NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Good Samaritan Hospital/Penn State University
Family and Community Medicine Residency Program:
One of the most important policy issues facing the country as a whole and, locally, Lebanon County and the surrounding 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 Good Samaritan Hospital/Penn State University family and community 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 have one from 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 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 Good Samaritan/Penn State University Family Medicine Residency Program
The Good Samaritan/Penn State University family and community medicine residency program was established in 1990, and has graduated over 87 family physicians, of whom ___ are practicing in the service area of Good Samaritan Hospital. These family physician residency graduates use Good Samaritan 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, Good Samaritan Hospital/Penn State University 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 Good Samaritan Hospital/Penn State University 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 common 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.
The Good Samaritan Hospital/Penn State Family Medicine Centers
A distinctive feature of the training provided to Good Samaritan/Penn State University 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.
For the Good Samaritan/Penn State University family medicine residency, this takes place in the Good Samaritan family medicine center, located a few blocks from the hospital, which is specifically designed to be the medical home for the family medicine center’s enrolled patients.
In addition, the residency program operates the Elco Family Health Center, which is a principal provider of care in the small rural town of Elco in Eastern Lebanon County, and provides an opportunity for residents to experience rural medicine.
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 family medicine centers are staffed by residents, their supervising physicians, and other health professionals.
The Good Samaritan/Penn State family medicine centers are specifically designed to be the medical home for their enrolled patients, utilizing a sophisticated medical record system to assure that their patients receive a full range of medical services.
Family Medicine Residency Women’s Health Services
The Good Samaritan/Penn State 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 those with risk factors, for its patients. The family medicine residency routinely provides such services as PAP smears, common gynecological procedures, birth control advice and mental health counseling within the family medicine centers. Additionally, the residency program maintains in-house consultation in obstetrics and gynecology.
Specialized services, such as exercise and aerobic sessions or weight loss programs, are also available.
The Good Samaritan/Penn State University Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Good Samaritan/Penn State family medicine centers, the family medicine residency program maintains inpatient services within the Good Samaritan Hospital. In these settings family medicine residents and faculty, in collaboration with colleagues in surgical and referral specialties, take care of Good Samaritan and Elco family medicine center patients who have to be hospitalized.
Additionally, the program acts as a “safety net provider” for Lebanon County and its surrounding communities. The residents and their supervising faculty assume the responsibility for caring for patients without a physician who are admitted to the Good Samaritan Hospital, from its emergency room or elsewhere. Persons in this category include many of the community’s most disadvantaged patients.
Good Samaritan’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. The residency program provides medical evaluation for psychiatric patients, who are co-managed with the hospital’s psychiatric service.
Training Physicians for Rural Areas
Although an important objective of the Good Samaritan/Penn State University family medicine residency program is the training of physicians for communities the size of Lebanon, 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.
Specifically chosen family medicine residents have contracted to spend a substantial portion of their three years of residency in the small rural town of Elco. In that setting, they provide health care services to an underserved portion of Eastern Lebanon County, thereby receiving direct experience in rural practice.
Because many small communities in Central Pennsylvania presently need physicians or anticipate the retirement of physicians currently in practice, the region benefits from having a residency program located in Lebanon County that is producing new family physicians.
The Good Samaritan/Penn State University Family Medicine Student Health Initiatives
The Good Samaritan/Penn State University family medicine residency program provides physicals and other health services to students of Lebanon County’s elementary, middle and high schools. The family medicine residency program also presents lectures to discourage smoking to elementary and middle school children.
Good Samaritan/Penn State University Family Medicine Cares for a Community’s Most Vulnerable
The Good Samaritan/Penn State family medicine center is a point of access to many of the community’s most vulnerable populations – the elderly and the disabled, with over __% receiving public assistance through Pennsylvania’s Medicaid program. An additional __% of its patients are mostly elderly persons enrolled in the Medicare program. A large percentage (__%) of those cared for are medically uninsured or indigent.
The remaining patients of the Good Samaritan/Penn State family medicine center include working class families covered by 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 Good Samaritan/Penn State University family medicine program provides access to a social worker to help the uninsured in obtaining health care financial assistance for which they may be eligible, and works with the Good Samaritan Hospital to obtain extended payment schedules for others in financial need.
Community Needs Assessment
The Good Samaritan/Penn State family medicine residency program has devoted considerable resources to studying the population of patients it serves in Lebanon county, identifying those communities with the highest percentage levels of mortality and morbidity with the objective of aligning evidence-based guidelines to the care provided to these populations.
Although the program is still in its early stages, it has already resulted in the “At Risk” program, an initiative designed to identify families at risk for bad health care outcomes and to proactively intervene with appropriate interventions (such as immunizations and home assessments) to address the identified risks.
Resources are being allocated currently to screen for diabetes in the community and to address the community’s high incidence of this chronic disease. The residency program is tracking the numbers of its diabetic patients and is collaborating with the national diabetes registry. Advanced processes of continuous quality improvement in community-based diabetes care will be implemented in order to provide better care to affected persons.
Good Samaritan/Penn State University Family Medicine Services for the Elderly
The Good Samaritan/Penn State University 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 Good Samaritan/Penn State family medicine center’s elderly patients.
In addition to the primary care and diagnostic services provided at the family medicine centers and the family medicine residency’s inpatient services at Good Samaritan Hospital, the residency program continues to serve its patients requiring nursing home or end of life care.
This includes periodic 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 home visits and within the Good Samaritan Hospital inpatient hospice settings.
Chronic Disease Care and Specialty Referrals
The Good Samaritan/Penn State family medicine residency program provides ongoing care to persons with such other chronic conditions as 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 Good Samaritan/Penn State University 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 Good Samaritan/Penn State University 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. The range of services provided at the Good Samaritan/Penn State family medicine center is consonant with the service mission of the Good Samaritan Hospital, and contributes to the improvement of the community’s health.