scholarly journals Family Medicine and Emergency Redeployment: Unrealized Potential

2022 ◽  
Vol 54 (1) ◽  
pp. 44-46
Author(s):  
Hoon Byun ◽  
John M. Westfall
Keyword(s):  
Family Medicine ◽  
Residency Training ◽  
Rural Areas ◽  
Family Physicians ◽  
Physician Assistants ◽  
Scope Of Practice ◽  
Separate Analysis ◽  
Medicare Beneficiaries ◽  
Emergency Rooms ◽  
Training Requirements

Background and Objectives: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. Methods: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare’s 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. Results: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Conclusions: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

scholarly journals Scope of Practice and Patient Panel Size of Family Physicians Who Work With Nurse Practitioners or Physician Assistants

2019 ◽  
Vol 51 (4) ◽  
pp. 311-318 ◽  
Author(s):  
Mingliang Dai ◽  
Richard C. Ingham ◽  
Lars E. Peterson
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Nurse Practitioners ◽  
Family Physicians ◽  
Physician Assistants ◽  
Scope Of Practice ◽  
Certification Examination ◽  
Panel Size ◽  
Practice Characteristics ◽  
Number Of Patients

Background and Objectives: Little is known about how the presence of nurse practitioners (NPs) and physician assistants (PAs) in a practice impacts family physicians’ (FPs’) scope of practice. This study sought to examine variations in FPs’ practice associated with NPs and PAs. Methods: We obtained data from American Board of Family Medicine practice demographic questionnaires completed by FPs who registered for the Family Medicine Certification Examination during 2013-2016. Scope of practice score was calculated for each FP, ranging from 0-30 with higher numbers equating to broader scope of practice. FPs self-reported patient panel size. Primary care teams were classified into NP only, PA only, both NP and PA, or no NP or PA. We estimated variation in scope and panel size with different team configurations in regression models. Results: Of 27,836 FPs, nearly 70% had NPs or PAs in their practice but less than half (42.5%) estimated a panel size. Accounting for physician and practice characteristics, the presence of NPs and/or PAs was associated with significant increases in panel sizes (by 410 with PA only, 259 with NP only and 245 with both; all P<0.05) and in scope score (by 0.53 with PA only, 0.10 with NP only and 0.51 with both; all P<0.05). Conclusions: We found evidence that team-based care involving NPs and PAs was associated with higher practice capacity of FPs. Working with PAs seemed to allow FPs to see a greater number of patients and provide more services than working with NPs. Delineation of primary care team roles, responsibilities and boundaries may explain these findings.

scholarly journals Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

2021 ◽  
Vol 18 (11) ◽  
pp. 6122
Author(s):  
Ryuichi Ohta ◽  
Yoshinori Ryu ◽  
Chiaki Sano
Keyword(s):  
Family Medicine ◽  
Rural Areas ◽  
Clinical Performance ◽  
Rural Hospital ◽  
Scope Of Practice ◽  
Quantitative Aspect ◽  
Educational Systems ◽  
Theory Approach ◽  
Community Hospitals ◽  
Medicine Education

Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research—based on a mixed-method study—clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases—categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees’ scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach—observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis—conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees’ experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.

scholarly journals Emergency medicine training demographics of physicians working in rural and regional southwestern Ontario emergency departments

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 449-452 ◽  
Author(s):  
Munsif Bhimani ◽  
Gordon Dickie ◽  
Shelley McLeod ◽  
Daniel Kim
Keyword(s):  
Emergency Medicine ◽  
Family Medicine ◽  
Residency Training ◽  
Emergency Departments ◽  
Training Programs ◽  
Family Physicians ◽  
Demographic Information ◽  
Trauma Resuscitation ◽  
Curriculum Content

ABSTRACT Objectives: We sought to determine the emergency medicine training demographics of physicians working in rural and regional emergency departments (EDs) in southwestern Ontario. Methods: A confidential 8-item survey was mailed to ED chiefs in 32 community EDs in southwestern Ontario during the month of March 2005. This study was limited to nonacademic centres. Results: Responses were received from 25 (78.1%) of the surveyed EDs, and demographic information on 256 physicians working in those EDs was obtained. Of this total, 181 (70.1%) physicians had no formal emergency medicine (EM) training. Most were members of the College of Family Physicians of Canada (CCFPs). The minimum qualification to work in the surveyed EDs was a CCFP in 8 EDs (32.0%) and a CCFP with Advanced Cardiac and Trauma Resuscitation Courses (ACLS and ATLS) in 17 EDs (68.0%). None of the surveyed EDs required a CCFP(EM) or FRCP(EM) certification, even in population centres larger than 50 000. Conclusion: The majority of physicians working in southwestern Ontario community EDs graduated from family medicine residencies, and most have no formal EM training or certification. This information is of relevance to both family medicine and emergency medicine residency training programs. It should be considered in the determination of curriculum content and the appropriate number of residency positions.

scholarly journals Geographical distribution of family physicians in Japan: A nationwide cross-sectional study

2019 ◽  
Author(s):  
Shuhei Yoshida ◽  
Masatoshi Matsumoto ◽  
Saori Kashima ◽  
Soichi Soichi Koike ◽  
Susumu Tazuma ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Rural Areas ◽  
Census Data ◽  
Family Physicians ◽  
Cross Sectional Study ◽  
Government Support ◽  
Free Access ◽  
Cross Sectional ◽  
Physician Distribution

Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results 519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

scholarly journals Experiences of new family physicians finding jobs with obstetrical care in the USA

2019 ◽  
Vol 7 (3) ◽  
pp. e000063 ◽  
Author(s):  
Aimee R Eden ◽  
Tyler Barreto ◽  
Elizabeth Rose Hansen
Keyword(s):  
Family Medicine ◽  
Qualitative Interviews ◽  
Family Physicians ◽  
Healthcare Services ◽  
Scope Of Practice ◽  
Job Seeking ◽  
Telephone Interviews ◽  
New Family ◽  
Job Selection ◽  
The Usa

ObjectiveThis study aimed to explore how new family medicine graduates who want to include obstetrics in their scope of practice identify and select jobs and to understand how employment influences scope of practice in family medicine, particularly the ability to provide maternity care and deliver babies.DesignMixed-methods study including a survey and qualitative interviews conducted in 2017.SettingWe electronically surveyed US family physicians and followed up with a purposeful subsample of these physicians to conduct in-depth, semistructured telephone interviews.Participants1016 US family medicine residency graduates 2014–2016 who indicated that they intended to deliver babies in practice completed a survey; 56 of these were interviewed.Main outcome measuresThe survey measured the reasons for not doing obstetrics as a family physician. To identify themes regarding finding family medicine jobs with obstetrics, we used a team-based, immersion–crystallisation approach to analyse the transcribed qualitative interviews.ResultsSurvey results (49% response rate) showed that not finding a job that included obstetrics was the primary reason newly graduated family physicians who intended to do obstetrics were not doing so. Qualitative interviews revealed that family physicians often find jobs with obstetrics through connections or recruitment efforts and make job decisions based on personal considerations such as included geographical preferences, family obligations and lifestyle. However, job-seeking and job-taking decisions are constrained by employment-related issues such as job structure, practice characteristics and lack of availability of family medicine jobs with obstetrics.ConclusionsWhile personal reasons drove job selection for most physicians, their choices were constrained by multiple factors beyond their control, particularly availability of family medicine jobs allowing obstetrics. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviours of newly graduating medical residents as well as for access to healthcare services by patients; understanding how employment influences scope of practice in family medicine can provide insight into how to support family physicians to maintain the scope of practice they desire and are trained to provide, thus, ensuring that families have access to care.

scholarly journals Neonatal Resuscitation Skills Among Pediatricians and Family Physicians: Is Residency Training Preparing for Postresidency Practice?

2011 ◽  
Vol 3 (4) ◽  
pp. 475-480 ◽  
Author(s):  
Amy M. Wood ◽  
M. Douglas Jones ◽  
James H. Wood ◽  
Zhaoxing Pan ◽  
Thomas A. Parker
Keyword(s):  
Family Medicine ◽  
Rural Areas ◽  
Current Practice ◽  
Neonatal Resuscitation ◽  
Family Physicians ◽  
Newborn Resuscitation ◽  
Rural Physicians ◽  
Resuscitation Training ◽  
National Cohort ◽  
Umbilical Catheters

Abstract Background Pediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers. Methods We surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice. Results Survey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P  =  .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P  =  .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P &lt; .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year. Conclusions Few primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training may provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.

Comparison of Intended Scope of Practice for Family Medicine Residents With Reported Scope of Practice Among Practicing Family Physicians

JAMA ◽  
2015 ◽  
Vol 314 (22) ◽  
pp. 2364 ◽  
Author(s):  
Anastasia J. Coutinho ◽  
Anneli Cochrane ◽  
Keith Stelter ◽  
Robert L. Phillips ◽  
Lars E. Peterson
Keyword(s):  
Family Medicine ◽  
Family Physicians ◽  
Scope Of Practice ◽  
Family Medicine Residents

scholarly journals Defining Essential Topics and Procedures for Korean Family Medicine Residency Training

2021 ◽  
Vol 42 (6) ◽  
pp. 477-482
Author(s):  
Youhyun Song ◽  
Jinyoung Shin ◽  
Yonghwan Kim ◽  
Jae-Yong Shim
Keyword(s):  
Family Medicine ◽  
Residency Training ◽  
Personal Experience ◽  
Family Physicians ◽  
Board Members ◽  
Minimum Requirement ◽  
Family Medicine Residency ◽  
Korean Family ◽  
Competency Based ◽  
E Mail

Background: This study aims to create a comprehensive list of essential topics and procedural skills for family medicine residency training in Korea.Methods: Three e-mailed surveys were conducted. The first and second surveys were sent to all board-certified family physicians in the Korean Academy of Family Medicine (KAFM) database via e-mail. Participants were asked to rate each of the topics (117 in survey 1, 36 in survey 2) and procedures (65 in survey 1, 19 in survey 2) based on how necessary it was to teach it and personal experience of utilizing it in clinical practice. Agreement rates of the responses were calculated and then sent to the 32 KAFM board members in survey 3. Opinions on potential cut-off points to divide the items into three categories and the minimum achievement requirements needed to graduate for each category were solicited.Results: Of 6,588 physicians, 256 responded to the first survey (3.89% response rate), 209 out of 6,669 to the second survey (3.13%), and 100% responded to the third survey. The final list included 153 topics and 81 procedures, which were organized into three categories: mandatory, recommended, and optional (112/38/3, 27/33/21). For each category of topics and procedures, the minimum requirement for 3-year residency training was set at 90%/60%/30% and 80%/60%/30%, respectively.Conclusion: This national survey was the first investigation to define essential topics and procedures for residency training in Korean family medicine. The lists obtained represent the opinions of Korean family physicians and are expected to aid in the improvement of family medicine training programs in the new competency-based curriculum.

scholarly journals Geographical distribution of family physicians in Japan: a nationwide cross-sectional study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuhei Yoshida ◽  
Masatoshi Matsumoto ◽  
Saori Kashima ◽  
Soichi Koike ◽  
Susumu Tazuma ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Rural Areas ◽  
Census Data ◽  
Family Physicians ◽  
Cross Sectional Study ◽  
Government Support ◽  
Free Access ◽  
Cross Sectional ◽  
Physician Distribution

Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results Five hundred nineteen JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p < 0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

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