NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Montgomery Family Medicine Residency Program:
One of the most important policy issues facing the country as a whole and, locally, Montgomery County and the counties that comprise Southeastern 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 Montgomery Hospital 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 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 Montgomery Hospital Medical Center Family Medicine Residency Program
The Montgomery Hospital Medical Center family medicine program was established in 1977, and has graduated 131 family physicians, 20 of whom are practicing in the Montgomery Hospital Medical Center service area, and an additional 20 of whom practice in nearby communities beyond the Montgomery Hospital service area. Twenty of these graduates utilize the Montgomery Hospital 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 for children and adolescents, and adult men and women, including prenatal and maternity services.
For example, Montgomery Hospital Medical Center 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 Montgomery Hospital 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.
Similarly, 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.
Montgomery Family Practice Center and Family OB/GYN Center
A distinctive feature of the training provided to Montgomery Hospital 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 Montgomery residency program’s family medicine center – Montgomery Family Practice Center at 1330 Powell Street, Suite 409, in Norristown – is staffed by residents, their supervising physicians, and other health professionals.
Montgomery Family Practice 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.
Montgomery Family Practice and OB/GYN Center Women’s Health Services
The women’s health services provided by the family medicine residency program at Montgomery Family Practice Center and the adjoining Family OB/GYN Center include pelvic exams, pre-pregnancy wellness programs, preconception counseling and comprehensive, family-centered maternity care.
The Montgomery Family Practice Center and Family OB/GYN Center arranges for mammography and other diagnostic services, such as osteoporosis screening for those with risk factors, for its patients.
The family medicine residency program routinely provides such services as PAP smears, common gynecological procedures, birth control advice, weight loss programs and mental health counseling within the family medicine center. Specialized services are available for adolescents.
The Montgomery Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Montgomery Family Practice Center, the family medicine residency program maintains an inpatient service within the Montgomery Hospital Medical Center. 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 Montgomery emergency rooms. Persons in this category will often be among the community’s most disadvantaged patients.
Montgomery Hospital Medical Center’s inpatient family medicine service provides internal medicine, pediatrics, gynecology, and post-surgical care. In the inpatient Labor and Delivery suites, the service provides for maternity and post-partum care. The family medicine residency staffs the intensive care unit for family medicine center patients.
Montgomery Family Medicine’s School Health Initiatives
The Montgomery family medicine program contracts to provide school health services throughout the Norristown Area School District, including Norristown Area High School; the Cole Manor, Gotwals, Hancock Street and Marshall Street Elementary Schools; the Stewart Middle School; the Paul V. Fly School; and the Roosevelt Annex.
Additionally, at the elementary and middle school levels, the residency program provides lectures to students to discourage smoking. It also provides lectures to adolescents at Norristown School District classroom sites to discourage teen pregnancies.
Montgomery Hospital Medical Center Family Medicine Cares for a Community’s Most Vulnerable
The mission statement of Montgomery Healthcare System is “to improve the health status of those who live and work in central Montgomery County through its provision of quality health care services and education.” This commitment is evidenced through the patient population served by its family medicine residency program.
The Montgomery Family Practice Center is a point of access to many of the community’s most vulnerable populations – those on public assistance and the medically uninsured, the elderly and the disabled. Over 29% of the 14,800 patient visits (representing 10,000 patients under the family medicine center’s care) receive public assistance through Pennsylvania’s Medicaid program, an additional 25% are mostly elderly persons on Medicare, and another 12% are medically uninsured or indigent.
The remaining 34% of Montgomery Family Practice patients include working class families covered by the private sector health insurance plans. Yet, even these 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 Montgomery Family Practice Center assists uninsured patients obtain health care financial assistance for which they may be eligible. To facilitate such assistance, the program employs a bilingual Spanish staff person who has expertise in billing and financial assistance eligibility criteria.
Montgomery Hospital Medical Center Family Medicine’s Community-oriented Family Medicine
The residency program provides health services to many community-based agencies in Philadelphia. It provides services to Laurel House, a shelter for abused women and their children, in Norristown. It also works with the Planned Parenthood of Southeastern Pennsylvania’s Norristown Center.
In a service to the community that many health care providers might prefer not to assume, the Montgomery family medicine residency provides medical care services, under caseworker supervision, for persons incarcerated in the Star Program at Carelink, Inc., a facility of Norristown State Hospital, that treats sexual abuse convicts and other incarcerated mentally ill individuals.
The program helps staff community-based health fairs, which include hypertension screening, at senior centers, community colleges and workplaces; and provides health education lectures in a variety of community settings.
Montgomery Hospital Medical Center Family Medicine Residency Services for the Elderly
The residency program has an extensive 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 medicine center’s elderly patients. The residency program provides home visits to the homebound elderly, and to persons in assisted living arrangements.
For those patients requiring nursing home or end of life care, the residency program continues to serve its patients through skilled nursing and long-term care facilities and hospice settings.
Chronic Disease Management and 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 Montgomery Hospital Medical Center family medicine residency program has mechanisms in place to help most patients obtain the services they need. In the case of public assistance or indigent 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 Montgomery Hospital Medical Center family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to Montgomery County.
The Montgomery family medicine residency program’s community-based initiatives complement the goals of neighborhood organizations promoting health, are consonant with the service and educational missions of Montgomery Hospital Medical Center, and contribute to the improvement of the community’s health.