• Meet Family Medicine

Meet Family Medicine

• Information,
Information, facts,
facts, and andtoanswers
answers to frequently
frequently asked questions about
careers in family medicine
asked questions ALTYNAI AKPARALIEVNA
What is Family Medicine? The four C’s of
primary care cover
some of the basics:

•First contact
•Continuous
•Comprehensive
•Coordinated
The Four C’s: Not Enough

5. Context in care—Family Medicine

includes understanding health as a
result of family and community
The Primary Care Specialties: What’s the Difference?
Sees infants, Sees adults? Comprehensive Options for Highest
kids? women’s health specialization? number of
procedures? graduates
practicing
primary care?

Family Medicine

Pediatrics

Internal Medicine

Med-Peds
More than half of all office visits in the US
are to a primary care physician.

Primary care
physician

Nonprimary
care
physician

Source: Centers for Disease Control and Prevention. Ambulator Care Use and Physician Visits, 2013.
https://www.cdc.gov/nchs/fastats/physician-visits.htm. Accessed September 1, 2017.
 Who Are Patients’ Primary Care
Physicians?

Physician characteristic Percentage of total office

visits
Family Medicine 21.8
Internal Medicine 14.3
Pediatrics 11.0

Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2014 State and National
Tables. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2014_namcs_web_tables.pdf. Accessed
September 1, 2017.
 Is There a “Primary” Primary Care Specialty?
.

Care for every patient.

At the center of the patient lifecycle.

Adaptable, meeting future needs.

Trainees want to be in primary care.

Advancing evidence that matters to patients.

Family Physicians Specialize in Care for All
Selected Area of Clinical Service Percentage of Family Physicians Who
Perform
Chronic care management 81.8

Adolescent medicine 80.1

Geriatric medicine 76.9

Care of infants and children 73.1

Urgent care 55.2

Inpatient care 36.2

Obstetrics 17.1

AAFP, Family Medicine Facts, 2016.

 Selected clinical procedure Percentage of physicians who perform
Skin procedures (e.g., biopsies) 73.4
Musculoskeletal injections 64.2
Spirometry 34.3
Endometrial sampling 30.0
Radiography 25.2
Colposcopy 16.1
Cosmetic procedures 8.6

Family Medicine Ultrasound imaging (OB)

Vasectomy
7.6
7.6
and Procedures Cardiac stress testing 6.7
Ultrasound imaging (non-OB) 6.0
Echocardiography 4.1
Allergy testing 3.7
Flexible sigmoidoscopy exam 3.6
 Esophagogastroduodenoscopy 2.3
Nerve conduction study 1.9

AAFP, Family Medicine Facts, 2016.

Comprehensive Care: It Makes a Difference

Physician Cost and

comprehensiveness hospitalizations

Source: Bazemore A, Petterson S, Peterson LE, Phillips RL Jr. More comprehensive care among family
physicians is associated with lower costs and fewer hospitalizations. Ann Family Med. 2015;13(3):206-2013.
 Primary Care Delivers Complex Care
100

90

80

70

60

50

40

30

20

10

0
One diagnosis Two diagnoses Three diagnoses Four diagnoses

Primary care Specialty care

Source: Moore M, et al. Prim Care Diabetes. 2016;10(4):281-286.
Putting It All Together

First Contact, Continuous,

Comprehensive, Coordinated

+
Context
 Taking Action on Population Health

Quiz
Which would save more lives: social change or
continued investment in medical advances?
 Taking Action on Population Health

Patients need more than medicine

Connections to community resources, help navigating the health care
system, care management from primary care teams

Family physicians care for special populations

Refugees, patients who are homeless, LGBT persons, minorities
Primary Care Health Professional Shortage Areas

(1999)
Primary Care Health Professional Shortage Areas if
Pediatricians Left
Primary Care Health Professional Shortage Areas if
Internists Left
Here is the original map one more time:

(1999)
Now Here It Is without Family Physicians
Med-Peds Workforce
A 2015 survey found:

• 63.2% of the Med-Peds workforce identified as primary care physicians

• Physicians less than 14 years out of medical school were less likely to
be in primary care

• Many in hospital medicine considered themselves primary care

physicians
Source: Donnelly MJ, Thornton SC, Radabaugh CL, et al. Characteristics of the combined internal
medicine-pediatrics workforce. Am J Med. 2015;128(12):1374-1379.
Why are More Internal Medicine Graduates
Choosing to Specialize?

The answer is in the training.

Majority of IM education happens in the hospital

and has subspecialty tilt.

39.6% of IM residents in a primary

care program planned to practice
primary care
The Family Medicine Residency Experience
• Three to four years
• Each program offers something unique

Major areas of training:

Maternity care, hospital medicine, outpatient care, mental health

care, surgical procedures, community medicine, end-of-life care

With Continuity of Care as a continual focus.

 What if I Have a Particular Area of Interest?
Selected Fellowships for Family Medicine Graduates
Adolescent medicine Integrative medicine
Behavioral medicine International health
Combined Residency
Clinical informatics Maternity care/obstetrics
Programs
Community medicine Pain management
Emergency medicine Preventive medicine
20-Plus Fellowship Options Faculty development Research
Geriatrics Rural medicine
Certificates of Added Health policy Sleep medicine
Qualification Hospice/palliative care Sports medicine
Hospitalist medicine Substance abuse
Human immunodeficiency Urgent care
virus/AIDS care
How Many More Primary Care Physicians Do We Need to Train?
How Many More Primary Care Physicians Do We Need to Train?

>44,000

Source: Annals of Family Medicine, 2015.

Hope for the System:
Team-Based Care

Collaboration makes anything possible.

Primary Care Teams
What is team-based care?
It’s relationship based: Two or more professionals working together to
improve patient care.

It’s flexible: Built around patient population needs.

It’s patient centered: Greater opportunity for expanded office access,

greater focus on education and self-management.

It’s physician dependent: Value of model stems from clinical efficiency

and expertise. Complex patients get physicians’ increased focus.
What Can I Expect From a Career in
Family Medicine?

• Average income in 2017: $209,000 (up from $175,000 in

2013)
• Average starting salary in 2017: $200,000 to $225,000
• Signing bonuses up to $30,000
• Most recruited specialty for more than 10 years
• Primary care–specific loan repayment assistance
Sources: Merritt Hawkins (2017), Medscape (2015)
 Burnout: Am I Going to Be at Risk?
In 2017, 55% of family physicians told Medscape that they were burning out.
Rates of burnout in other specialties ranged from 42% to 59%.

It’s not the doctors. It’s the system.

FACTOR 1: Administrative complexity

FACTOR 2: Documentation requirements + tools that need to catch up
FACTOR 3: Payment incentives that emphasize the wrong measures of care

Family physicians know what needs to change. Policymakers want their solutions.
The AAFP consistently advocates for improvement of the family physician work environment.
 In Family Medicine You Can Take Care of Yourself, Your
Patients, and Your Family.

75% of AAFP
members reported Family physicians
Practice model
being satisfied or Use your skills: have long-term
plays a role in
very satisfied with broad scope of career flexibility
well-being. In
their careers. practice is because of
primary care
associated with training scope
there are many
79% said they lower levels of and high
clinic styles to
have a good sense burnout. recruitment
choose from.
of well-being. demand.
(2017)
Career Settings
• Office practices
• Hospitals
• Nursing homes
• Community health centers
• Urgent care centers
• Emergency rooms
• University-based health centers
• Rural and urban
• International
• Health care system leadership
• Government
Presenter: Want to add information about
delivery of care in your talk?
See our slide collection “How Care Happens” in the AAFP’s presentation
resource center at
www.aafp.org/medical-school-residency/fmig/presentations.html and
mix in the context here.

If not, delete this slide and continue.

Portrait of a Week in Practice

• Hours worked: 47
• Most of time spent: with
patients
• Weeks worked per year: 47
• Percent of family physicians
who work part time: 11.4

Source: AAFP, 2015

 Community Trust

86% of Americans agree: primary care leads to better health

And that it also represents:

-Higher-quality health care

-Greater cost-effectiveness

Source: Health is Primary, 2017

 Portrait of Family Medicine in the Future
Building on a Strong Past

First professional
organization Starfield, et al publish
Family practice #FMRevolution:
(eventually known on FM’s unique effect on
approved as physicians reclaim
as AAFP) formed lives saved in a
specialty 1969 counterculture origins
1947 community 2005
2010s

Folsom Commission: Expansion of hospital Affordable Care Act Record number

“Health Is a Community privileges; schools elevates preventive of students
Affair” 1966 rewarded for graduating care, creates new match into FM
generalists 1980s payment incentives 2016
2010
 Portrait of Family Medicine in the Future
What can you expect to change?

• Growing salary
• Increasing demand
• Health care reform emphasizing primary care
• Urban centers will have higher populations
• Population is aging
• High tech, high touch skillset shaping care delivery
• “Chronic care will unseat acute care”
Presenter: Want to add information about
the future of health care in your talk?
See our slide collection “Health Reform Highlights” in the AAFP’s
presentation resource center at
www.aafp.org/medical-school-residency/fmig/presentations.html and
mix in the context here.

If not, delete this slide and continue.

People don’t need more health care;
They need more family physicians.

From newborns to older patients, everyone is healthier when there are more
primary care physicians.
Source: Starfield B, Shi L. Policy relevant determinants of health:
an international perspective. Health Policy 2002; 60(3):201-218

Patients actually live longer when family physicians are added to a

community compared with all other physicians.
Source: Starfield B, Shi L, Macinko J. Contribution of primary care to
health systems and health. Milbank Q. 2005;83(3):457-502.
What Do You Look Forward to As a
Physician?
Intellectual challenge of the undifferentiated patient?
Forming relationships with patients?
Public health implications?
The physician lifestyle?
Following a patient through treatment?
Using scientific evidence in practice?
Stature in the community?
Presenter: Want to show students real-world
examples of the possibilities in family
medicine?
See our slide collection “Meet Family Physicians” in the AAFP’s
presentation resource center at
www.aafp.org/medical-school-residency/fmig/presentations.html and
mix in the context here.

If not, delete this slide and continue.

 Five Ways to Find Family Medicine
1. Identify mentors early

2. Go to National Conference

3. Get involved in the campus Family Medicine Interest Group

4. Join AAFP (free; includes Board Review)

5. Explore the scope: read American Family Physician journal and

listen to AFP Podcast
 Questions?

“This is not a job. It is a

"I love being a generalist “…Providing care to
and being able to speak lifestyle choice that
underserved populations challenges your intellect
with experience about a
wide range of clinical also brings a similar sense daily and your ability to
topics. I also appreciate of purpose and pride. I interact and develop
the ability to bring clinical entered the field of relationships based on
experience to research medicine because I mutual trust to promote the
and health policy wanted to help people health and wellbeing of your
discussions.” and to make a patients.“
—Dr. Frederick Chen difference.” —Dr. Flora Sadri-
—Dr. Devry C. Anderson Azarbeyejain