NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Pennsylvania’s “Rural T”: the State’s
Northeastern, Northwestern and Central Counties
One of the most important policy issues facing the urban and rural counties that comprise the rural and non-metropolitan counties of Pennsylvania (those outside of Greater Philadelphia and Greater Pittsburgh) 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.
Three of the 12 programs are located in the Lehigh Valley, but the remaining nine are distributed in the smaller cities of Reading, York, Lancaster, Lebanon, Altoona, Erie, Williamsport, Wilkes-Barre and Sayre. The 12 programs collectively train about 75 new family physicians each year. At least 660 family physicians, trained in Pennsylvania’s “Rural T” residency programs, are currently practicing in communities near to the residency program from which they graduated.
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 Pennsylvania’s “Rural T” counties 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 twelve Rural T family medicine residency programs constitute an important part of the non-metropolitan Pennsylvania’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.
Most of the family medicine residency programs report the ability to add patients at the present time. The Reading Hospital program operates an outreach program to enroll Medicaid, Medicare and indigent patients. The family medicine residency program operated by Guthrie Hospital in Sayre, in cooperation with the area Women and Infant Children [WIC] program is seeking to increase the numbers served of Medicaid mothers and their young children.
Central Pennsylvania is fortunate to have five family medicine residency programs – located in Altoona, Lancaster, Lebanon, Sayre and Williamsport – with strong orientation towards rural practice and a significant record of training family physicians for such areas. In fact the Altoona, Lebanon and Lancaster programs have satellite family medicine centers, staffed by residents and residency faculty, in small rural communities at some distance from their main programs. Additionally, the York Hospital family medicine residency provides obstetrical services in rural Gettysburg and the Erie family medicine residency maintains a satellite in Elk Valley.
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.
The community service activities of family medicine residency programs can take many forms. The Lancaster General Hospital family medicine residency partners with Southeast Health Services, a nearby community health center, to increase access in that diverse community. Similarly, the Wyoming Valley famly medicine residency has residents at the McKinney Health Center in Wilkes-Barre.
The York General Hospital’s family medicine residency takes care of pediatric and obstetrical patients at the York Community Health Center, and the St Vincent’s family medicine residency in Erie provides obstetrical and gynecological services for Erie’s Community Health Net. The St Luke’s family medicine residency program provides school health services at the Donegan Elementary School and Broughal Middle Schools in low-income areas of Bethlehem.
Each of the twelve hospitals are non-profit hospitals with tax exemptions in exchange for their charitable projects and community service. Through their family medicine residency programs, they are providing the medical homes for many of the region’s most vulnerable populations.