NATIONAL PROJECT ON THE COMMUNITY IMPACT OF FAMILY MEDICINE RESIDENCY PROGRAMS
Washington Hospital Family Medicine Residency Program
One of the most important policy issues facing the country as a whole and, locally, Washington County and the surrounding rural communities, 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 Washington 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 Washington Hospital Family Medicine Residency Program
The Washington Hospital family medicine residency program was established in1971, and has graduated 195 family physicians, 55 of whom are practicing in or near Washington County. All 55 of these graduates utilize Washington Hospital when hospitalization of their patients is required, which contributes to the financial health of this important community institution. Each year the program graduates eight 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, Washington 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 Washington 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.
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 Washington Hospital Family Medicine Center
A distinctive feature of the training provided to The Washington 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.
The Washington Hospital family medicine residency program operates two such family medicine centers, the Washington Family Medicine Center at 95 Leonard, and the Canonsburg Family Medicine Center at 67 E. Pike Street, Canonsburg.
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, both family medicine centers are staffed by residents, their supervising physicians, and other health professionals. The family medicine centers are 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.
The Washington Hospital Family Medicine Residency Women’s Health Services
The Washington Hospital 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 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 centers. Additionally, the residency program also maintains in-house consultation in obstetrics and gynecology.
Washington Hospital Inpatient Family Medicine Service
Beyond the ambulatory care provided in the family medicine centers in Washington and Canonsburg, the family medicine residency program maintains an inpatient service within Washington 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 Washington Hospital emergency room and elsewhere. Persons in this category will often be among the community’s most disadvantaged patients.
Washington Hospital’s inpatient family medicine residency service encompasses internal medicine, pediatrics, labor and delivery and post-partum maternity care, gynecology, and psychiatry. The residency program staffs intensive care units and provides post-surgical care.
Training Physicians for Rural Areas
Although an important objective of Washington Hospital’s family medicine residency program is the training of physicians for communities the size of Washington, 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.
Long-term studies of the physician practice choice patterns have confirmed that the existence of a family medicine residency program in a region that it is oriented towards rural practice is a critical factor in recruiting family physicians to the small cities and rural towns in that region.
Because many small communities in Western Pennsylvania presently need physicians or will soon anticipate the retirement of physicians currently in practice, the region benefits from having a residency program located in Washington County that is producing new family physicians.
The Washington Hospital Family Medicine Residency School Health Initiatives
The Washington family medicine residency program presents lectures to elementary and middle school children of the Canon-McMillan School District to discourage smoking.
The Washington Hospital Family Medicine Residency Program Cares for a Community’s Most Vulnerable
The Washington Hospital family medicine residency acts as 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 30% of the 40,000 patient visits (representing 16,000 patients under the family medicine center’s care) receive public assistance through Pennsylvania’s Medicaid program, 20% are uninsured, and an additional 20%, mostly elderly persons, are enrolled in the Medicare program.
Of the remaining patients of Washington Hospital family medicine center, 30% are working class families covered by 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 Washington Hospital family medicine program works with its social work staff to help the uninsured in obtaining health care financial assistance for which they may be eligible.
Community Needs Assessment
The Washington family medicine residency has devoted resources to community needs assessment, in cooperation with the Washington Hospital administration. After a community health assessment discovered a shortage of primary health care providers in the rural town of Cecil, the Washington family medicine residency established a new family medicine practice there.
Washington Family Medicine Center’s Community-oriented Primary Care
Beyond the provision of care in the Washington and Canonsburg family medicine centers, and the needs assessment initiatives described above, the Washington family medicine residency is involved in various functions in the community for groups that often have difficulty obtaining physician services.
It works with AdagioHealth, which provides planned parenthood services at various sites in Washington County. It also provides inpatient detoxification care for severely ill patients cared for by the Greenbriar Treatment Center (for patients with chemical dependency) in Washington.
Washington Hospital Family Medicine Residency Services for the Elderly
The Washington Hospital family medicine residency provides an extensive range of services for the community’s elderly population. Ongoing primary preventive, chronic and acute care is provided to maintain the health and well-being of the elderly patients of the family medicine centers in Washington and Canonsburg.
In addition to the primary care and diagnostic services provided at the family medicine center and the family medicine residency’s inpatient services at Washington 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 principally through the Donnell House, a hospice care facility whose medical director is also associate director of the residency program.
Chronic Disease Care and Coordination of Specialty Referrals
Additionally, the Washington Hospital family medicine residency 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 Washington 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 Washington Hospital family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to Washington County and surrounding areas. The family physicians it trains and the care it provides is consonant with the education and service missions of Washington Hospital, and contributes to the improvement of the community’s health.