NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Altoona Family Physicians
Family Medicine Residency Program:
One of the most important policy issues facing the country as a whole and, locally, Blair County and the other rural counties of Central 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 Altoona Family Physicians 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 accredited 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.
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.
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 who is training to become a board-certified family physician is called a family medicine resident.
The Altoona Family Physicians Residency Program
The Altoona Family Physicians residency program was established in 1975, and has graduated 162 family physicians, over half of whom are practicing in the Altoona service area, and another 20 percent who practice in nearby communities of Central Pennsylvania. Of these graduates, 36 utilize the hospitals of the Altoona Regional Health System when hospitalization of their patients is required, which contributes to the financial health of these important community institutions. 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 take of men, women and children, and to provide pediatric care and a full range of women’s health services, including prenatal and obstetrical services.
For example, Altoona 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 Altoona Family Physicians residency are trained to diagnose and treat congestive heart failure and coronary artery disease, hypertension and high cholesterol, working with referral cardiologists and surgeons when appropriate and necessary.
Similarly, such chronic diseases as arthritis, diabetes, asthma, chronic obstructive pulmonary disease (COPD) and chronic renal failure 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.
Altoona Family Physicians
A distinctive feature of the training provided to Altoona 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 at Altoona Family Physicians, which provides care in an outpatient setting like a family doctor’s office.
Altoona Family Physicians is specifically designed to be the medical home for its 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, Altoona Family Physicians is staffed by residents, their supervising physicians, and other health professionals.
Within Altoona Family Physicians, the women’s health services include pelvic exams, pre-pregnancy wellness programs and preconception counseling. Specialized services are available for adolescents.
The Altoona Family Physicians women’s health program arranges for mammography and other diagnostic services, such as osteoporosis screening for those with risk factors, for its patients. The program routinely provides such services as PAP smears, colposcopy, cryotherapy and endometrial biopsies, and also provides birth control advice, exercise and aerobics programs, weight loss programs, and mental health counseling.
The Altoona Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Altoona Family Physicians office suite, the family medicine residency program maintains an inpatient service at the Altoona Hospital. In these settings family medicine residents and faculty, in collaboration with colleagues in surgical and referral specialties, take care of Altoona Family Physicians patients who have to be hospitalized.
Additionally, the program, through its participation in “unassigned call”, assumes responsibility for caring for many patients without a physician who are admitted to the hospital through the Altoona emergency rooms. Persons in this category will often be among the community’s most disadvantaged patients.
The hospital’s inpatient family medicine services provide internal medicine, pediatrics, gynecology, psychiatric, and post-surgical care. The inpatient service also provides obstetrical and post-partum care.
Training Physicians for Rural Areas
Although an important objective of the Altoona Family Physicians residency program is the training of physicians for communities the size of Altoona, there are also many smaller rural communities that need physicians. Altoona Family Physicians has a nationally recognized “rural training track” incorporated into its residency program.
Consequently, all Altoona family medicine residents spend a substantial portion of their three years of residency practicing in the small Blair County town of Williamsburg, which provides that community access to physicians who are trained in “state of the art” medicine, while providing real-life experiences in rural practice to the resident physicians. Additionally, a subset of the residents will have even more intense training in the Williamsburg setting.
Altoona Family Physicians’ School and College Health Initiatives
The Altoona family medicine program’s residents and faculty provide clinical services to students of area high schools and of Juniata College in Huntingdon. At the elementary and middle school levels, the residency program conducts lectures to students to discourage smoking and on other health-related topics.
Altoona Family Physicians Residency Cares for a Community’s Most Vulnerable Populations
The residency program’s mission is to serve all populations within Altoona and surrounding areas, including the small towns and rural communities. Those patients who have enrolled in the residency program receive high quality care, including state of the art obstetrical care, that is often difficult for many persons to obtain elsewhere.
Therefore, the program is the point of access to many of the community’s most vulnerable populations – the elderly and the disabled, with over 40% receiving public assistance, and an additional 30%, mostly elderly persons, on Medicare. An additional fifth of its patients are medically uninsured or indigent.
The remaining ten percent of the Altoona Family Physician patients include working class families covered by private sector health insurance plans. Yet, even the privately insured patients may encounter problems in negotiating the health care system without such advocates for their health care as they might obtain in their medical home.
Because the health care has become increasingly costly for many individuals and families, 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 Altoona family medicine program works closely with the Altoona Regional Health Systems case management services offices to help uninsured patients obtain health care financial assistance for which they may be eligible. For those patients in need that do not qualify for public assistance, efforts are made to obtain discounted care for them, wherever possible.
Altoona Family Physician’s Community-oriented Primary Care
In rural counties, there often are inadequate resources allocated for HIV prevention, surveillance and care. Altoona Family Physicians provides these services.
Additionally, the program 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 to be seen by sub-specialists. Altoona Family Physicians has mechanisms in place to help most patients obtain the services they need. In the case of public assistance 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 residency program has a range of services for the community’s elderly. Ongoing primary preventive, chronic and acute care is provided to maintain the health and well-being of the Altoona Family Physicians elderly patients. The program provides services to patients needing skilled nursing care, or long-term custodial care.
A family medicine residency program that trains physicians for Altoona, Blair County and surrounding communities of Central Pennsylvania is a valuable community resource. Altoona Family Physicians residency advances the community service missions of the Altoona Regional Health System, and contributes to the improvement of the community’s health and well-being. The Altoona family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to patients under its care.