NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Chestnut Hill Family Medicine Residency Program:
One of the most important policy issues facing the country as a whole and, locally, Greater Philadelphia 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 Chestnut Hill 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 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 Chestnut Hill Hospital Family Medicine Residency Program
The Chestnut Hill Hospital family medicine program was established in 1735, and has graduated 137 family physicians, 30 of whom are practicing in the Chestnut Hill Hospital service area and 20 additional who practice in the community outside of the Chestnut Hill service area. Of these graduates, 30 utilize the Chestnut Hill 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 for children, men and women, including prenatal and maternity services.
For example, Chestnut Hill Hospital 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 Chestnut Hill Hospital 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.
Chestnut Hill Family Practice Center
A distinctive feature of the training provided to Chestnut Hill Hospital 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 Chestnut Hill residency program’s family medicine center – adjacent to the hospital at 8815 Germantown Avenue – is staffed by residents, their supervising physicians, and other health professionals.
The Chestnut Hill Family Practice 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.
Chestnut Hill Family Medicine Residency Women’s Health Services
At the Chestnut Hill Family Practice Center, the women’s health services include pelvic exams, pre-pregnancy wellness programs, preconception counseling and comprehensive, family-centered maternity care.
The Chestnut Hill Family Practice 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 residency program also maintains in-house consultation in obstetrics and gynecology.
The Chestnut Hill Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Chestnut Hill Family Practice Center, the family medicine residency program maintains an inpatient service within the Chestnut Hill 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.
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 Chestnut Hill emergency rooms. Persons in this category will often be among the community’s most disadvantaged patients.
The Chestnut Hill Hospital’s inpatient family medicine service provides internal medicine, gynecology, labor and delivery and post-partum maternity care. The family medicine residency program staffs intensive care units and provides post-surgical care.
Chestnut Hill Family Medicine Residency’s School Health Initiatives
The Chestnut Hill family medicine residency director also serves as medical director for the School District of Springfield Township in Erdenheim (Montgomery County). The family medicine residency contracts to provide sports medicine services to Springfield Township High School and to La Salle University in Philadelphia.
The family medicine residency also contracts with Arcadia University in Glenside to provide student health services. At Philadelphia’s Leeds Middle School, the residency program provides lectures to students to discourage smoking.
Chestnut Hill Family Practice Center Cares for a Community’s Most Vulnerable
The Chestnut Hill 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 27% of the center’s 22,000 patient visits receive public assistance through Pennsylvania’s Medicaid program, an additional 8% are mostly elderly persons on Medicare, and another 5% are medically uninsured or indigent.
The remaining 60% of Chestnut Hill Family Medicine Center 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.
Chestnut Hill Hospital Family Medicine’s Community-oriented Family Medicine
The family medicine residency program has long-established ties with agencies serving the special needs of the community. One such tie is the provision of medical services to children at the Carson Valley School, which provides educational and social services to behaviorally disordered and emotionally disturbed children. Similarly, Chestnut Hill family medicine residents and residency faculty provide services to mentally retarded adults at EMAN in Philadelphia, and to retarded adolescents at the Silver Stream Center facilities in Norristown.
Additionally, the Chestnut Hill family medicine residency serves as medical consultants for the counselors of the Samaritan Counseling Center of Southeastern Pennsylvania at the St Paul’s Episcopal Church on Chestnut Hill Avenue.
The Chestnut Hill family medicine residency program participates in services to the homebound in collaboration with the Meals on Wheels Program administered by Chestnut Hill Hospital; and regularly volunteers at the Monday evening medical clinics of the United Community Clinic located at the First African Presbyterian Church on Girard Avenue.
The family medicine residency program has a long history of providing health care to Philadelphia’s homeless, through participation in the St Catherine Laboure Medical Clinic on Germantown Avenue and the Catholic Worker Free Clinic on Hagert Street in Philadelphia. Additionally, the Chestnut Hill family medicine residency volunteers to provide health care to the homeless at the JeffHOPE Clinic Ridge Shelter on Ridge Avenue in Philadelphia.
Chestnut Hill Hospital 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 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 Chestnut Hill Hospital 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 Chestnut Hill Hospital family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to the neighborhoods of Philadelphia surrounding Chestnut Hill.
Its community-based initiatives complement the goals of neighborhood organizations promoting health, are consonant with the service and educational missions of Chestnut Hill Hospital, and contribute to the improvement of the community’s health.