NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Conemaugh Memorial Family Medicine Residency Program:
One of the most important policy issues facing the country as a whole and, locally, Cambria County and the other rural counties of Southwestern and South 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 Conemaugh Memorial 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 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 Conemaugh Memorial Family Medicine Residency Program
The Conemaugh Memorial Medical Center family medicine program was established in 1971, and has graduated 167 family physicians, 30 of whom are practicing in the Conemaugh Memorial service area, and another 20 who practice in nearby communities of Southwestern and South Central Pennsylvania. Many of these graduates utilize the Conemaugh Memorial 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.
Unlike other primary care physician specialties, family physicians are trained to provide pediatric care and women’s health, including prenatal and obstetrical services.
For example, Conemaugh Memorial 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 Conemaugh Memorial 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 Conemaugh Memorial Family Medical Center
A distinctive feature of the training provided to Conemaugh Memorial 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 Conemaugh Memorial Family Medical Center is staffed by residents, their supervising physicians, and other health professionals.
The Conemaugh Memorial Family Medical 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. The residency program interacts strategically with pharmacists to assure that all pharmaceutical prescriptions have been determined to be safe and appropriate for the patient.
The Conemaugh Memorial Family Medical Center, maintains a geographic space within the hospital’s obstetrics and gynecology clinic, staffed by the family medicine residents and their faculty. The ConemaughValley family medicine women’s health services include pelvic exams, pre-pregnancy wellness programs and preconception counseling. Specialized services are available for adolescents.
The 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, usually within the Family Medical Center, and LEEPS in the women’s health center. It provides birth control advice, weight loss programs, and mental health counseling within the Family Medical Center. The residency program also maintains in-house consultation in obstetrics and gynecology.
The Conemaugh Memorial Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Conemaugh Memorial Family Medical Center, the family medicine residency program maintains an inpatient service at the Conemaugh Memorial Medical Center. In these settings family medicine residents and faculty, in collaboration with colleagues in surgical and referral specialties, take care of Family Medical 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 Conemaugh Memorial 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, and post-surgical care. The inpatient service also provides obstetrical and post-partum care. Psychiatric patients are co-managed with the hospital’s psychiatric staff.
Training Physicians for Rural Areas
Although an important objective of the Conemaugh Memorial family medicine residency program is the training of physicians for communities of the size of Johnstown and Ferndale, there are also many smaller rural communities that need physicians.
Therefore, all Conemaugh Memorial family medicine residents spend a portion of their third year of residency practicing in a small rural community, not only assuring access of that community to physicians being trained in “state of the art” medicine, but providing real-life experiences in rural practice to the resident physicians.
Conemaugh Memorial Family Medical Center’s School Health Initiatives
The Conemaugh Memorial family medicine program’s residents and faculty are the school physicians for the entire Ferndale school system. They provide sports physicals for, as well as other services to, the students of Ferndale High School. At the elementary and middle school levels, in both public and private schools in Johnstown, Ferndale, Sidman, Partton and Nanty Glo, the residency program conducts lectures to students to discourage smoking.
Community-based Chronic Disease Care
Care for chronic diabetes, not only takes place in the Family Medical Center (or, in extreme situations, in the hospital), but in the community as well. The Conemaugh Memorial family medicine residency program, through its nursing staff participates in diabetes information and assessment at health fairs and provides outreach to church groups and community organizations.
Conemaugh Memorial Family Medicine Cares for a Community’s Most Vulnerable
The mission of Conemaugh Memorial Family Medical Center states its commitment to providing the highest quality health care to a diverse patient population in a compassionate environment.
The program is the point of access to many of the community’s most vulnerable populations – the elderly and the disabled, with over 35% receiving public assistance, and an additional 28%, mostly elderly persons, on Medicare. Although the program has only limited capacity to expand, the Family Medical Center accepts and welcomes referrals from community social service agencies.
Over a third of the remaining Conemaugh Memorial Family Medical Center patients include working class families covered by private sector health insurance plans. Yet, even the 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 Conemaugh Memorial family medicine program works closely with the hospital’s billing and social services offices to help uninsured patients to 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 find charity care for them.
Conemaugh Memorial Family Medical Center’s Community-oriented Primary Care
The program has devoted considerable resources to community needs assessment, which has led to an initiative, as part of the Teen Pregnancy Advisory Board of the Greater Johnstown Career and Technology Center, to discourage teen pregnancy. The program also has provided both community and statewide leadership to breastfeeding advocacy. It also works with the Planned Parenthood of Johnstown.
Because so often the health care needs of rural counties are overlooked, the residency program established a grant-funded project to strengthen the community’s HIV prevention, surveillance and care.
The residency program works with the Christian Home of Johnstown, that provides residences for homeless adolescents, and those whose parents may be incarcerated.
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 Conemaugh Memorial 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.
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 Family Medical Center’s elderly patients. The program provides services to patients needing skilled nursing care, or long-term custodial care at three Johnstown nursing homes – Laurel Wood Convalescent Center, Good Samaritan Nursing Care Center, and Select Specialty Hospital.
The Conemaugh Memorial family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to Johnstown, Ferndale and the surrounding communities of Cambria County. It community-based initiatives complement the goals of neighborhood organizations promoting health, are consonant with the service missions of Conemaugh Memorial Medical Center, and contribute to the improvement of the community’s health and well-being.