ROP May SNACK: The Need for FM Programs
Steven Brown, MD, and Vanessa Cardy, MD
- Why is it a problem if prestigious medical schools do not have departments of family medicine?
- Medical students and residents get less exposure to the “5 Cs of primary care”
- Comprehensive care
- Coordinated care
- First Contact
- Continuous care
- Context (of family and community)
- Training pediatricians and internists to cover elements of primary care is not the same as creating a family medicine residency program
- Robust family medicine programs lead to Improved health care experience, better population health outcomes, and decreased overall cost of health care
- Why do so many prestigious medical schools lack departments of family medicine?
- Financial disincentives for the prestigious medical schools to start family medicine programs as departments of family medicine only receive 0.2% of total research funding dollars and 0.3% of NIH awards
- Medical schools and residency are rated based on their endowments and reputations rather than their social mission therefore there is less incentive to invest in family medicine
- Historically black colleges and universities tend to have the most robust departments of family medicine, and not coincidentally, score well in terms of their social missions
Michelle L. - May 20, 2021 5:59 AM
Thanks for bringing up this important issue! Unfortunately, I think it will be a "if you build it, they will come" hope; and a supply/demand problem. For some reason, the people who are in charge are under the delusional impression that an NPP (NOT APPs, ask any lawyer) can do just a good a job as an FP trained physician. The NPPs seem to agree, and sometimes even claim they do a better job than a physician (ie, the AANP "We choose NPs" campaign"). The FP jobs are going to be going to these folks- because, well, they are cheaper - and a provider is a provider is a provider. Geez, in your "rural medicine talks" in the May EMRAP you presented a complicated case that was managed by a solo PA covering an ED AND a hospital in the rural US without backup (!!!???) - how can we find this situation acceptable AND advocate for more FP spots at prestigious universities? I think the problem is also evident with boarded EM physicians - it looks like there will be a huge "surplus" of them in 2022 (something like 10,000)- meanwhile, the majority of urgent cares and many emergency rooms are slowly and methodically replacing physicians with NPPs. The whole situation is horrible to watch. Thankfully, I have a back up plan - if I lose my rural, full-spectrum FM job to an NPP- because, after all, they are just as good as a physician, and cheaper! - I will go online and get my DNP in a couple of years; then I can practice independently in any specialty!
Steven B. - May 22, 2021 10:57 AM
Hi Dr. L. I hear you. Your point is valid and certainly one a lot of docs worry about. I for one always believe in the value of the family doctor in any setting! Hopefully prestigious universities without FM departments can lead the charge to show how family docs bring the triple aim to healthcare.