Williamsport Hospital and Medical Center FMRP

NATIONAL PROJECT ON THE COMMUNITY IMPACT

OF FAMILY MEDICINE RESIDENCY PROGRAMS

Williamsport Hospital and Medical Center

Family Medicine Residency Program:

A Report

(First draft)

One of the most important policy issues facing the country as a whole and, locally, Lycoming County and the other rural counties that comprise 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 Williamsport Hospital and Medical 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 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 Williamsport Hospital and Medical Center Family Medicine Residency Program

The Williamsport Hospital and Medical Center family medicine program was established in 1972, and has graduated 201 family physicians, 30 of whom are practicing in Lycoming County and surrounding communities, and another 15 who practice in North Central or Northeast Pennsylvania, but beyond the service area of Williamsport Hospital.

Of these graduates, 15 utilize the Williamsport Hospital and Medical Center Hospital when hospitalization of their patients is required, which contributes to the financial health of this important community institution. Each year the program graduates seven 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, Williamsport Hospital and Medical Center family medicine residents provide 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 Williamsport Hospital and Medical 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 Williamsport Hospital and Medical Center Family medicine center

A distinctive feature of the training provided to Williamsport Hospital and Medical 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.

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 Williamsport Hospital family medicine center is staffed by residents, their supervising physicians, and other health professionals.

The Williamsport Hospital and Medical Center 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.

Williamsport Family Medicine Residency Women’s Health Services

The Williamsport 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 Williamsport Hospital and Medical Center Inpatient Family Medicine Service

Beyond the ambulatory care provided in the Williamsport family medicine center, the family medicine residency program maintains an inpatient service within the Williamsport Hospital and Medical Center itself.  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 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 Williamsport Hospital and Medical Center emergency room and elsewhere.  Persons in this category will often be among the community’s most disadvantaged patients.

Williamsport Hospital and Medical Center’s inpatient family medicine residency service encompasses internal medicine, pediatrics, labor and delivery and post-partum maternity care. On its service, the residency program staffs intensive care units.

Training Physicians for Rural Areas

Although an important objective of the Williamsport Hospital and Medical Center family medicine residency program is the training of physicians for communities the size of Williamsport, 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.

Long-term studies of the physician practice choice patterns have confirmed that the existence of a family medicine residency program in a region that it is oriented towards rural practice is a critical factor in recruiting family physicians to the small cities and rural towns in that region.

Because many small cities and rural 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 Williamsport.

Williamsport Family Medicine Residency School Initiatives

The Williamsport family medicine residency program provides health services to students at Cochran Middle School and Williamsport High School. Such services include lectures to students at both the middle and high school levels to discourage smoking.

Every year, the Williamsport family residency program are the physicians who cover and provide medical services for the Little League World Series in Williamsport, which draws school-age baseball teams from throughout the world.

The family medicine residency program also provides sports medicine services to athletics teams at both Jersey Shore and Williamsport High Schools.

Williamsport Hospital and Medical Center Family Medicine Cares for a Community’s Most Vulnerable

The mission of Williamsport Hospital states its commitment to “improve the health and well being of every life we touch.” This commitment is evidenced through the patient population served by its family medicine residency program.  The 4,800 family medicine center patients have 12,000 visits annually.

The program is a point of access to many of the community’s most vulnerable populations – 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 Williamsport Hospital and Medical Center family medicine 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.

In addition to the Williamsport family medicine center, the Williamsport family medicine residents and faculty also help staff the Susquehanna Health Systems Community Health Center at Divine Providence Hospital in Williamsport.  That community health center operates for persons in Lycoming County that have no primary care physician.

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 Williamsport Hospital 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.

Williamsport Hospital and Medical Center Family Medicine Residency’s Services for the Elderly

The Williamsport Hospital and Medical Center family medicine residency provides an extensive range of services for its elderly population. Ongoing primary preventive, chronic and acute care is provided to maintain the health and well-being of the Williamsport Hospital 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 Williamsport Hospital and Medical Center, 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 through inpatient 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 Williamsport 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 Williamsport Hospital and Medical Center family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to Lycoming County and the surrounding area. Helping fulfill the education and service missions of The Williamsport Hospital and Medical Center, the family physicians that the family medicine residency program trains and the patient care services the residency program provides, contribute to the improvement of the community’s health.