NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
The Reading Hospital and Medical Center
Family Medicine Residency Program:
One of the most important policy issues facing the country as a whole and, locally, Berks County and the other rural counties of East 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 Reading Hospital 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 are in one of 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 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 Reading Hospital Family Medicine Residency Program
The Reading Hospital family medicine program was established in 1972, and has graduated over 150 family physicians, of whom 40 percent are practicing in the service of the Reading Hospital and Medical Center, and another 20 percent practice in nearby communities of Central Pennsylvania. Over 50 of these graduates utilize the Reading Hospital and Medical 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.
But, unlike other primary care physician specialties, family physicians are trained to care for men, women and children, and to provide pediatric care and a full range of women’s health services, including prenatal and obstetrical care.
For example, Reading Hospital 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 Reading Hospital family medicine residency program 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.
The Reading Hospital family medicine center
A distinctive feature of the training provided to Reading Hospital 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. The Reading Hospital family medicine center is specifically designed to be the medical home for their 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 Reading Hospital family medicine center is staffed by residents, their supervising physicians, and other health professionals.
In its family medicine center, the women’s health services include pelvic exams, pre-pregnancy wellness programs and preconception counseling. The women’s health program arranges for mammography and other diagnostic services, such as osteoporosis screening, for its patients.
The Reading family medicine residency women’s program routinely provides such services as PAP smears, colposcopy, and cryotherapy; birth control advice and mental health counseling within the family medicine center. The centers are staffed to meet the special needs of adolescent females. Additionally, the residency program maintains in-house consultation in obstetrics and gynecology.
The Reading Hospital Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Reading Hospital family medicine center, the family medicine residency program maintains inpatient services within the Reading Hospital and Medical Center. In these settings family medicine residents and faculty, in collaboration with colleagues in surgical and referral specialties, take care of family medicine center patients who have to be hospitalized.
Additionally, the family medicine residency program, through its participation in “unassigned call”, assumes responsibility for caring for many patients without a physician who are admitted to Reading Hospital through its emergency room. Persons in this category will often be among the community’s most disadvantaged patients.
The family medicine residency program’s inpatient family medicine service provides internal medicine, pediatrics, gynecology, ICU and post-surgical care. If necessary, they provide stabilizing medical care to psychiatric patients before transfer to the Reading Hospital’s psychiatric service. The family medicine residency program maintains a separate Labor and Delivery within Reading Hospital suite for obstetrical deliveries.
Training Physicians for Rural Areas
Although an important objective of the Reading Hospital family residency program is the training of physicians for communities the size of Reading, there are also many smaller rural communities that need physicians able to provide comprehensive set of skills that family physicians learn in their residency. For those residents interested in practicing in rural areas, an elective rotation in the small Carbon County town of Lehighton provides real-life experiences in rural practice.
The Reading Hospital Family Medicine Student Health Initiatives
The Reading Hospital family medicine residency program provides ongoing medical consultation to the schools of the Reading School District, working with the school health nurses. Additionally, the Reading family medicine center maintains relationships with the athletics teams of three area high schools – Wyomissing High School in Wyomissing; Schuylkill Valley High School in Leesport and Conrad Weiser High School in Robesonia, contracting to provide physicals and other clinical services to the high school students.
At the collegiate level, the residency program provides the family physician workforce for the student health centers at two Reading colleges – Penn State Berks and Alvernia College – with five clinics a week split between the two campuses.
Reading Hospital Family Medicine Cares for a Community’s Most Vulnerable
The mission of Reading Hospital states its commitment to providing “compassionate, accessible, high quality, cost effective health care to the community . . .” This commitment is evidenced through the comprehensive care provided by the family medicine residency to the patient population it serves.
The program is also a point of access to many of the community’s most vulnerable populations – the elderly and the disabled, with over a third receiving public assistance through Pennsylvania’s Medicaid program. An additional 30% of its patients are mostly elderly persons enrolled in the Medicare program. A large percentage (10%) of those cared for are medically uninsured or indigent.
The remaining patients of the Reading Hospital family medicine center include working class families covered by the private sector health insurance plans. Yet, even the small number of privately 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.
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 Reading Hospital family medicine program maintains an in-house staff to help uninsured in obtaining health care financial assistance for which they may be eligible, and works with the Reading Hospital and Medical Center to obtain discounted care for others in financial need.
Reading Hospital family Medicine’s Community-oriented Family Medicine
The Reading Hospital family medicine residency has devoted considerable attention to assessing and addressing community needs. Among the initiatives created in response to community needs have been a migrant health program and the student health centers described above. The program director serves as chair of the Eastcentral Pennsylvania Area Health Education Center program advisory committee, and Reading Hospital family medicine center faculty and staff volunteer at a community free clinic.
Reading Hospital Family Medicine Services for the Elderly
The family medicine residency program provides a range of services for the community’s elderly. Ongoing primary preventive, chronic and acute care helps maintain the health and well-being of its elderly patients. The program provides services to patients needing skilled nursing care, or long-term custodial care.
Chronic Disease Care and Specialty Referrals
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 need to be seen by sub-specialists. The Reading Hospital 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 Reading Hospital 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. It community-based initiatives complement the goals of educational institutions and neighborhood organizations promoting health, are consonant with the service missions of the Reading Hospital and Medical Center, and contribute to the improvement of the community’s health and well-being.