West Penn Hospital – Forbes Regional Campus FMRP

NATIONAL PROJECT ON THE COMMUNITY IMPACT

OF FAMILY MEDICINE RESIDENCY PROGRAMS

West Penn Hospital – Forbes Regional Campus Family Medicine Residency Program:

A Report

(First draft)

One of the most important policy issues facing the country as a whole and, locally, the urban and rural counties that comprise Southwestern 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 West Penn Hospital – Forbes Regional Campus’ 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 West Penn Hospital – Forbes Family Medicine Residency Program

The Forbes Family Medicine Residency Program was established in 1977, and has graduated 139 family physicians, 20 of whom are practicing near Monroeville, and another ten who practice in communities beyond the Monroeville area.  Twenty of these graduates utilize the West Penn Hospital – Forbes Regional Campus 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, Forbes 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 Forbes 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 West Penn Hospital – Forbes Regional Campus Family Medicine Center

A distinctive feature of the training provided to Forbes 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 Forbes family medicine center is staffed by residents, their supervising physicians, and other health professionals.

The Forbes family medicine center is specifically designed to be the medical home for its enrolled patients, utilizing a sophisticated medical record-keeping system to assure that their patients receive a full range of medical services.

Forbes Family Medicine Residency Women’s Health Services

The Forbes 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 center.  Additionally, the residency program also maintains in-house consultation in obstetrics and gynecology.

The West Penn Hospital – Forbes Regional Campus Inpatient Family Medicine Service

Beyond the ambulatory care provided in the Forbes family medicine center, the family medicine residency program maintains an inpatient service within the West Penn Hospital – Forbes Regional Campus 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 residency program, through its participation in “unassigned call”, assumes a major community responsibility for caring for patients without a physician who are admitted to the hospital through the West Penn Hospital – Forbes Regional Campus emergency rooms or elsewhere.  Persons in this category include the community’s most disadvantaged patients.

Forbes Regional Campus’ 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.

Forbes Family Medicine Residency School Health Initiatives

The Forbes family medicine residency program provides periodic health educational programs to students of the Gateway School District’s elementary, middle and high schools. A residency program faculty member operates as school physician for Gateway High School.

The family medicine residency program provides sports medicine services to Gateway and Yough High Schools. The residency also presents lectures to elementary and middle school children to discourage smoking.

Forbes Family Medicine Cares for a Community’s Most Vulnerable

The Forbes family medicine center is a point of access to many of the community’s most vulnerable populations – the elderly and the disabled, with over 40% receiving public assistance through Pennsylvania’s Medicaid program.   An additional 8% of its patients are mostly elderly persons enrolled in the Medicare program.  A large percentage (8%) of those cared for are medically uninsured or indigent.

The remaining 44% of  the patients of the Forbes family medicine center include working class families covered by 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 Forbes family medicine program works with the hospital billing office 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.

Forbes Family Medicine Residency Program’s Community-oriented Family Medicine

The Forbes family medicine residency faculty also provides the core medical staff to the Metro Family Practice in Wilkinsburg.  The community health center is noted not only for its family-centered maternity care (including the use of doulas, women experienced in providing the emotional and physical support from women in labor can benefit), but also provides HIV+/AIDS care, and comprehensive services for the Gay and Lesbian communities.  Many of the community health center’s patients are medically indigent or are enrolled in public assistance programs.

The Forbes family medicine residency program has devoted considerable resources to community needs assessment, regularly meeting with the Metro Health Center advisory board. This has resulted in such initiatives as a program to conduct medical reviews of the medications of community seniors, and physical exams for low-income school children who need them to participate in summer camps.

Forbes Family Medicine Residency Services for the Elderly

The Forbes family medicine residency provides an extensive range of services for the elderly. Ongoing primary preventive, chronic and acute care is provided to maintain the health and well-being of the Forbes family medicine center’s elderly patients.

In addition to the primary care and diagnostic services provided at the Forbes family medicine center and the family medicine residency’s inpatient services at West Penn Hospital – Forbes Regional Campus, 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 through home visits, nursing home hospice, and the Forbes Regional Campus’ inpatient hospice.

Chronic Disease Care and Coordination of Specialty Referrals

Additionally, the Forbes 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 Forbes 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 West Penn Hospital – Forbes Regional Campus family medicine program is achieving its goal of promoting access to primary health care, and to comprehensive, continuous health care to the Monroeville and Wilkinsburg areas.  It community-based initiatives complement the goals of neighborhood organizations promoting health, are consonant with the service and education missions of the West Penn Hospital – Forbes Regional Campus, and contribute to the improvement of the community’s health.