in programs using EMR systems. Findings revealed that the length of EMR training a resident received was unrelated to the perceived adequacy of training but was related to the residents' assessment of the difficulty of implementing the EMR in their continuity clinic. Residents who perceived training to be adequate and perceived a relative ease of implementing the EMR were more likely to perceive the EMR to be beneficial and were more likely to choose the EMR over traditional paper records for future use. Computer background/experience was not related to perceived satisfaction with the EMR, nor was it related to perceived difficulty of implementation, adequacy of training, or anticipated future use of an EMR system. CONCLUSIONS: Although residents recognize the benefits of the EMR, our study demonstrates an overall ambivalence and frustration toward EMR systems currently in use in family practice residency continuity clinics. However, the training they receive regarding EMR use in their residency may influence not only the perceived ease of EMR implementation but attitudes regarding the ability of the EMR to assist them with preventive opportunities, time management, and medical record accuracy. This may in turn have influence on the use of EMR systems in their practices after residency.

Attitude of Health Personnel↗
PubMed1995

Trend analysis of changes in family practice residency graduates' practice characteristics and comparison with recent graduates.

BACKGROUND AND OBJECTIVES: Graduate follow-up studies provide medical educators with important evaluation information and insight into graduates' practices. This study compares early practice choices of two cohorts of family practice residents who graduated a decade apart. The earlier cohort's changes in practice characteristics over a 10-year period were also analyzed. METHODS: Using a mailed survey, graduates of the University of California-Davis Family Practice Residency Network have been periodically surveyed since 1978. Using data from these surveys, early practice choices of the two cohorts were compared. In addition, the responses of the earlier cohort were tracked over time to determine whether any early practice patterns still existed. RESULTS: Significant differences in the early practice choices of the two cohorts of graduates were found in the areas of practice organization, use of mid-level practitioners, perception of need for primary care physicians, and inclusion of pregnancy care in practice. A significantly lower percentage of recent graduates had entered private practice, compared with the earlier cohort (37% vs 50%, P = .02). Recent graduates were more likely to perceive a need for primary care physicians. Finally, the early practice choice differences between the two cohorts had all but disappeared 10 years later as the earlier cohort's practices had changed to resemble more closely those of the recent graduates. CONCLUSIONS: This study concludes that the practices of both established family physicians and recent graduates are changing. Residency faculty must understand how these changes influence the skill and knowledge needs of their future graduates and should design practice management curricula accordingly.

California↗
PubMed1998

Family practice in the new South Africa.

Remarkable changes are taking place in the new South Africa. Planned changes in the health care arena present the new, relatively small discipline* of family practice with great opportunity for development and growth. With established generalist roots and recent formal recognition in South Africa, family practice should be well suited for a lead role in the government's efforts to extend health care access to those denied it under apartheid. Whether family practice moves into that role will depend on whether as a discipline it can project a vision of how it can meet the country's health care needs. Close examination of family practice in South Africa shows how the field reflects many of the societal problems of the past and the challenges of the future. With a clear vision of its role in the new South Africa, family practice could overcome these challenges, as well as answer a broader question about the place of family practice outside of the first world setting.

Family Practice↗
PubMed1993

A comparison of university and community-based family practice physician educators.

BACKGROUND: Differences in satisfaction with training and perceived preparation for practice have been observed among residents trained in community and university family practice residency programs. Our study was undertaken to determine the degree to which faculty training, experience, or practice patterns may contribute to these different resident experiences. METHODS: Questionnaires addressing prior training, experience, current practice content, motivation for entering academic medicine, and satisfaction with current teaching position were sent to full-time physician faculty at 60 family practice residency programs. RESULTS: The 208 faculty responses showed no differences in faculty at various types of residency programs with respect to demographic factors, prior training, or past experience. Only small differences were found in the proportion of time devoted to most professional activities or in the content of clinical practice. CONCLUSIONS: Few differences were found between faculty at university- and community-based family practice residency programs. This implies that differences in residents' perceptions of training may be due to other factors, such as institutional philosophy or self-selection. However, qualitative differences in family practice faculty activities that were not measured in this research cannot be ruled out as factors influencing residents' perceptions of their training experiences.

Attitude of Health Personnel↗