Friday, August 30, 2013
Sunday, August 4, 2013
Family Medicine Residents Adopt Resolution to End Falsification of Primary Care Workforce Production by Medical Schools and Residency Programs
Change through disruption (check)
Change through creating policy (check)
Change through educating the media, legislators, and the public (pending)
All of the above are the reasons for continuing efforts to ensure that medical schools are held accountable for the primary care workforce numbers it publicizes and promotes to medical students, federal/state/local legislators, and the public. All of the aforementioned stakeholders deserve the right to know how many of its medical school and residency graduates ACTUALLY practice primary care.
We have used this blog to call out medical schools that lie to the media and ultimately lie to themselves. These blogs have served as references for a number of articles in the media to help explain what "the Dean's Lie" actually is. Over the past year, a number of media outlets have caught on to and have called out medical schools that, despite being shown the data, continue to publicize primary care percentages that cannot be proven until at least 3-5 years after graduation from medical school.
An article by Medical Economics ("How Medical Schools consistently cover up their primary care failures") focuses on an interview with Primary Care Progress CEO and primary care change agent, Dr. Andrew Morris-Singer. The article does an exceptional job in trying to relay this information to the media. By utilizing the media for these numbers, they may be more likely to show how many of the "primary care institutions" are actually performing at the bottom of all medical schools in the entire country. In fact, this is already being evaluated in our internal medicine residency programs by the Graham Center and resulted in several media pieces, including the "20 worst" residency programs for contributing to the primary care workforce.
Now that our efforts are finally starting to show promise, it is now important to continue this momentum and accumulate organizational support. Since medical schools and residencies refuse to face the truth and provide the correct data proving their inability to produce primary care physicians, we must now do the work ourselves in finding this objective data and distributing it via multiple large-scale organizations to legislators and the public.
The opportunity to provide guidance and create policy outlining the specifics of this initiative presented itself this past weekend at the 2013 American Academy of Family Physicians (AAFP) National Conference of Family Medicine Residents and Medical Students. The Resident Congress provided a forum to present a resolution that, upon approval by the Resident Congress, a specific action and policy could be put into place to task an organization that represents over 110,000 Family Medicine physician, resident, and medical student members with advocating and collaborating with others in amplifying these efforts.
The following resolution was submitted and approved by the AAFP Resident Congress:
RESOLUTION NO. R1-407
Rebuilding Trust In and Accountability for Primary Care Workforce Production Reporting
WHEREAS, The United States (U.S.) educational system is currently doing a woefully inadequate job of producing enough primary care physicians to satisfy future demand, and
WHEREAS, medical school deans and residency programs consistently cover up their primary care failures, regularly exaggerating the number of medical school students and residents they report graduating into “primary care residencies” and practicing in “primary care fields,” also known as “The Dean’s Lie,” and
WHEREAS, publicizing misleading data of primary care workforce production gives the taxpaying community and politicians a false sense that the primary care workforce shortage is being fixed, and
WHEREAS, after factoring in the specialization rate of pediatrics (66%), internal medicine (80-98%), and other “primary care” residencies (e.g. IM/Peds, etc.), a much lower number of medical students actually end up practicing primary care, and
WHEREAS, medical schools utilize other non-primary care specialties when reporting their primary care production numbers (e.g. obstetrics and gynecology), and
WHEREAS, the institutions touted at producing primary care physicians have recently been found to be among the worst at producing primary care workforce when looking at graduating classes from five years prior, and
WHEREAS, it costs $500,000 of taxpayer dollars to train the average resident and as part of the Affordable Care Act, provisional funding will be given to “primary care” residencies including internal medicine, pediatrics, etc., now, therefore, be it
RESOLVED, That the American Academy of Family Physicians (AAFP) advocate for accurate reporting by medical schools and residencies of primary care workforce production measuring the type of practice five years following medical school graduation, and be it further
RESOLVED, That the American Academy of Family Physicians (AAFP) explore the feasibility of working with other organizations and news outlets to collaborate in advocacy for more accurate reporting of primary care workforce production to politicians and the public.
Things are about to get very interesting....
Highlight on interesting comments:
Thursday, May 30, 2013
Hello, Fellow Downstaters!
Yesterday, we graduated from SUNY Downstate. Two days ago,we were med students just like you, and now we are four soon-to-be residents who have chosen to go into various primary care fields. We wrote this letter to you, and hope that you enjoy reading it. Please, help spread the word!
Primary Care, it's the Awesomest! To Be People's Doctor, there's No Better Way to Be!*
There. The title of this memo-to-all-med-students says it all. But we’d like to elaborate! First of all, our title might be, well, over the top, some might say--but we’re excited about where we’re headed (!), and we’ll tell you why in a second. Plus, we felt it was that important to catch your attention, especially since in 1940, three-quarters of all doctors were general practitioners(1), but with the subsequent proliferation and dominance of specialist fields in American medicine, by 2010, less than one-third of practicing physicians were focused on providing primary care.(2) Moreover, the need for primary care physicians will continue to increase with the aging of our population and the millions more Americans who will soon be able to acquire health insurance, as a result of the Affordable Care Act.(3)
What does our opinion matter to you? We don’t claim to be the end-all-be-all, or the know-it-alls, but among us, we have a good number of accumulated experiences as MS1-MS4 medical students during the years 2008-2013. To be sure, our experiences in primary care have spanned providing care within an efficient team-based care model at a top-tier Patient-Centered Medical Home in Portland, Oregon; to staying after-clinic-hours to join in Zumba and nutrition classes with patients, led by the spirit-rich community of caregivers at Lefferts Family Health Clinic in the resource-poor community in Crown Heights; to working on public health studies of disparities in cancer screening; to experiencing successful integrative medicine practices that are helping patients to achieve better outcomes in Brooklyn Heights; to providing primary health care for uninsured patients at free clinics; to helping determine goals of care for patients and families faced with terminal cancer.
In primary care, the patient--and your relationship with that patient--comes first. If this excites you, and you haven’t considered going into primary care yet, then we recommend that you start doing some considering. Primary care is not defined by one organ system or illness category, but by whatever it is that brought that patient to you, and keeps bringing her or him back to you, in illness and/or in health.(4) The person, their significant other, their family, their psychology, their context, their home, their community, their daily struggles, their life’s joys, their life’s tragedies, their health, illness, growth, journey to death--they all matter, and you get to be there with them, for them and their families, when they need. The buzzword these days is “continuity” of care. That is what primary care does and is.
Asfuture primary care physicians, we are excited by the chance to hone and master diverse clinical, interpersonal, research, and policy skills, depending on our interests and our patients’ needs. One of the greatest assets of being a primary care doctor is that you truly are a lifelong learner, with your patients at the center of the learning process. Additionally, we work with other providers including specialists, psychologists, integrative medicine providers, nurses, and home health aides--not to mention teachers,not-for-profits, and policy makers--to provide care that best fits our patients’ needs, values, and life circumstances. As “frontline providers,” we are in a unique position to work with communities--e.g. organizing community health efforts or contributing our voices to healthcare policy--as advocates for our patients. We are incorporated into their lives and communities, and, from this unique vantage point, have initiated the development of many social initiatives and advocacy efforts; we have been pioneers of social justice and pushers of public health policy initiatives, from vaccination to improved access to care. In all of these endeavors, primary care doctors have led the way.
There is also an abundance of dynamic opportunities in primary care research, from improving preventive medicine to management of chronic diseases; from the hospital-to-outpatient transition to the complex needs of our aging population; and from end of life care to ending racial/ethnic health disparities. As just one example, take the recent changes in the U.S. Preventive Task Force recommendations for mammography, prostate cancer screening, and HIV testing: primary care doctors not only help navigate their patients through these complexities, we are the ones formulating and conducting the vital research that ultimately improves our national guidelines! As primary care becomes the centerpiece of health care reform, the opportunities to be involved in research are becoming endless.
If there wasn’t enough respect for and investment in primary care in our country from the mid-20th century through 2010, then at least you can be sure that in the coming months, years and decades, primary care will be the main focus of healthcare investment and reform. Who, by now, has not heard of the “chronic care model” or the more recent Patient-Centered Medical Home (PCMH)? While there are a number of components to understand regarding these models(5), including continuity/coordination of care and patient access, at their roots, they recognize the evolutionary shift that has occurred in modern industrialized society--that people are living longer and predominance of acute morbidity has shifted now to an overwhelming burden of chronic disease in our country.
The 2001 national assessment by the Institute of Medicine, Crossing the Quality Chasm(6), called for transforming a “fundamentally flawed” US health care system; this report helped to propel the momentum that has led to the first serious attempt now at implementing health care reform in our country’s recent history. With this, is a growing focus on primary care: in the words of the Institute of Medicine, “primary care is the logical basis of an effective health care system... [and] is essential to reaching the objectives that constitute value in health care.”(7) This recognition has led to increased reimbursement rates and medical school grants for those going into primary care (contrary to popular belief, a recent study has proven that medical students with median loans are able to pay it off on a primary care physician salary(8), and there are many federal, state and private scholarships targeted to attract brilliant and compassionate future-physicians--like yourself!--to the field), which have paralleled the overall shift ingovernmental priorities to strengthen our health care workforce through support of its frontline providers. This growing emphasis on primary care has crescendoed over recent years and is now evident in restructured health systems and practices in many parts of the country, federal and state policy, and is even beginning to take hold in medical education(9). There has been no better time, as a medical student, to choose primary care as your match and future career.
In fact, many are! Check out David Margolius, a resident physician at UCSF primary health track who is speaking at conventions across the country about reinventing primary care and improving access, continuity, and clinical outcomes . Take a secondto google David Katz, an internist at Yale, and his Huffington Post article titled “The Case for Caring About Primary Care” (as well as his other great food and exercise tools!). While you’re at it, meet a few long-time primary care leaders who have, for years, inspired doctors starting their careers: go on Amazon or to the good ‘ol library and check out, Big Doctoring in America: Profiles in Primary Care. Among the fascinating profiles turn to “Neil Calman, M.D.: Urban Warrior,” to read about the self-proclaimed “flag-waving family physician...warrior for urban health,” who founded the trailblazing Institute for Family Health in New York City. Or, look no farther than our current U.S. Surgeon General, Dr. Regina Benjamin, who once founded a primary care clinic in a poor shrimp-fishing village on the coast of Alabama--and rebuilt it three times after two hurricanes and a fire; we are now nearing two years since the release of her unprecedented National Prevention Strategy, which has been the centerpiece of her tenure. Its successes mirror the improved health outcomes seen across the country, in the places where there has been increased emphasis on primary care.
-Abraham Young, soon-to-be resident in Family Medicine! atEinstein/Montefiore Hospital, Bronx, New York
-Jessica Bloome, soon-to-be resident in Primary Care Internal Medicine at UCSF Medical Center/San Francisco General Hospital, San Francisco, California
-Alinea Noronha, soon-to-be resident in Family Medicine at UC Davis leadership track, Sacramento, California
-Rachael Maciasz, soon-to-be-resident in Pediatrics atBrown, Providence, Rhode Island