What Clinical and Social Needs Does the Public Need Family Medicine to Address?

In 1969, Family Medicine brought innovation to residency training by placing residency training in communities
and incorporating behavioral health and practice management. Over the last fifties, our patients and communities
have changed. What disease and social problems have emerged—and what should be explicitly included in residency
training for family medicine.In addition, there have been dramatic changes in the organization of health care
and technology for patient care and for teaching. What new and emerging competencies should be addressed in the
requirements for all residencies?

Potential Curricula For Consideration INCLUDE

• Advocacy and Leadership in Communities and in Health Systems
• Improving Population Health—knowledge, attitudes and skills
• Integrated behavioral health
• Team-based Care, to include other professionals and patients
• Lifelong Learning—critical appraisal of evidence, adoption of innovation and learning habits
• Application of Genomics as it becomes useful
• Emergency Preparedness
• Emerging Infectious Disease
• Mind/body/spirit connections
• Lifestyle medicine, including nutrition, exercise, wellness, other MAT/Addiction medicine/Pain control
• POC Ultrasound
• Telehealth
• Others?

September 17, 2020
Ron Stout, MD

Family physicians must be empowered with the knowledge to guide their patients in preventing, treating and reversing chronic disease. COVID has demonstrated that pills, potions and procedures don’t address the underlying challenges of a damaged physiology. The emerging field of Lifestyle Medicine deserves significant attention and engagement from educators.

September 17, 2020
Kelly Mayfield, MD

After reviewing the documents, there should be strong consideration given to recognizing the role that religious faith plays in the health of our patients. If we are going to be comprehensive, this should at least be acknowledged in these documents. The family physician should not be afraid to address these issues while, just as with other issues, referring the patient who is seeking answers to those who can provide them rather than ignoring this important component of many patients’ lives.

October 14, 2020
David Perry-Smith, MD

After reviewing the documents, there should be strong consideration given to recognizing the role that religious faith plays in the health of our patients. If we are going to be comprehensive, this should at least be acknowledged in these documents. The family physician should not be afraid to address these issues while, just as with other issues, referring the patient who is seeking answers to those who can provide them rather than ignoring this important component of many patients’ lives.

October 14, 2020
Patrick Couchot, MD

Thank you all for opening up this dialogue among family medicine providers. I would offer two suggestions to add or at least have a discussion about.

1. I would like to see a stronger emphasis of preventative medicine. Many of the systemic disease that affect and plague our country are preventable disease (ie heart disease, obesity, diabetes, etc). I am happy to provide research material supporting this claim. Family medicine providers are uniquely positioned to have a dramatic impact on this expanding field of medicine. I would place an emphasis on diet and exercise as lifestyle modifications which can be used as treatment modalities. Medical schools and residency programs are not fully preparing our physicians for these tasks and additional requirements would be paramount, especially as we move into quality based payments. I also have additional research to back this claim.
2. I would also like to see some involvement of training with mid level providers, as many large primary care groups are moving toward this model. I think exposure to these other specialties will allow for a more seamless transition when moving into different practices. Understanding the role of the mid level provider, and the role of the physician leader, can be crucial in providing care to an increasing amount of patients.

November 23, 2020
Alberto Alzate, MD

Perhaps is time to start thinking of having some subspecialties in Family Medicine. other specialties like EM that is a new specialty compere with

Family Medicine is advancing a lot because they are not asking other specialties for approval to embrace procedures that were not part of that specialty some time ago like ultrasound, echocardiogram, critical care, sport medicine, palliative medicine. Family Medicine need to give the chance to us to pursue different avenues and we need as specialty to get the recognition the we deserve.

November 30, 2020
Rk SM, MD

Below is a list of what I feel is a must have knowledge for new grads

1. DM2 management- including what is better for DM2+obesity, DM2+CHF, DM2+osteoporosis etc
2. HEpEF, CHF management
3. Cirrhosis management and appropriate HCC screening etc
4. Dermatology-office based skin lesion removal, other skin conditions trt like Eczema, psoriasis, etc, Peds-common rashes vs. concerning
5. Mood d/o initial screening and trt- Depression, PTSD, bipolar etc
6. Dementia w/u and initial trt
7. Education on health insurance coverage, billing etc
8. COPD/Asthma eval, trt and maintenance
9. Private business management (my residency didn’t teach any)
10. Common Gyn d/o and management
11. Knowledge of alternative Pain management trt

December 29, 2020
Christopher Haymaker, MD

I love the Starfield Summit. The re-envisioning of residency education in Family Medicine and primary care is absolutely vital to the health of humans.

However, without a more explicit focus on physician well-being and support during residency education, I worry that this effort is doomed to fail in its auspicious goals. Without integrated reflective practice that builds physician identity around well-being and compassion, our future physicians will struggle to encounter the challenges of future practice and community engagement with a sense of equanimity. When our resident physicians do not feel cared for by our programs, and when our programs do not have sufficient capacity to guard against fatigue and burnout, professional ‘imprinting’ validates a hidden curriculum of independence over caring, reduces the likelihood of clear-eyed assessment of vulnerabilities, and puts duties ahead of nurturing professional relationships and self-care. Ultimately, this increases the risk for both patients and physicians.

As a profession, the failure to recognize a nurturing environment as fundamental to learning puts our learners at risk for long term caring deficits that interfere with community building, patient care, and empathy. We need to care more for our learners to put them in a position where they can advocate for a better health care system and a better world. This caring should start with changes to the learning environment at the systems level to mitigate burnout and other threats to well-being.

Here’s hoping we can all do our part to engage our learners effectively and encourage well-timed reflection regarding personal and professional vulnerabilities. I am hopeful that as the project unfolds, more ambitious and explicit curriculum will be establsihed to encourage imprinting that leaves graduates with the energy and compassion to become excellent Family Medicine Physicians.

Respectfully submitted,

Chris

January 15, 2021
Elisha McLam, MD

Consider making OB optional, as so few family doctors currently have the opportunity to practice OB.

January 16, 2021
Wendy Fuhr, MD

I spent 10 years in high-volume employed practice, and now am in my 11th year as a core faculty member in a FM residency program.

The AAFP and ABFM need to put their attention and funding towards creating new Fellowships (Behavioral Health for one) AND allow physician to complete these Fellowships while in practice. I cannot take a year off to complete Fellowship at this point in my career, and I have spoken to many, many other mid-career physicians who feel the same.

Also, all FM residents should be able to apply to specialty fellowships that are currently only open to IM residents. This would improve our applicant pool, and I am sure that many would end up staying with broad-spectrum Family Medicine because they will see rewarding it is.

Lastly, there is no place for a required number of Obstetrics patients and deliveries in many FM residencies; the struggle to get adequate teaching and see enough patients is ongoing, as is the struggle to be respected by OB nurses and ObGyn physicians. I would ask that certain residencies be considered OB Track, and the rest incorporate 1 month of OB only, with the option to use elective time for more experience if desired.

January 16, 2021
Antoinette Martinez, MD

I want to ensure that BIPOC and health equity issues are being addressed in residency training. We are at a critical time and it is urgently needed. Residents need to be competent and able to understand justice, health equity, and antiracism and how this affects health.

Has this been discussed?

January 16, 2021
Cara Horrop, MD

Although I haven’t had a chance to deeply delve into the website, I was pleased to see topics like leadership, advocacy and team based care as part of a proposed curriculum. I also think it is critically important to teach residents about the business of medicine so that they can be conversant in leadership roles with members of administration and be advocates for their own practices. It is time for family physicians to not graduate from residency and believe that the only way they can make a living is to be employed by someone else. Thank you for your time.

January 17, 2021
Emily Shaw, MD

Hello! Preparing graduates for practice over their lifetimes is what I do as a life coach specifically for physicians. I’m a practicing family doc and a certified life coach. Please consider looking at the growing body of evidence (including randomized controlled trials) that we have now that shows the power of coaching for physicians. For life-long learning. For personal and professional growth. And professionalism within and between varied practice settings. Coaching not only prevents and treats burnout. It also sets physicians up for success for every challenge that we face along our journey through life. We are so blessed as family physicians in that our careers can morph and change over the course of our lifetimes. There is so much flexibility in family medicine. And with that flexibility and change comes the need to train our learners to adapt in a healthy way and to pursue growth in a healthy way. That’s what coaching does! Let me know if you’d like help learning more!

January 20, 2021
Jamie Osborn, MD

Make sure you bring forward what we learned in P4 from 2006-2012. Team based care, patient centered whole person care, asynchronous care, preventive care, integrated behavioral and pharmacy… And most importantly: the process of team transformation (becoming the change we wish to see in the world) means we each transform along the way as we love one another through the uncertainty.

January 21, 2021
Mark Timmerman, MD, FAACP

My life changed little when prostate cancer struck, until I found that my diet led me to cancers doorstep! Neal Barnard’s PCRM AND ICNM Conference should be taught in EVERY Medical and Nursing curriculum PA, NP as well. LIFESTYLE is still ahead of medical care.

February 8, 2021
Jeff Taber, MD

31 years in rural America, the last 21 as a solo FP….I feel FP training for those looking to serve in rural locations must somehow include things like OB, ER, IM and some surgical skills…along with the core of FP training. With fewer and fewer physicians willing to live and work in rural America, there must be a group of high quality residency programs that commit to such a broad and intensive training.

I feel my training was excellent (University of Iowa affiliated – Broadlawns Medical Center in DSM, IA), but that was 31 years ago. I hate to think family medicine might be contemplating a residency training retooling that better fits/serves the urban/metropolitan oriented, large medical system employed physician, outpatient clinic only family physician. Rural medicine requires a broad based training which addresses the whole person care approach.

Telemedicine has been a real benefit in some areas of rural patient care (ER), but unfortunately, like any new approach or methodology, it can also be used in a manner which makes it more difficult for FPs to keep a rural practice open, for many sub-specialties seem eager and ready to expand their BUSINESS efforts ($) into any geographical areas which will use them. “Outreach clinics” in small rural hospitals, where specialist travel ‘from afar’ to see patients, or now might ‘zoom in’ to see them by tele-medicine….are at risk for turning into “Inreach clinics”. No babies will be delivered via Zoom!

As for rural family medicine training needs….keep it broad and comprehensive. You can always tailor your focus and narrow down your practice focus after having received a quality broad based training,….but to do the opposite is very difficult and nigh unto impossible. Try adding OB, ER, and some surgical training “later”. Up hill and extremely difficult. I trained for GI endoscopy, OB, Cesareans, ER, newborn issues, and a few gen surgical procedures. I am so very grateful for the training I received. Perhaps there should be three and four year FP training tracks, the four year being for those desiring a rural Family Medicine involvement.

Respectfully

March 10, 2021
Mary Callis MD, MPH

As a clinician dualy residency training in both family and emergency medicine I feel that family medicine residencies should increase the amount of emergency medicine and critical care training given that many emergency rooms nationwide particularly in more rural areas are staffed by family medicine physicians who may not be adequately trained to treat trauma or critical illness.