Wyoming Valley FMRP

NATIONAL PROJECT ON THE COMMUNITY IMPACT

OF FAMILY MEDICINE RESIDENCY PROGRAMS

Wyoming Valley Family Medicine Residency Program:

A Report

(First draft)

One of the most important policy issues facing the country as a whole and, locally, Luzerne County and the surrounding rural counties that comprise Northeast and North 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 Wyoming Valley 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 accredited 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 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 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 Wyoming Valley Family Medicine Residency Program

The Wyoming Valley family medicine program was established in 1974, and has graduated 155 family physicians, 60 of whom are practicing in Luzerne County and surrounding communities, and another 20 who practice in Northeast or North Central Pennsylvania beyond the Wyoming Valley.

Of these graduates, 60 utilize the Wyoming Valley Hospital 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, Wyoming Valley 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 Wyoming Valley 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 Wyoming Valley Family Care Centers

A distinctive feature of the training provided to Wyoming Valley 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 (the Wyoming Valley Family Care Center), which provides care in an outpatient setting like a family doctor’s office.

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 Wyoming Valley Family Care Center, located in Kingston, is staffed by residents, their supervising physicians, and other health professionals.

The Wyoming Valley Family Care 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.

Wyoming Valley Family Medicine Residency Women’s Health Services

The Wyoming Valley 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 Wyoming Valley Inpatient Family Medicine Service

Beyond the ambulatory care provided in the Wyoming Valley Family Care Center, the family medicine residency program maintains an inpatient service within the Wyoming Valley.  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.

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 Wyoming Valley emergency room and elsewhere.  Additionally, it includes patients of the McKinney Clinic, a federally qualified health center in Wilkes-Barre. Persons in both these categories will often be among the community’s most disadvantaged patients.

Wyoming Valley’s inpatient family medicine residency service encompasses internal medicine, pediatrics, labor and delivery and post-partum maternity care, and gynecology.  The residency program staffs intensive care units and provides post-surgical care.

Training Physicians for Rural Areas

Although an important objective of the Wyoming Valley family medicine residency program is the training of physicians for communities the size of Wilkes-Barre, 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.

Because many small communities in North Central and Northeast 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 the Wyoming Valley that is producing new family physicians.

Wyoming Valley Family Medicine Residency School Initiatives

The Wyoming Valley family medicine residency program provides extensive health services to students of area public schools.  It conducts wellness classes, provides lectures on STDs and contraception, and provides state-mandated physicals for eleventh graders at Lake-Lehman High School, Dallas Senior High School and West Side Area Vo-Tech School in Pringle.

The family medicine residency sports medicine program also serves both school and community athletics and cheerleading teams, including those of West Side Vo-Tech, and the Plymouth Area and the Lake-Lehman Knights Mini-Football teams.  The residency program also provides pre-participation physicals for the Special Olympics held for the mentally challenged.

At Wilkes University, the Wyoming Valley family medicine residency provides two half-days a week staffing the student infirmary.

Wyoming Valley Family Medicine Cares for a Community’s Most Vulnerable

The mission of Wyoming Valley Health Care System states that its “comprehensive health system will meet the changing health needs of our community in a compassionate, collaborative and cost-effective manner”. This commitment is evidenced through the patient population served by its family medicine residency program.

The Wyoming Valley family medicine residency is a point of access to many of the community’s most vulnerable populations – those on public assistance, the medically uninsured, the elderly and the disabled, with over 20% receiving public assistance through Pennsylvania’s Medicaid program, ten percent uninsured or indigent patients, and an additional 30%, mostly elderly persons, enrolled in the Medicare program.

The remaining 40 percent of the Wyoming Valley Family Care Center patients include working class families covered by the private sector health insurance plans. Yet, even 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 Wyoming Valley 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, and assists other patients gain access to needed pharmaceuticals and certain diagnostic tests which they could not otherwise afford.

Community Needs Assessment

The Wyoming Valley family medicine residency has devoted considerable resources to community needs assessment, which has led to the development of a chronic disease registry for diabetes, participation in community initiatives to disseminate information about diabetes.  It has led the family medicine residency to identify and establish quality care for diabetics, and to make improvements in the residency’s curriculum to better train its family medicine resident physicians to address their diabetic patients’ needs. The Wyoming Valley family medicine residency is also creating new programs for treatment of childhood obesity.

Past studies of community needs resulted in the development of the sex education courses in schools, the pre-participation physicals for community sports, the student health services, and the strengthening of linkages with the McKinney Clinic.

Wyoming Valley Family Medicine Center’s Community-oriented Primary Care

Beyond the provision of care in the Wyoming Valley family medicine center and Kinney Clinic, and the needs assessment initiatives described above, the Wyoming Valley family medicine residency is involved in various functions in the community for groups that often have difficulty obtaining physician services.

The program provides care to residents of group homes for the mentally or physically challenged.   The program provides health care examinations and tuberculosis screening for Luzerne County’s Head Start volunteers; and provides inpatient care services for Pottsville Prison. It works with the Luzerne County Department of Health to provide HIV testing and services to the HIV+ community;

Community partners include Luzerne County Children and Youth Services; the First Hospital Wyoming Valley Behavioral Health Services; and Choices (a substance abuse treatment facility), and the Nesbitt Memorial Medical Center, where key community behavioral health services are centered.  These community partners share many of the same clientele with the Wyoming Valley family medicine residency program, which confers daily on care issues with each of these partners.

Wyoming Valley Family Medicine Residency’s Services for the Elderly

The Wyoming Valley 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 Wyoming Valley family medicine center’s elderly patients.

In addition to the primary care and diagnostic services provided at the family medicine center and the family medicine residency’s inpatient services at Wyoming Valley, the residency program continues to serve its patients requiring nursing home or end of life care.

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. Hospice care is provided both as part of nursing home hospice and through home visits.

Chronic Disease Management and Coordination of 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 to be seen by sub-specialists.  The Wyoming Valley family medicine residency program 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.

Summary

The Wyoming Valley family medicine residency is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to Luzerne County and the surrounding area. Helping fulfill the education and service missions of the Wyoming Valley family medicine residency, 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.