NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Saint Vincent Health Center
Family Medicine Residency Program:
(First draft, first revision)
One of the most important policy issues facing the country as a whole and, locally, Erie County and the surrounding counties of Northwestern Pennsylvania, 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.
A common complaint is that the health care system is fragmented, with many health care facilities and personnel offering very specialized services, often at high cost even to patients with medical insurance. However, educational systems – including the Saint Vincent Health Center family medicine residency program – exist for training physicians that can provide health care comprehensively and that can assure continuity in the care provided.
Forty years ago the nation, through a partnership of the medical professions and the federal and state governments, established the family physician medical specialty and created three-year residency programs accredited 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 have one from these primary care specialties.
An important public policy objective is to encourage everyone to establish a “medical home”, in which 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.
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 are among the major employers in a neighborhood.
The accredited entities that train family physicians are called family medicine residency programs. A physician who is training to become a board-certified family physician is called a family medicine resident.
The Saint Vincent Health Center Family Medicine Residency Program
The Saint Vincent Health Center family medicine program was established in 1977, and has graduated over 160 family physicians, of whom 50 are practicing in the service area of Saint Vincent Health Center, and 15 practice in nearby communities outside of the service area. Of these, 35 family physician residency graduates use Saint Vincent Health Center when hospitalization of their patients is required, which contributes to the financial health of this important community institution. Each year the program graduates six new family physicians.
Although helping a patient maintain good health is a principal goal of all family physicians (and primary care physicians generally), possibly the majority of patients that seek care are concerned with acute or chronic illness. Family physicians are trained to diagnose and actively manage the range of medical problems that a person or family may encounter in their lifetime.
Unlike other primary care physician specialties, family physicians are trained to provide care for children, men and women, including prenatal and maternity services.
For example, Saint Vincent Health Center family medicine residents provide obstetrical, gynecological and pediatric care, as well as adult and geriatric care. Additionally, all residents and faculty and all graduates of the Saint Vincent Health Center family medicine residency program are trained to diagnose and treat all of the common chronic conditions, including diabetes, congestive heart failure and coronary artery disease, asthma and COPD, hypertension, arthritis and high cholesterol, among others. They do so as the first contact physician, primary managing physician, and perhaps most important of all, coordinator of care, working with referral cardiologists and surgical specialists.
Such chronic diseases are best treated when detected early, and family physicians are extensively trained in determining which of their patients either show signs of these problems or are at risk for them. A family medicine resident or board-certified family physician will be able to obtain the diagnostic tests and, whenever medically appropriate, specialty procedures that a patient needs.
With proper care, most persons whose medical problems have advanced to a stage needing surgery or a highly specialized medical intervention, can still achieve a satisfactory lifestyle after their surgery or specialized treatment. A family physician, working in collaboration with the surgeons or specialists to whom the patient has been referred, will provide ongoing care afterwards to maximize a person’s health and well-being.
The Saint Vincent Family Medicine Center
A distinctive feature of the training provided to Saint Vincent Health Center family medicine residents is that, in addition to the hospital inpatient rotations that constitute the site of learning for most physician specialties, each family medicine resident trains in a family medicine center, which provides care in an outpatient setting like a family doctor’s office. For the Saint Vincent Health Center family medicine residency, this takes place in the Saint Vincent Family Medicine Center, which is specifically designed to be the medical home for the Center’s enrolled patients.
Designed to give the family medicine resident a three-year experience in providing a full range of medical and health maintenance services to the same group of patients, the Saint Vincent Family Medicine Center is staffed by residents, their supervising physicians, and other health professionals.
The Saint Vincent family medicine center is specifically designed to be the medical home for its enrolled patients, utilizing a sophisticated electronic medical record system to assure that their patients receive a full range of medical services.
Saint Vincent Family Medicine Residency Women’s Health Services
The Saint Vincent family medicine residency women’s health services include pelvic exams, pre-pregnancy wellness programs, preconception counseling and comprehensive, family-centered maternity care.
The family medicine residency women’s health program arranges for mammography and other diagnostic services, such as osteoporosis screening, for its patients. The program routinely provides such services as PAP smears, common gynecological procedures, birth control advice, programs for adolescents, exercise and aerobics, weight loss programs and mental health counseling within the family medicine center. Additionally, the residency program also maintains in-house consultation in obstetrics and gynecology.
The Saint Vincent Health Center Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Saint Vincent Family Medicine Center, the family medicine residency program maintains inpatient services within Saint Vincent Health Center. In these settings family medicine residents and faculty, in collaboration with colleagues in surgical and referral specialties, take care of Saint Vincent Family Medicine Center patients who have to be hospitalized.
Saint Vincent Health Center’s inpatient family medicine residency service encompasses internal medicine, pediatrics, labor and delivery and post-partum maternity care, gynecology, and psychiatry. The residency program staffs intensive care units and provides post-surgical care.
Training Physicians for Rural Areas
Although an important objective of the Saint Vincent Health Center family medicine residency program is the training of physicians for communities the size of Erie, there are also many smaller rural communities that need physicians able to provide the comprehensive set of skills that family physicians learn in their residency.
Specifically chosen family medicine residents have contracted to spend a substantial portion of their three years of residency at the residency program’s Elk Valley Medical Center in the small rural town of Girard. In that setting, they provide health care services to an underserved portion of Erie County, thereby receiving direct experience in rural practice.
Because many small communities in Western Pennsylvania presently need physicians or will soon anticipate the retirement of physicians currently in practice, the region benefits from having a residency program located in Erie County that is producing new family physicians.
The Saint Vincent Health Center Family Medicine Student Health Initiatives
The Saint Vincent Health Center family medicine residency program, as part of the residency curriculum at the Saint Vincent Sports Medicine at 2501 W 12th Street in Erie provides sports medicine services to three area universities – Penn State Behrend, Edinboro University and Mercyhurst College, as well as to three high schools in the Erie School District. The family medicine residency program also presents lectures to elementary and middle school children to discourage smoking.
Saint Vincent Health Center Family Medicine Cares for a Community’s Most Vulnerable
The mission of Saint Vincent Health Center states its commitment to “compassion and excellence in the delivery of a continuum of wholistic care.” This commitment is evidenced through the comprehensive care provided by the Saint Vincent Family Medicine Center to the patient population it serves.
The Saint Vincent Family Medicine Center is a point of access to many of the community’s most vulnerable populations – the elderly and the disabled, with over 43% receiving public assistance through Pennsylvania’s Medicaid program. An additional 16% of its patients are mostly elderly persons enrolled in the Medicare program.
The remaining patients of the Saint Vincent Family Medicine Center include both indigent and uninsured patients, and working class families covered by private sector health insurance plans. Yet, even the privately insured patients, who comprise only 38% of the number served, 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.
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 to assure quality health care on an ongoing basis.
The Saint Vincent family medicine program works with the hospital billing office and social work staff to help the uninsured in obtaining health care financial assistance for which they may be eligible, including access to Saint Vincent Health Center’s “Community Care Fund” for those ineligible for public assistance.
The residency program assists other patients gain access to needed pharmaceuticals and certain diagnostic tests that they could not otherwise afford. This includes a collaborative relationship with the “Children’s Miracle Network” for indigent pediatric patient prescriptions.
The Saint Vincent Health Center family medicine residency also provides pediatric and maternity services to uninsured and indigent patients at Erie’s Community Health Net, a federally qualified health center with maternity care offices at 2314 Sassafras Street in Erie.
Saint Vincent Family Medicine Services for the Elderly
The Saint Vincent family medicine residency provides an extensive range of services for elderly population. Ongoing primary preventive, chronic and acute care is provided to maintain the health and well-being of the Saint Vincent family medicine center’s elderly patients.
In addition to the primary care and diagnostic services provided at the family medicine centers in Erie and Girard and the family medicine residency’s inpatient services at Saint Vincent Health Center, the residency program continues to serve its patients requiring nursing home or end of life care.
This includes periodic home visits of homebound elderly, and clinical services to area nursing homes, both for skilled-nursing patients and those patients needing long-term custodial care. Hospice care is provided both through home visits and within Saint Vincent Health Center inpatient hospice settings.
This includes home visits of homebound elderly, and clinical services to area nursing homes, both for skilled-nursing patients and those patients needing long-term custodial care. Home hospice care is provided in collaboration with the Visiting Nurses Association of Erie.
Chronic Disease Care and Specialty Referrals
Additionally, the family medicine residency provides 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 need to be seen by sub-specialists. The Saint Vincent Health Center family medicine residency program has mechanisms in place to help most patients obtain the services they need. In the case of public assistance and uninsured patients, these mechanisms prove invaluable, since many sub-specialists often do not offer their services to persons who do not have private sector health insurance.
The Saint Vincent Health Center family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to the community it serves.
Helping fulfill the education and service missions of the Saint Vincent Health Center, the family physicians the family medicine residency program trains and the patient care services the residency program provides, contribute to the improvement of the community’s health.