The Coastal Research Group Family Medicine Graduate Data Base provided the underpinnings for a seminar on the Geographical Bases of Family Medicine presented twice at the American Academy of Family Physicians Family Medicine Residency Program Directors Workshop in June, 2004.
The seminar was presented by AAFP Director of Education Perry A. Pugno, MD and William H. Burnett, MA, with the assistance of Scott Christman, an expert on the use of Geographic Information Systems technology in health planning.
The presenters noted that “geographical mission” is a fundamental concept of family medicine, and that the specialty from its origins was designed to prepare physicians for rural areas, for the inner city, and for the population at large wherever they live.
The geographic mission is reinforced in multiple ways through the residency training process. The patients of each residency program come from the communities surrounding the program. Community medicine is a core component of the family medicine resident’s training. Many residency programs embrace the concepts of community-oriented primary care [COPC] as an ideal. (See Dr Marc Babitz’ discussion of COPC elsewhere on this website.) Unlike the residency programs of many physician specialties, community physicians are encouraged to teach in family medicine residency programs.
Cumulative research on the distribution of physicians, demonstrates that family physicians distribute themselves more in proportion to the population than any other specialty. GIS technology applied to the Coastal Research Group Family Medicine Residency Graduate Data Base was used to confirm that, in the case of Los Angeles County and the surrounding region, this pattern of family medicine residency graduate practice locations is consistent with these cumulative studies.
However, in a presentation in which audience interaction was encouraged, the finding went far beyond the conclusions of the studies. Several geographical data bases, utilizing advanced GIS technology, were able to be overlaid simultaneously. This permitted a more comprehensive view of the interactions between residency training, residency graduate practice locations, and the socioeconomic aspects of the surrounding population.
The following data bases were used simultaneously: 1) the geographic location of every “point of service” in Southern California of the “profiled family medicine residency programs” participating in the Coastal Research Group’s National Project on the Community Benefits of Family Medicine Residency Programs, 2) the practice locations of physicians represented in the Coastal Research Group family medicine residency program graduate data base, 3) the socioeconomic, racial, ethnic and linguistic data from the 2000 United States census.
In a dynamic process in which audience participants were able to “command” shifts back and forth between the data bases, it became evident that the best visual fit between the census data, the “point of service” data and the practice locations of family medicine residency graduates was the relationship between points of residency program service, family physician locations and the Spanish speaking households of the Los Angeles region. This is precisely the group where the greatest population growth occurred, and, from a public policy standpoint, could only be considered a successful outcome of 35 years of investment of family physician training in Southern California.
The results, the presenters concluded, should be different for most other parts of the country, especially where the Spanish-speaking population is a very small part of the population. It is their expectation, however, that when other studies are conducted they will confirm that family medicine residency programs in other parts of the nation will show that they met their regional needs.
The presenters concluded that besides using GIS technology to map family medicine residency programs points of service and to study the distribution of residency graduates, GIS will prove invaluable in conducting patient origin and disease prevalence studies; assisting in community needs assessments; and supporting COPC initiatives.
The next interactive presentation of GIS technology and the Coastal Research Group Family Medicine Residency Graduate data is scheduled for the Sixth National Workshop on the Community Benefits of Family Medicine Residency Programs, September 10 and 11, 2006 at the Pittsburgh (PA) International Airport.