NATIONAL PROJECT ON THE COMMUNITY IMPACT
OF FAMILY MEDICINE RESIDENCY PROGRAMS
Guthrie/Robert Packer Hospital
Family Medicine Residency Program:
One of the most important policy issues facing the country as a whole and, locally, Bradford County and the surrounding rural counties that comprise North 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 Guthrie/Robert Packer 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 Guthrie/Robert Packer Hospital Family Medicine Residency Program
The Guthrie/Robert Packer Hospital family medicine residency program was established in 1993, and has graduated 43 family physicians, eight of whom are practicing in Bradford County and surrounding communities.
Of these graduates, three utilize the Robert Packer Hospital when hospitalization of their patients is required, which contributes to the financial health of this important community institution. Each year the program graduates four 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, Guthrie/Robert Packer 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 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 Guthrie Center for Family Medicine
A distinctive feature of the training provided to Guthrie/Robert Packer 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 (the Guthrie Center for Family Medicine), 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 Guthrie Center for Family Medicine, located at 1 Guthrie Square in Sayre, is staffed by residents, their supervising physicians, and other health professionals.
The Guthrie Center for Family Medicine 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.
Guthrie Center for Family Medicine Women’s Health Services
The women’s health services provided by the Guthrie Center for Family medicine include pelvic exams, 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, weight loss counseling and mental health counseling within the family medicine center.
Additionally, the residency program maintains in-house consultation in obstetrics and gynecology.
The Guthrie/Robert Packer Hospital Inpatient Family Medicine Service
Beyond the ambulatory care provided in the Guthrie Center for Family Medicine, the family medicine residency program maintains an inpatient service within the Robert Packer 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.
The Guthrie/Robert Packer Hospital inpatient family medicine 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.
Training Physicians for Rural Areas
An important objective of the Guthrie/Robert Packer Hospital family medicine residency program is the training of physicians for communities the size of Sayre and even smaller rural communities that need physicians able to provide the comprehensive set of skills that family physicians learn in their residency.
Because many small communities in North Central Pennsylvania and South Central New York presently need physicians or will soon anticipate the retirement of physicians currently in practice, the region benefits from having a residency program located in Bradford County that is producing new family physicians.
Guthrie/Robert Packer Hospital family medicine Residency School Initiatives
The Guthrie/Robert Packer Hospital family medicine residency contracts with four area high schools to provide medical services to their athletics departments and sports teams. The high schools served are Athens Area High School (Athens, PA), Owego Free Academy (Owego, NY), Sayre Area High School (Sayre, PA) and Waverly High School (Waverly, NY).
Guthrie Center for Family Medicine Cares for a Community’s Most Vulnerable
The Guthrie Center for Family Medicine 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 18% of the 16,200 patient visits (representing an estimated 12,000 patients under the family medicine center’s care) receive public assistance through Pennsylvania’s Medicaid program, five percent are uninsured or indigent patients, and an additional 19%, mostly elderly persons, enrolled in the Medicare program.
(The Guthrie Center for Family Medicine also has responsibility for the care of Guthrie Clinic employees, that assignment accounting for 14% of patient visits.)
The remaining 44 percent of the Guthrie Center for Family Medicine 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 Guthrie Center for Family Medicine works with the hospital billing office, whose staff helps the uninsured obtain health care financial assistance for which they may be eligible, and enlists the Guthrie Clinic’s charitable resources for others in need.
In addition, the family medicine residency program provides outreach to enroll children and pregnant women under the Women’s, Infants and Children (WIC) program, providing them with the medical need they need.
Guthrie Center for Family Medicine Services for the Elderly
The Guthrie/Robert Packer Hospital 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 Guthrie/Robert Packer Hospital 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 Robert Packer 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, for those patients needing long-term care. Hospice care is provided both as part of Guthrie Clinic Hospice and through home visits.
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 Guthrie/Robert Packer Hospital 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 Guthrie/Robert Packer Hospital family medicine residency is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to Bradford County and the surrounding area.
Helping fulfill the education and service missions of the Guthrie/Robert Packer Hospital family medicine residency, 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.