Family Physicians Take a Hard Look at the Future

It's no secret that family physicians work long hours, and their compensations pale in comparison to that of many other specialists. They spend too much time with paperwork and in frustrating discussions with payers. They don't get to spend enough time with their patients, and they often lack quick access to information that can help them provide better care for their patients. Yet, most family physicians still find their profession rewarding.

To examine the state of family medicine in the United States, a bold step was taken to explore what's wrong and what's right with family medicine, proposing solutions to ensure the continuing health of the specialty. The Future of Family Medicine project was launched in 2002 by seven medical organizations – led by Leawood, Kan.-based American Academy of Family Physicians (AAFP) – to develop a strategy to transform and renew the discipline of family medicine. The project calls on family physicians to implement a compelling vision for better family medicine and stronger primary care. Yet, it calls for the broader U.S. healthcare system to get its house in order, too. Indeed, without assurances that every U.S. citizen has access to high-quality healthcare, the family physician can't do what he does best: deliver personalized, high-quality healthcare to everyone who comes through his door.

A role for family docs?
The project began with the most fundamental question of all: Is there a role for family physicians? The study found that the public has difficulty identifying family physicians for what they are and what they do. "At least in part, this reaction is based on the belief that it is unrealistic to expect any one physician to be able to stay current and maintain competence in all areas of medicine," the report says.

Patient-centered medicine
The study and subsequent interviews found that patients value the quality of their relationships with their family doctors above all else. The "first and most exciting response" to researchers' questions was that Americans still need a family physician to act as a "quarterback" to coordinate their care, adds James Martin, M.D., board chair of the AAFP and project chair of the Future of Family Medicine project. "They made it clear that they want a doctor who will take time with them, who will be available when they need him or her," says Martin.

Indeed, ongoing relationships with patients are perhaps the family physicians' strongest offerings, and it's what the authors of the Future of Family Medicine project hope to preserve and nurture. Yet, never before have physician/patient relationships been so threatened. Part of the reason lies with physicians' adherence to outdated approaches to medicine.

"Healthcare in this country is very physician-focused," says Martin. "We tell patients when to come in and how much time they can spend with their doctor." Patients often have to wait too long to see their doctor and when they finally get to the exam room, they feel their visits are hurried and that they are unable to get all their questions answered, he says.

Noticeable changes
If some of the changes espoused by the Future of Family Medicine project are adopted, patients will begin seeing workflow changes in family physicians' offices, predicts Martin. Most of these will be driven by the desire for physicians to create patient-centered practices.

For one, the waiting room may have fewer patients. "As new technology continues to be developed, we'll find more and more ways to provide patient care without the patient leaving their home," says Martin.

Electronic communication between patients and physicians (and staff) will increase as well, he predicts. Of course, before family physicians can participate in either of these trends, payers will have to agree to reimburse them for their time, instead of reimbursing them only for face-to-face visits.

Also in the future, family physicians will implement electronic health records in their practices, says Martin. "The patient will be able to carry his or her own medical record on a memory chip, so there's no worry about a stack of paper getting lost," he says. Physicians will call up patient information, make notes and access clinical guidelines at a workstation in the exam room.

All of these changes will affect the physical setup of the physician's office. For example, when patients come in, they will check in at an electronic kiosk. While at the kiosk, patients can check their medical records using a password. In the exam room, doctors will have online access to information about illnesses or diseases, as well as treatment plans and options. When patients leave the office, their prescriptions will have been transmitted electronically to the pharmacy, and they will have an information packet on the prescribed drugs.

The changes will affect the lives of family physicians – for the better. For example, instead of rushing through 25 to 30 patient visits a day, then plowing through hours of phone calls and record keeping, family physicians may see only 10 or more fewer patients a day, spending a longer time with each.

"If you talk to any family physician, they'll tell you they entered this field because of the relationships they could build with their patients, and the continuity," says Martin. "But when managed care came in and employers began treating employees like commodities, that continuity was lost. At the same time, managed care dumped a lot of paperwork on the family physician. So it's been a very frustrating go for them.

"Yet when family doctors were asked, 'If you had it to do all over again, would you?' Ninety percent said they would. The bottom line is that at the end of the day, they feel like they've mattered to their patients. I'm glad that's not lost."

Perhaps securing the future of family medicine means ensuring strength by preserving the best of the past.

The New Model
Following two years of research, surveys and interviews, the organizations identified what they call a “New Model” of practice, with the following characteristics:
  • A patient-centered team approach
  • Elimination of barriers to access healthcare
  • Advanced information systems, including an electronic health record
  • Redesigned, more functional offices
  • A focus on quality and outcomes
  • Enhanced practice finance.

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