The Future of Family Medicine
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FFM3B-1
The Future of Family Medicine
Disclosure: Market research for the FFM project was conducted by Siegelgale, Inc. of New York, with subcontracts to Greenfield & Associates (Qualitative) and Roper ASW (quantitative), under direction of the FFM Research Advisory and Project Leadership Committees
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FFM3B-2
The Future of Family Medicine
All data, analysis, interpretations, conclusions and recommendations, while they may have been generated by Siegelgale, Greenfield and/or Roper, are the property and responsibility of FFM PLC, are on-going within the FFM project, and are not to be considered final until a final report is published.
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FFM3B-3
Comprehensiveness
Summary ―Comprehensiveness‖ labors under the weight of two problems:
• Believability – The concept is too broad to be credible • Ownability – Other disciplines are perceived to deliver on certain dimensions, i.e., preventive care and even caring about the whole person
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Comprehensiveness
Treatment of a wide range of medical problems
Family practice communications and research defend the wide scope of the practice:
―The family physician evaluates the patient’s total health needs, and provides personal care within one or more fields of medicine.‖ —AAFP Definition of Family Practice ―The scope of clinical conditions managed by family physicians is extremely broad. Only 6.3% of all visits require referral to other physicians.‖ —Public Use Data File: 1999 National Ambulatory Medical Care Survey
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Comprehensiveness
Treatment of a wide range of medical problems
The skills family physicians tend to give up are not valued as fundamentally important by patients.
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FFM3B-6
Least Opportunity to Use
Most common responses
Obstetrics/gynecology* Surgical skills Pediatrics Care of patients in hospital Orthopedics Cardiac testing 9% 9% 13% 13% 25% 58%
―Deliver babies‖ ranks least important on patients’ attribute list A majority of parents take their children to a pediatrician
―See patients in the hospital‖ ranked 30th out of 39 in the attribute list
Q16. What skills or expertise do you feel you don’t have enough opportunity to use? Anything else? Base: National FPs who say they don’t have opportunity to use all of their skills.
*
This question did not separate obstetrics from gynecology, therefore the results do not reflect family physicians providing gynecological care, but not providing obstetrical care.
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FFM3B-7
Comprehensiveness
Treatment of a wide range of medical problems
Patients want a physician who can treat a majority of their basic health problems.
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FFM3B-8
FP and GI Patients Share an Equally Strong
Desire for a PCP With a Variety of Skills
Percent say ―agree strongly‖
“I prefer to have a PCP who treats a wide variety of medical problems, but who refers me to a specialist as needed” 88% 84% “I prefer to have a PCP who specializes in one specific area of medicine and is not a generalist”
12%
15%
FP is PCP
GI is PCP
FP is PCP
GI is PCP
Q18. Please tell me whether you agree strongly, agree somewhat, disagree somewhat, disagree strongly, or neither agree nor disagree with each of the following statements. First… Base: Have PCP
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FFM3B-9
Comprehensiveness
Treatment of a wide range of medical problems
However, too much emphasis on comprehensiveness engenders skepticism and even fear among patients.
―It’s dangerous for anyone to try to know all of this.‖ ―It asks way too much of a person—they’ll be overworked.‖ ―I have very little confidence that one person can meet all these needs.‖
―They could miss something because they think they know as much as specialists and won’t refer.‖
www.futurefamilymed.org FFM3B-10
Comprehensiveness
Treatment of a wide range of medical problems
Healthcare professionals doubt the family physician’s ability to keep up with ever-increasing medical advances.
―The knowledge is so vast; to claim that you know so much in so many fields is ridiculous.‖ —Payor ―Science has gotten so complex that it’s not reasonable to expect someone to have the depth of knowledge necessary.‖ —Consumer advocate ―One of the most difficult challenges for family practice is how to keep up with the expansive amount of medical knowledge and build confidence that you are the right caregiver.‖ —Payor
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Comprehensiveness
Adherence to the biopsychosocial model Family physicians regard their holistic approach to medicine as unique.
―Internists are more fascinated with diseases. Family doctors are interested in people.‖ —Family physician ―We know and understand people’s limitations, problems, and variations when deciding on a treatment.‖ —Family physician
―You can’t be a good family doctor if you’re not ready to deal with the impact the illnesses have on the person themselves. You have to be able to assess the emotional impact and the stressors and dynamics that are going on in a patient’s life.‖ —Family physician ―Internists do not equally address the psychological and social aspects of health.‖ —Family physician
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Importance of PCP Attributes/Services (1st Quartile) Percent say ―extremely‖ or ―very important‖
Does not judge; understands, supports Always honest and direct Acts as partner in maintaining health Treats serious, non-serious conditions Attends to emotional/physical health Listens to me
Encourages me to lead healthier lifestyle 75% 70% 94% 85% 76% 68% 78% 85% 84%
DI Rank* 1
97%
2 3 4 5 6 7 8 9 10
Tries to get to know me Can help with any problem Someone I can stay with as I grow older
Q19. For each of the following, please tell me if it is extremely important, very important, somewhat important, not very important, or not important at all to you when it comes to your primary doctor. Base: Have PCP. *Derived importance rank.
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FFM3B-13
Comprehensiveness
Adherence to the biopsychosocial model
Healthcare professionals doubt that family physicians have the time, training, or appropriate compensation to use this approach in practice.
―That sounds very nice, but in fact if you look at their magazines, they don’t have the time to do that. That takes time.‖ —Consumer advocate
―Mental health gets short shrift in most medical schools. While family medicine is more involved, they’re still at the medication stage.‖ —Consumer advocate ―It’s not possible to look at the whole person because no one gets reimbursed for that. If there is no reimbursement, it doesn’t happen.‖ —Payor
―I don’t see family physicians as having different relationships with their patients than internists.‖ —Benefits manager
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Comprehensiveness
Commitment to preventive care
While family physicians have less faith that patients value preventive care, patients rate it very highly, although they may not recognize the term.
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FFM3B-15
Comprehensiveness
Commitment to preventive care Specialists recognize family physicians’ superiority in providing preventive care versus other primary care sources.
―I’m impressed with the way family doctors take care of all preventive measures. They are more concerned about the whole family’s preventive health needs.‖ ―Family practice’s orientation is to make sure that the problem does not occur. Family doctors are interested in promoting health. Internists are more problembased and interested in fixing a problem.‖
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Comprehensiveness
Care across all demographics
Most people associate family practice with treating all ages.‖
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FFM3B-17