Lehigh Valley Hospital FMRP

NATIONAL PROJECT ON THE COMMUNITY IMPACT

OF FAMILY MEDICINE RESIDENCY PROGRAMS

Lehigh Valley Hospital

Family Medicine Residency Program:

A Report

(First draft)

One of the most important policy issues facing the country as a whole and, locally, the Lehigh Valley and the rural counties that comprise Northeast 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 Lehigh Valley 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 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 Lehigh Valley Hospital Family Medicine Residency Program

The Lehigh Valley Hospital family medicine program was established in 1995, and has graduated 45 family physicians, 11 of whom are practicing in the community.

Of these graduates, 10 utilize the Lehigh 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, Lehigh 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 Lehigh 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 Lehigh Valley Hospital Family Medicine Center

A distinctive feature of the training provided to Lehigh 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 Lehigh Valley Hospital 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 ßto the same group of patients, the Lehigh Valley Hospital Family Medicine Center is staffed by residents, their supervising physicians, and other health professionals.

The Lehigh Valley Hospital Family Medicine Center is specifically designed to be the medical home for its enrolled patients, utilizing a sophisticated medical record system to assure that their patients receive a full range of medical services.

Lehigh Valley Family Medicine Center Women’s Health Services

The women’s health services provided by the Lehigh Valley Family Medicine Center 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 maintains in-house consultation in obstetrics and gynecology.

The Lehigh Valley Inpatient Family Medicine Service

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

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

Lehigh Valley Family Medicine Residency School Initiative

The Lehigh Valley family medicine residency program provides health services to students of the Central Elementary School in Allentown.

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

The mission of Lehigh Valley Hospital states that “we heal, comfort and care for the people of our community by providing advanced and compassionate health care of superior quality and value, supported by education and clinical research”. This commitment is evidenced through the patient population served by its family medicine residency program.

The Lehigh 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. Over 35% of the patients cared for in the family medicine center are receiving public assistance through Pennsylvania’s Medicaid program, ten percent uninsured or indigent patients, and an additional 20%, mostly elderly persons, are enrolled in the Medicare program.

The remaining 35 percent of the Lehigh Valley Hospital 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.

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 Lehigh Valley family medicine program works with the hospital’s financial counselor 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 Lehigh Valley family medicine residency has devoted considerable resources to community needs assessment, seeking to determine the health care needs of the Lehigh Valley, beyond those of its patients currently served in the Lehigh Valley family medicine center.

These needs assessment activities have led us to develop collaborative efforts with community agencies to assist in establishing the Caring Place and its Caring Place Clinic, serving the greater Allentown Community and expanding services at the Casa Guadalupe Center, which specializes in care to the Lehigh Valley’s Latino community.

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

The Lehigh Valley family medicine residency contracts to provide medical services to the Health Center at Trexlertown, a center for treating the developmentally disabled.  It provides ongoing medical services to the Caring Place Clinic and the Casa Guadalupe Center.

Additionally, the family medicine residency faculty serves on community boards, including that of the Children and Youth Agency, the domestic violence and elder abuse agencies, and the Area Agency on Aging.  Coordinating with these community agencies, specific community medical needs are addressed by family medicine residents and faculty.

Lehigh Valley Family Medicine Residency’s Services for the Elderly

The Lehigh Valley 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 Lehigh 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 Lehigh Valley Hospital, 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 care. Hospice care is provided both as part of Lehigh Valley Hospital’s inpatient hospice.

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 Lehigh 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 Lehigh Valley family medicine residency is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to Allentown and the surrounding communities of the Lehigh Valley.

Helping fulfill the education and service missions of the Lehigh Valley Hospital, 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.