Joint Guidelines for Protected Nonclinical Time for Faculty in Family Medicine Residency Programs

Background and Objectives: Family medicine faculty face increasing expectations for clinical productivity. These expectations impinge on academic and education time and make it difficult to pursue research or scholarly activities. A task force convened by the Society of Teachers of Family Medicine created national guidelines to protect nonclinical time for family medicine faculty. Methods: The task force reviewed existing guidelines for protected time, as well as data on current and past distribution of time for faculty in academic medicine, including a specific look at family medicine. Based on the evidence and expert opinion from task force members and leaders of family medicine organizations, the task force developed eight consensus recommendations. Results: The guidelines include recommendations for allocation of protected time for program directors, associate program directors, and core faculty. These represent best practices to ensure programs have appropriate time to devote to the nonclinical duties of training and educating residents, while also promoting innovation in education, faculty well-being, and faculty retention. discussion: Faculty require nonclinical time for resident development, curriculum creation and maintenance, program assessment, and scholarship. Without these functions, programs can’t meet accreditation requirements or fulfill their responsibility to develop strong family physicians. Residency programs, sponsoring institutions, universities, health care systems, and accrediting bodies should use these recommendations to develop budgets that provide appropriate time allocation to enhance faculty wellness, reduce turnover, and meet organizational missions and objectives around education and providing care for communities.

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The Time Is Now: A Plan to Redesign Family Medicine Residency Education

Family Medicine ◽

10.22454/fammed.2022.197486 ◽

2022 ◽

Vol 54 (1) ◽

pp. 7-15

Author(s):

Larry A. Green ◽

William L. Miller ◽

John J. Frey ◽

Hilliard Jason ◽

Jane Westberg ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Interprofessional Education ◽

Health Care Systems ◽

Well Being ◽

Community Based ◽

Family Medicine Residency ◽

Medical Education Program ◽

New Graduate ◽

Care Systems

A new graduate medical education program in family medicine is urgently needed now. We propose an innovative plan to develop community-based, community-owned family medicine residency programs. The plan is founded on five guiding principles in which residencies will (1) transition to independent, community-owned organizations; (2) sustain comprehensiveness and generalism; (3) emphasize collaborative learning and interprofessional education; (4) develop local educators with national guidance; and (5) share resources, responsibilities, and learning. We describe actionable steps to begin the process of transforming residencies and strengthening primary care. As community-based and locally-run organizations, residencies will gain self-determination in how time is allocated, budgets are spent, and teams function. Building on the momentum of the National Academy of Medicine’s 2021 primary care implementation plan and recommendations by family medicine organization leaders, we propose a Decade of Family Medicine Residency Transformation. We encourage individuals and organizations spanning disciplines, health care systems, and communities, to join forces to reimagine and recreate the preparation of outstanding personal physicians dedicated to individual and community health and well-being.

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An Overview of Digital Health in the Transition of Pediatric to Adult Epilepsy Care

Journal of Pediatric Epilepsy ◽

10.1055/s-0040-1716825 ◽

2020 ◽

Vol 09 (04) ◽

pp. 106-113

Author(s):

Ysabeau Bernard-Willis ◽

Emily De Oliveira ◽

Shaheen E Lakhan

Keyword(s):

Health Management ◽

Digital Health ◽

Health Care Systems ◽

Well Being ◽

Pediatric Care ◽

Medical Mistrust ◽

Patient Portals ◽

Language Therapy ◽

Adult Care ◽

Care Systems

AbstractChildren with epilepsy often have impairments in cognitive and behavioral functioning which may hinder socio-occupational well-being as they reach adulthood. Adolescents with epilepsy have the added worry of health problems while starting the transition from family-centered pediatric care into largely autonomous adult care. If this transition is not appropriately planned and resourced, it may result in medical mistrust, nonadherence, and worsening biopsychosocial health as an adult. In recent years, there has been increased availability of digital health solutions that may be used during this stark change in care and treating teams. The digital health landscape includes a wide variety of technologies meant to address challenges faced by patients, caregivers, medical professionals, and health care systems. These technologies include mobile health products and wearable devices (e.g., seizure monitors and trackers, smartphone passive data collection), digital therapeutics (e.g., cognitive/behavioral health management; digital speech–language therapy), telehealth services (e.g., teleneurology visits), and health information technology (e.g., electronic medical records with patient portals). Such digital health solutions may empower patients in their journey toward optimal brain health during the vulnerable period of pediatric to adult care transition. Further research is needed to validate and measure their impact on clinical outcomes, health economics, and quality of life.

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Adult Care in Cystic Fibrosis

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0039-3400289 ◽

2019 ◽

Vol 40 (06) ◽

pp. 857-868 ◽

Cited By ~ 4

Author(s):

J. Stuart Elborn

Keyword(s):

Health Care ◽

Cystic Fibrosis ◽

Care Delivery ◽

Health Care Systems ◽

Well Being ◽

Models Of Care ◽

Adult Care ◽

Care Systems ◽

Expanding Population ◽

Almost All

AbstractCystic fibrosis (CF) is now more common in adults than children in countries with well-developed health care systems. The number of adults continues to increase and will further increase if the new cystic fibrosis transmembrane conductance regulator (CFTR) modulators are disease modifying. Most of the complex morbidity and almost all the mortality of CF occur in adults and will increasingly follow this pattern even with new effective modulator therapies. Maintaining good quality of life including social functioning and maximizing survival for adults are the key priorities. This requires a highly knowledgeable and adaptable multidisciplinary team, which, though focused on maintaining lung health, requires an increasing range of other disciplines and specialties to maximize well-being. Changes in health care systems will require current models of care to adapt to provide care for the large number of adult patients. With increasing survival and age, many are likely to have both CF morbidities and additional diseases of aging. New models are needed for health care delivery for this expanding population with complex medical conditions.

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Family medicine physicians’ report strong support, barriers and preferences for Registered Dietitian Nutritionist care in the primary care setting

Family Practice ◽

10.1093/fampra/cmaa099 ◽

2020 ◽

Author(s):

Lauren R Sastre ◽

Leslie T Van Horn

Keyword(s):

Family Medicine ◽

Online Survey ◽

Interprofessional Collaboration ◽

Health Care Systems ◽

Descriptive Analysis ◽

Strong Support ◽

Full Time ◽

Registered Dietitian ◽

Cross Sectional ◽

Care Systems

Abstract Background Previous studies have examined barriers (e.g. time) for Family Medicine Providers (FMPs) to provide nutrition and lifestyle counseling, however, to date no studies have examined access or interest to Registered Dietitian Nutritionist (RDN) care for patients. Objective The objective of this study was to explore FMP access, referral practices, barriers and preferences for RDN care. Methods A cross-sectional online survey, with content and face validation was conducted with Family Medicine Departments within large academic health care systems in the Southeastern United States. The main variables of interest included: FMP access, interest, current referrals and referral preferences for RDN care, barriers to referrals and overall perceptions regarding RDN care. Descriptive analysis of close-ended responses was performed with SPSS 26.0. Open-ended responses were analysed using inductive content analysis. Results Over half of the respondents (n = 151) did not have an RDN on-site (64%) yet were highly interested in integrating an RDN (94.9%), with reported preferences for full-time on-site, part-time on-site or off-site RDN care (49.1%, 39.5% and 11.4% respectively). The greatest reported barriers to RDN referrals were perceived cost for the patient (64.47%) and uncertainty how to find a local RDN (48.6%). The most consistent theme reported in the open-ended responses were concerns regarding reimbursement, e.g. ‘Insurance does not cover all of the ways I would like to use an RDN’. Conclusions FMPs report interest and value in RDN services despite multiple perceived barriers accessing RDNs care. Opportunities exist for interprofessional collaboration between dietetic and FMP professional groups to address barriers.

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Health care and the future of economic growth: exploring alternative perspectives

Health Economics Policy and Law ◽

10.1017/s1744133119000276 ◽

2019 ◽

Vol 15 (4) ◽

pp. 419-439 ◽

Cited By ~ 3

Author(s):

Martin Hensher ◽

John Tisdell ◽

Ben Canny ◽

Craig Zimitat

Keyword(s):

Economic Growth ◽

Health Care ◽

Health Expenditure ◽

Global Economy ◽

Global Financial Crisis ◽

Health Care Systems ◽

Health Financing ◽

Well Being ◽

Gdp Growth ◽

Care Systems

AbstractThe strong and positive relationship between gross domestic product (GDP) and health expenditure is one of the most extensively explored topics in health economics. Since the global financial crisis, a variety of theories attempting to explain the slow recovery of the global economy have predicted that future economic growth will be slower than in the past. Others have increasingly questioned whether GDP growth is desirable or sustainable in the long term as evidence grows of humanity's impact on the natural environment. This paper reviews recent data on trends in global GDP growth and health expenditure. It examines a range of theories and scenarios concerning future global GDP growth prospects. It then considers the potential implications for health care systems and health financing policy of these different scenarios. In all cases, a core question concerns whether growth in GDP and/or growth in health expenditure in fact increases human health and well-being. Health care systems in low growth or ‘post-growth’ futures will need to be much more tightly focused on reducing overtreatment and low value care, reducing environmental impact, and on improving technical and allocative efficiency. This will require much more concerted policy and regulatory action to reduce industry rent-seeking behaviours.

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Pacing Forward in the Face of Fragility: Lessons From African Institutions and Governments' Response to Public Health Emergencies

Frontiers in Public Health ◽

10.3389/fpubh.2021.714812 ◽

2021 ◽

Vol 9 ◽

Author(s):

Byron Bitanihirwe ◽

Derrick Ssewanyana ◽

Ismael Ddumba-Nyanzi

Keyword(s):

Public Health ◽

Social Inequalities ◽

Health Care Systems ◽

Well Being ◽

Public Health Emergencies ◽

Economic Diversity ◽

Western Africa ◽

The Face ◽

Care Systems ◽

Sustainable Health

Africa is home to 54 United Nation member states, each possessing a wealth of ethno-cultural, physiographic, and economic diversity. While Africa is credited as having the youngest population in the world, it also exhibits a unique set of “unfortunate realties” ranging from famine and poverty to volatile politics, conflicts, and diseases. These unfortunate realities all converge around social inequalities in health, that are compounded by fragile healthcare systems and a lack of political will by the continent's leaders to improve smart investment and infrastructure planning for the benefit of its people. Noteworthy are the disparities in responsive approaches to crises and emergencies that exist across African governments and institutions. In this context, the present article draws attention to 3 distinct public health emergencies (PHEs) that have occurred in Africa since 2010. We focus on the 2013–2016 Ebola outbreak in Western Africa, the ongoing COVID-19 pandemic which continues to spread throughout the continent, and the destructive locust swarms that ravaged crops across East Africa in 2020. Our aim is to provide an integrated perspective on how governments and institutions handled these PHEs and how scientific and technological innovation, along with educational response played a role in the decision-making process. We conclude by touching on public health policies and strategies to address the development of sustainable health care systems with the potential to improve the health and well-being of the African people.

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Economic Crises as a Motive for Change in Health Care Systems – A Historical Perspective with Reference to the COVID-19 Pandemic

Acta medico-historica Adriatica ◽

10.31952/amha.18.2.8 ◽

2021 ◽

Vol 18 (2) ◽

pp. 355-374

Author(s):

Snježana Kaštelan ◽

Martina Sopta ◽

Milena Radonjić ◽

Uršula Kaštelan ◽

Boris Kasun

Keyword(s):

Health Care ◽

Health Care Systems ◽

Economic Recession ◽

Well Being ◽

Healthcare Systems ◽

Economic Crises ◽

Social Equality ◽

Social Reforms ◽

Care Systems ◽

Potential Damage

Economic crises throughout history have often given an impetus for health and social reforms leading to the introduction of general healthcare systems and social equality in a large number of countries. The aim of this paper is to present the major economic crises and their effect on healthcare and social system chronologically. Bismarck’s and Beveridge’s model, the two most prominent healthcare models, which emerged primarily as a response to major economic crises, constitute the basis for the functioning of most health care systems in the world. An overview of historical events and experiences may be valuable in predicting future developments and potential effects of the crisis on healthcare systems and health in general. An analysis of past crises as well as current health and economic crisis caused by the COVID-19 pandemic and their impact on the healthcare system can facilitate the comprehension of the mechanisms of action and consequences of economic recession. It may also help identify guidelines and changes that might reduce the potential damage caused by future crises. The historical examples presented show that a crisis could trigger changes, which, in theiressence, are not necessarily negative. The response of society as a whole determines the direction of these changes, and it is up to society to transform the negative circumstances brought about by the recession into activities that contribute to general well-being and progress.

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Governance of health care systems in an ageing world – the case of Australia

Corporate Ownership and Control ◽

10.22495/cocv13i1c7p1 ◽

2015 ◽

Vol 13 (1) ◽

pp. 729-735 ◽

Cited By ~ 2

Author(s):

Ewa Banasik

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Systems ◽

Well Being ◽

World Health ◽

The Political ◽

Central Component ◽

Australian Health ◽

Care Systems ◽

Care System

The main argument of this paper is that because the burden of diseases increases with age, a greater numbers of older individuals will increase the demand for health care, and whether this demand will be met very much depends on how health care systems are governed. This task is particularly complex in jurisdictions with multi-layer governing systems such as the Australian health care system. Governance, described in terms of stewardship of the well-being of the population and as a central component for building effective health care systems, is increasingly considered to be very important for a well performing health care system (World Health Organization, 2000, 2007). Governance is, however, the least studied function in a health care system (Alliance 2009). Furthermore, the limited governance frameworks and assessments that have been developed thus far fail to include the political context in which health care systems operate (Baez-Camargo and Jacobs, 2011). This paper intends to fill this knowledge gap by exploring the political dynamics of the Australian health care system’s governance and its accountability. Furthering the discourse on governance is especially important in times when health care systems are confronted with the challenges of ageing populations

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An Update of Oral Health Curricula in US Family Medicine Residency Programs

Family Medicine ◽

10.22454/fammed.2018.372427 ◽

2018 ◽

Vol 50 (6) ◽

pp. 437-443 ◽

Cited By ~ 4

Author(s):

Hugh Silk ◽

Judith A. Savageau ◽

Kate Sullivan ◽

Gail Sawosik ◽

Min Wang

Keyword(s):

Oral Health ◽

Family Medicine ◽

Online Survey ◽

Program Directors ◽

Residency Programs ◽

Health Curriculum ◽

Family Medicine Residency ◽

Important Health ◽

Dental Professional ◽

Residency Program Directors

Background and Objectives: National initiatives have encouraged oral health training for family physicians and other nondental providers for almost 2 decades. Our national survey assesses progress of family medicine residency programs on this important health topic since our last survey in 2011. Methods: Family medicine residency program directors (PDs) completed an online survey covering various themes including number of hours of oral health (OH) teaching, topics covered, barriers, evaluation, positive influences, and program demographics. Results: Compared to 2011, more PDs feel OH should be addressed by physicians (86% in 2017 vs 79% in 2011), yet fewer programs are teaching OH (81% vs 96%) with fewer hours overall (31% vs 45% with 4 or more hours). Satisfaction with the competence of graduating residents in OH significantly decreased (17% in 2017 vs 32% in 2011). Program directors who report graduates being well prepared to answer board questions on oral health topics are more likely to have an oral health champion (P<0.001) and report satisfaction with the graduates’ level of oral health competency (P<0.001). Programs with an oral health champion, or having a relationship with a state or national oral health coalition, or having routine teaching from a dental professional are significantly more likely to have more hours of oral health curriculum (P<0.001). Conclusions: Family medicine PDs are more aware of the importance of oral health, yet less oral health is being taught in residency programs. Developing more faculty oral health champions and connecting programs to dental faculty and coalitions may help reduce this educational void.

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Integrating Marriage Education into Perinatal Education

The Journal of Perinatal Education ◽

10.1891/1058-1243.11.4.1 ◽

2002 ◽

Vol 11 (4) ◽

pp. 1-10 ◽

Cited By ~ 7

Author(s):

Alan J. Hawkins ◽

Tamara Gillil ◽

Glenda Christiaens ◽

Jason S. Carroll

Keyword(s):

Health Care ◽

Transition To Parenthood ◽

Health Care Systems ◽

Perinatal Care ◽

Well Being ◽

Couple Relationship ◽

Relationship Education ◽

Couple Relationship Education ◽

Care Systems ◽

Adults And Children

Couples making the transition to parenthood experience challenges that can threaten the quality and stability of their relationships and the health of family members. Currently, the educational infrastructure to support the delivery of couple-relationship education during the transition to parenthood is limited. Because new-parent couples interact with the health care system at many points during this transition time, an opportunity exists for strengthening couple relationships within the system to improve the well-being of adults and children. In this article, we propose a productive collaboration between marriage/couple educators and health care systems to integrate couple-relationship education into the standard of perinatal care.

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