03-30-04 - Press Release - Two-year Study Produces Recommendations to Transform and Renew Family Medicine
Future of Family Medicine Project presents new vision for patient-centered care, outlines changes needed
Contact: Angela Lower
(800) 274-2237, Ext. 5224
alower@aafp.org
Karen Siebert
(800) 274-2237, Ext. 5221
ksiebert@aafp.org
LEAWOOD, Kan. -- A report released today by America's family physicians calls for systemic changes to the U.S. health care system, medical education and clinical practice, and the development of a New Model of patient-centered care based on the concept of a "personal medical home" for all Americans. The recommendations from the two-year Future of Family Medicine (FFM) Project are published today in a supplement to the March/April issue of Annals of Family Medicine.
"Patients and their physicians are increasingly frustrated with the fragmented and complex health care system," said James C. Martin, M.D., chair of the FFM Project Leadership Committee and a practicing family physician in San Antonio, Texas. "As advocates for our patients, we are presenting a vision for the personal, integrated care they want and need."
The FFM Project, which was initiated in 2000, is a joint effort of the Family Practice Working Party and the Academic Family Medicine Organizations. The organizations are the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Practice, Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, North American Primary Care Research Group and Society of Teachers of Family Medicine.
"We are acutely aware of the problems our patients encounter in the U.S. health care system because we face them every day, too," Martin said. "However, we wanted to ensure that this project was grounded in scientific research, not just anecdotes and assumptions."
To that end, the FFM leaders enlisted independent researchers to conduct qualitative and quantitative research to provide them with an objective understanding of the contemporary situation of family medicine in the United States. The research also provided a clear understanding of what patients need and want from America's health care system and their personal physicians.
"We found there is a pervasive need and desire for family physicians and the personal, integrated care they provide, not only among individual patients, but among the broader health care and business communities as well," Martin said.
The FFM Project has been patient-centered from the outset. In order to improve patient care and outcomes, the specialty had to take a critical look not only at itself, but at the broader system in which it operates and the entire spectrum of care that a patient experiences. "We recognize that family medicine cannot fully succeed without fundamental changes in the larger health care system," Martin said.
However, the current U.S. health care system does not sufficiently support family medicine and primary care through training, research funding or reimbursement. As a result, the number of U.S. medical school graduates choosing family medicine has declined nearly 50 percent since 1997, with fewer than 10 percent of U.S. medical graduates now choosing family medicine.
"We have to address how to make the specialty more appealing to medical students as a career choice and more responsive to patient needs in today's ever-changing health care system," Martin said. "The time has come for family medicine to take a leadership role on behalf of the millions of patients - from infants to the elderly - family doctors care for every day. If we don't take action now, we will very soon face an alarming shortage of family physicians to care for patients who want and need care."
The FFM Project recommendations published today are designed to stimulate and guide initial steps toward a serious revision of family medicine and health care in the United States. The vision the report presents focuses on three key areas:
Clinical practice
In the area of clinical practice, patient, physician and practice will be reintegrated through a New Model of care. The New Model will be based on the concept of a personal medical home, which will be the focal point through which all individuals - regardless of age, gender, race, ethnicity or socioeconomic status - participate in health care. In this new medical home, patients will receive a basket of acute, chronic and preventive medical care services that are accessible, accountable, comprehensive, integrated, patient-centered, safe, scientifically valid and satisfying to both patients and their physicians. The transformation will include physician office redesign, electronic health record systems, a team approach to managing a patient's health care, elimination of barriers to access and enhanced practice finance.
Medical education
Medical education, both for medical students and practicing physicians, is key to insuring the adoption and success of the New Model of care. Family physician residency training will include curriculum changes to effectively train family physicians to work within the New Model. The academic training centers will redefine and rearticulate the commitment of family medicine to community and family while addressing the declining interest in family medicine among medical students. They will train physicians who will humanize medicine, are prepared to work in a world of changing demographics, utilize the biopsychosocial model, actively measure outcomes, and adapt to and are involved in the creation of relevant new knowledge.
The formal process of lifelong learning for practicing family physicians will also be redesigned. The new developmental approach will ensure continual improvement of clinical practice skills based on evidence-based knowledge, personal development and improvement of the patient care environment, all with the goal of improving patient care.
U.S. health care system
Family medicine operates within a broader system that needs to support the integrated care that patients need and desire. Steps must be taken to ensure that every American has a personal medical home, basic health care coverage and protection against extraordinary health care costs. The use and reporting of quality measures should be promoted in order to enhance patient care, and research that supports the integrated care of the whole person must be funded. Reimbursement models that sustain family medicine and primary care must be developed to ensure that the New Model of care is viable.
The FFM Project includes 10 recommendations to provide a framework to guide innovation in the three key areas of clinical practice, medical education and the U.S. health care system:
- New Model of family medicine
- Electronic health records
- Family medicine education
- Lifelong learning
- Enhancing the science of family medicine
- Quality of care
- Role of family medicine in academic health centers
- Promoting a sufficient family medicine workforce
- Communications
- Leadership and advocacy
Each of the seven participating organizations has assumed responsibility for enacting the recommendations that fall within its purview.
"This will be a long process," Martin said. "Systemic change won't occur overnight, but it will happen. In fact, we are already moving ahead in several areas with major initiatives that will affect every family physician in this country."
The American Academy of Family Physicians launched the Electronic Health Records Initiative in 2003 with the goal of having all family physician offices in the United States using electronic health records systems by 2005. In addition, the American Board of Family Practice has already announced changes to its recertification process that will enhance the educational development of family physicians across the country.
"We are moving forward with vision and purpose," Martin said. "The FFM Project has provided the specialty with a compelling vision for the future and it is now up to organizational leaders and practicing family physicians around the country to take the lead in transforming health care in this country."
A complete copy of the FFM report is available at the Annals of Family Medicine website.
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