NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Greater Philadelphia and the Five Counties of Southeastern Pennsylvania
One of the most important policy issues facing the counties that comprise the Metropolitan Philadelphia area is the need to find better ways to assure that the area’s population has access to health care that is of high quality and is affordable.
Forty years ago the United States, through a partnership of the medical professions and the federal and state governments, established the family physician medical specialty and accredited three-year family medicine residency programs to train them. Family physicians, with general internists and general pediatricians, are the physicians who provide primary health care in the United States. Most persons who have a personal physician are in one of these primary care specialties.
Of the various physician specialties, family physicians are the most proportionately distributed to where the country’s population lives. Family physicians, unlike referral specialists, practice in most neighborhoods and communities. Often the practices of one or more family physicians will be one of the major employers in a neighborhood.
The accredited entities that train family physicians are called family medicine residency programs. A physician training to become a board-certified family physician is called a family practice resident.
Southeastern Pennsylvania is fortunate to have ten such programs in the five counties surrounding Metropolitan Philadelphia. Three of Philadelphia’s medical schools (University of Pennsylvania, Thomas Jefferson University, and Drexel University) operate family medicine residency programs. Penn and Jefferson’s university hospitals serve Philadelphia’s Downtown area. Drexel’s family medicine residency is centered in suburban Warminster in Bucks County.
Additionally, five other programs are located in suburban non-profit hospitals that serve Delaware County (Crozer-Keystone in Springfield, Bryn Mawr Hospital’s family medicine program in Broomall), Montgomery County through Abington Memorial Hospital’s family medicine center in Jenkintown and Montgomery Hospital Medical Center’s residency program in Norristown; and Philadelphia County through the Chestnut Hill Hospital family medicine residency.
The eight Philadelphia residency programs collectively graduate around 42 new family physicians each year. Even though two of the programs are relatively new, the eight programs collectively have trained at least 375 family physicians who are practicing in the Greater Philadelphia area.
A distinctive feature of the training provided to family physicians is that, in addition to the hospital inpatient rotations that constitute the site of learning for most physician specialties, each family physician trains in a family medicine center, which provides care in an outpatient setting like a family doctor’s office.
Designed to give the family physician resident a three year experience in providing a full range of medical and health maintenance services to the same group of patients, family medicine centers are staffed by residents, their supervising physicians, and other health professionals.
An important public policy objective is to encourage everyone to establish a “medical home”, in which all of a person’s medical information can be cared for by a single medical entity, including direct patient care, providing or obtaining diagnostic testing, referral to sub-specialists when needed, coordination of pharmaceutical prescriptions, and management of chronic conditions.
In the box to the right is a list of family medicine centers associated with family medicine centers in the Greater Philadelphia area and a map showing their location. In the aggregate they are providing the medical home for _____ patients.
Although each family medicine center provides a substantial percentage of care to populations covered by the private sector health insurance plans of working class families, the family medicine centers also are points of access to the community’s most vulnerable populations – the elderly, those on public assistance, the indigent and disabled.
Because the costs of health care have become increasingly difficult for many individuals and families to manage, persons in these vulnerable categories of patients often defer necessary health services until they become acutely ill. The community at large benefits if such persons are encouraged to establish a medical home. Each of the family medicine residency programs, either directly or working through their host hospitals, have processes for assisting patients in obtaining health care financial assistance for which they may be eligible.
The family medicine centers serve important community functions. They provide ongoing care to persons with such chronic conditions as diabetes, cardiovascular and neurological diseases, severe asthma and behavioral disorders. With ongoing, continuous care, most of these patients can be kept out of hospital emergency rooms, one of the most costly ways of providing health services. In the case of public assistance or uninsured patients, the financial impact of the community of avoidable emergency room use can be very high.
One of the functions of family medicine residency programs is to help patients determine when they need diagnostic tests or to be seen by sub-specialists. The family medicine residency programs also have mechanisms in place to help most patients obtain the services they need. In the case of public assistance or uninsured patients, these mechanisms prove invaluable, since many sub-specialists do not offer their services to persons without private sector health insurance. Even insured patients may find it difficult to negotiate the health care system without such advocates for their health care as they might obtain in their medical home.
In fact, the eight Greater Philadelphia family medicine residency programs constitute an important part of the area’s safety net for vulnerable populations, not only by providing care in its centers, but through the community health outreach activities that an essential element of family medicine residencies. These community service activities can take many forms. For example, the Crozer-Keystone family medicine residency is a major provider of pediatric services to the ChesPenn Health Center in Chester.
Most of the family medicine residency programs report the ability to add patients at the present time. Jefferson’s program works with community organizations to enroll low income Medicaid and indigent persons in the Downtown Philadelphia area, and both Jefferson and Crozer-Keystone have outreach programs to add elderly patients.
Because of the rapidly growing numbers of ethnic and linguistic minorities in our community, each of the residency programs has devoted considerable resources to teach their residents competence in providing care to persons from diverse cultures, and in addressing care of non-English speaking patients.
Each of the ten hospitals are non-profit hospitals with tax exemptions in exchange for their charitable projects and community service. Among the important contributions these ten hospitals make to Southwestern Pennsylvania is providing, through their family medicine residency programs, the medical homes for many of the region’s most vulnerable populations.