Board Certification in Family Board Certification in Family Medicine Obstetrics—An Medicine Obstetrics—An Opportunity for Good Opportunity for Good Wm. MacMillan Rodney MD, FAAFP, FACEP Wm. MacMillan Rodney MD, FAAFP, FACEP Professor and Chair, Medicos para la Familia Professor and Chair, Medicos para la Familia Memphis, Nashville, and International Memphis, Nashville, and International Editor, American Journal of Clinical Medicine Editor, American Journal of Clinical Medicine American Board of Family Medicine Obstetrics American Board of Family Medicine Obstetrics WONCA 2010; Cancun, Mexico; Presenting WONCA 2010; Cancun, Mexico; Presenting The Family Medicine Obstetrics Curriculum and The Family Medicine Obstetrics Curriculum and Data Data Medicos: A Success in Expanding Services at a Medicos: A Success in Expanding Services at a Lower Cost. Lower Cost. Eliminating Barriers to Family Planning: Eliminating Barriers to Family Planning: Hysteroscopic Tubal Occlusion without Hysteroscopic Tubal Occlusion without Anesthesia Anesthesia
Transcript
Board Certification in Family Medicine Board Certification in Family Medicine Obstetrics—An Opportunity for GoodObstetrics—An Opportunity for Good
Wm. MacMillan Rodney MD, FAAFP, FACEPWm. MacMillan Rodney MD, FAAFP, FACEPProfessor and Chair, Medicos para la FamiliaProfessor and Chair, Medicos para la Familia
Memphis, Nashville, and InternationalMemphis, Nashville, and International
Editor, American Journal of Clinical MedicineEditor, American Journal of Clinical Medicine
American Board of Family Medicine ObstetricsAmerican Board of Family Medicine Obstetrics
WONCA 2010; Cancun, Mexico; PresentingWONCA 2010; Cancun, Mexico; Presenting The Family Medicine Obstetrics Curriculum and DataThe Family Medicine Obstetrics Curriculum and Data
Medicos: A Success in Expanding Services at a Lower Medicos: A Success in Expanding Services at a Lower Cost.Cost.
Eliminating Barriers to Family Planning: Eliminating Barriers to Family Planning: Hysteroscopic Tubal Occlusion without AnesthesiaHysteroscopic Tubal Occlusion without Anesthesia
Why Certification in Family Why Certification in Family Medicine Obstetrics?Medicine Obstetrics?
The American Model of highly specialized services is untenable The American Model of highly specialized services is untenable wherever per capita income is less than $25,000 per year. This is wherever per capita income is less than $25,000 per year. This is most of the planet.most of the planet.
Childbirth has become a treacherous technical adventure with Childbirth has become a treacherous technical adventure with over 30% of women receiving a Cesarean birth.over 30% of women receiving a Cesarean birth.
A start up OB service in a Florida Hospital requested and received A start up OB service in a Florida Hospital requested and received over $12 million to deliver 300 babies per year.[$40,000 each]over $12 million to deliver 300 babies per year.[$40,000 each]
In the USA, OB-Gyn has subspecialized to the point that many In the USA, OB-Gyn has subspecialized to the point that many OB’s no longer deliver babies. Unfortunately hospitals and many OB’s no longer deliver babies. Unfortunately hospitals and many international medical schools are following this modelinternational medical schools are following this model
Africa, the UK, and USA are now developing 4 year options with Africa, the UK, and USA are now developing 4 year options with one of these options to include surgical OB. Australians broke one of these options to include surgical OB. Australians broke away from General Practice and created a specialty for rural and away from General Practice and created a specialty for rural and frontier medicine frontier medicine
A new model is needed and available. Although , dwarfed by A new model is needed and available. Although , dwarfed by traditional academic medical centers, there are 30+ viable Family traditional academic medical centers, there are 30+ viable Family Medicine Obstetrics programs currently in operation. Africa has Medicine Obstetrics programs currently in operation. Africa has several others.several others.
See See www.aafp.org fellowshipsfellowshipsTerminology Varies: Terminology Varies:
Maternal Child Health is a thesis requiring 2 year program at Brown. Maternal Child Health is a thesis requiring 2 year program at Brown.
The others are one year programs with most using the title Family The others are one year programs with most using the title Family Medicine ObstetricsMedicine Obstetrics
Tacoma, Wa. Calls itself a rural fellowshipTacoma, Wa. Calls itself a rural fellowship
30 current MCH/OB fellowships programs offering 30 current MCH/OB fellowships programs offering 48 positions48 positions– 3 Maternal Child Health fellowships3 Maternal Child Health fellowships– 15 programs established since 200015 programs established since 2000– 10 programs established 1990-200010 programs established 1990-2000– 5 programs established in 1980’s5 programs established in 1980’s
The unifying feature is training in surgical The unifying feature is training in surgical obstetrics. For example ETSU has a rural fellowship obstetrics. For example ETSU has a rural fellowship without obstetrics.without obstetrics.
Pecci CPecci C, , LeemanLeeman L, L,WilkinsonWilkinson J. J. Family Medicine Family Medicine OObstetrics Fellowship Graduates: Training and Post-bstetrics Fellowship Graduates: Training and Post-fellowship Experience. Fam Med 2008;40(5):326-32.fellowship Experience. Fam Med 2008;40(5):326-32.
Spent ≥ 2 years RuralSpent ≥ 2 years Rural 47 47 64%64%
At Least 1 year as FacultyAt Least 1 year as Faculty 36 36 49%49%
Fellowship Training Fellowship Training GoalsGoals
– Maintain an identity in and a role for Family Maintain an identity in and a role for Family Medicine.Medicine.
– Provide continuing comprehensive health care Provide continuing comprehensive health care unrestricted by age, organ system, and location unrestricted by age, organ system, and location of service .of service .
– Develop credentialed physicians similar to the Develop credentialed physicians similar to the African model of a district hospital physician African model of a district hospital physician combining public health, family medicine combining public health, family medicine obstetrics with the ability to function in a obstetrics with the ability to function in a mission hospital[some ortho, ER, +]mission hospital[some ortho, ER, +]
Operative vaginal delivery and Cesarean sectionsOperative vaginal delivery and Cesarean sectionsNewborn resuscitation and stabilizationNewborn resuscitation and stabilizationObstetrical, gyn, and emergency ultrasoundObstetrical, gyn, and emergency ultrasoundColposcopy , gyn, and office surgeriesColposcopy , gyn, and office surgeriesCare of complicated obstetric patientsCare of complicated obstetric patientsEvidence-based, family-centered maternal-child careEvidence-based, family-centered maternal-child care
Fellowship Certification Fellowship Certification Advantages and Advantages and Disadvantages Disadvantages
Creates clear advantage for family physicians in Creates clear advantage for family physicians in communities where some surgical skills are communities where some surgical skills are necessary. The GP is elevated to OB with necessary. The GP is elevated to OB with additional skills in general Med-Peds-Office additional skills in general Med-Peds-Office Surgery.Surgery.
Creates an academic credential for hospitals Creates an academic credential for hospitals unlikely to accept generic primary care unlikely to accept generic primary care physicians.physicians.
Difficult process of training, written examination, Difficult process of training, written examination, and oral examination which needs to be and oral examination which needs to be expanded for international physicians. Need USA expanded for international physicians. Need USA or Canadian medical license.or Canadian medical license.
Fellowships pay $50,000-90,000 per year in US.Fellowships pay $50,000-90,000 per year in US.
Am Board of Family Medicine Am Board of Family Medicine Obstetrics—To Apply for Written Obstetrics—To Apply for Written
Exam Exam http://www.abpsga.org/certification/family_medicine_obstetric/application.htmlBe a graduate of a recognized college of medicine confirmed by a Be a graduate of a recognized college of medicine confirmed by a copy of an allopathic/osteopathic degree or a letter of verification copy of an allopathic/osteopathic degree or a letter of verification from the institution where the degree was earned. In the case of from the institution where the degree was earned. In the case of foreign medical schools, an English translation of the document is foreign medical schools, an English translation of the document is also required. Graduates of foreign medical schools must also also required. Graduates of foreign medical schools must also include a copy of their Education Commission for Foreign Medical include a copy of their Education Commission for Foreign Medical Graduates (ECFMG) Certificate. Canadian medical schools and Graduates (ECFMG) Certificate. Canadian medical schools and medical training programs are considered equivalent to U.S. medical training programs are considered equivalent to U.S. medical schools and medical training programs.medical schools and medical training programs.
Hold a valid and unrestricted license to practice medicine in the Hold a valid and unrestricted license to practice medicine in the United States, or its territories, or in Canada and submit copies of United States, or its territories, or in Canada and submit copies of all licenses. License(s) must include date of expiration.all licenses. License(s) must include date of expiration.
Am Board of Family Am Board of Family Medicine Obstetrics-Medicine Obstetrics-
RequirementsRequirementsVerify staff privileges by means of an original signed letter from Verify staff privileges by means of an original signed letter from the administrator of each hospital, or facility, at which privileges the administrator of each hospital, or facility, at which privileges are held confirming good standing at that facility. The letter(s) are held confirming good standing at that facility. The letter(s) must be current, dated no more than one year prior to the date must be current, dated no more than one year prior to the date the application is received by ABPS.the application is received by ABPS.
Be certified on the "Provider" level in the Advanced Life Support Be certified on the "Provider" level in the Advanced Life Support in Obstetrics (ALSO) program, and Neonatal Resuscitation in Obstetrics (ALSO) program, and Neonatal Resuscitation Provider (NRP) program. ALSO and NRP do not have to be Provider (NRP) program. ALSO and NRP do not have to be current at the time of submitting the application, but must be current at the time of submitting the application, but must be current and on file 30 days prior to taking the examination.current and on file 30 days prior to taking the examination.
Be board certified in Family Medicine by the ABMS, ABPS or AOA Be board certified in Family Medicine by the ABMS, ABPS or AOA or be eligible to be certified by the Canadian Council of Family or be eligible to be certified by the Canadian Council of Family Practice (CCFP), or the Royal College of Physicians and Practice (CCFP), or the Royal College of Physicians and Surgeons (RCPSC). Other Board Certifications may be Surgeons (RCPSC). Other Board Certifications may be considered on an individual basis.considered on an individual basis.
Am Board Family Medicine Am Board Family Medicine Obstetrics-RequirementsObstetrics-Requirements
Be qualified under Be qualified under oneone of the following: of the following: – Have completed residency training in a program approved by the Have completed residency training in a program approved by the
Accreditation Council of Graduate Medical Education or the Accreditation Council of Graduate Medical Education or the American Osteopathic Association, Canadian Council of Family American Osteopathic Association, Canadian Council of Family Practice (CCFP), or the Royal College of Physicians and surgeons Practice (CCFP), or the Royal College of Physicians and surgeons (RCPSC) and deemed acceptable to the American Board of Family (RCPSC) and deemed acceptable to the American Board of Family Medicine Obstetrics. Such training must include identifiable Medicine Obstetrics. Such training must include identifiable training and experience in Family Medicine Obstetrics as training and experience in Family Medicine Obstetrics as determined by the American Board of Family Medicine Obstetrics determined by the American Board of Family Medicine Obstetrics and approved by the ABPS.and approved by the ABPS.
The ABPS now accepts all residencies accepted by the Royal The ABPS now accepts all residencies accepted by the Royal College of Physicians and Surgeons of Canada (RCPSC). ABPS College of Physicians and Surgeons of Canada (RCPSC). ABPS therefore now accepts all residencies approved by ACGME, therefore now accepts all residencies approved by ACGME, AOA, or RCPSC. It should be noted that the ABPS accepts ALL AOA, or RCPSC. It should be noted that the ABPS accepts ALL medical residencies approved by the RCPSC, including medical residencies approved by the RCPSC, including approved residencies outside Canada.approved residencies outside Canada.
Am Board Family Medicine Am Board Family Medicine Obstetrics--RequirementsObstetrics--Requirements
Osteopathic physicians who have successfully completed an Osteopathic physicians who have successfully completed an AOA-approved internship, plus an AOA-approved General AOA-approved internship, plus an AOA-approved General Medicine residency and have a minimum of two (2) years Medicine residency and have a minimum of two (2) years full-time experience in Family Medicine and 300 hours of full-time experience in Family Medicine and 300 hours of CME acceptable to the BCFM. CME acceptable to the BCFM.
Submit three (3) letters of recommendation from active Submit three (3) letters of recommendation from active Diplomates of an ABPS, ABMS, or AOA-recognized board of Diplomates of an ABPS, ABMS, or AOA-recognized board of certification. Letters of recommendation must be current certification. Letters of recommendation must be current (dated no more than one year prior to the date the (dated no more than one year prior to the date the application is received by the ABPS) and on letterhead application is received by the ABPS) and on letterhead stationery. The ABFMO requires original letters; copies are stationery. The ABFMO requires original letters; copies are not acceptable. The ABFMO recommends that the letters be not acceptable. The ABFMO recommends that the letters be sent to the applicant for inclusion with other application sent to the applicant for inclusion with other application documents.documents.
Clinical Practice TrackClinical Practice Track - This Track Will Be - This Track Will Be Available Until 2018.Available Until 2018.
The applicant must have been actively engaged in The applicant must have been actively engaged in the practice of Family Medicine with care of obstetric the practice of Family Medicine with care of obstetric patients on an ongoing basis for five (5) years. This patients on an ongoing basis for five (5) years. This care should include the practice of surgical care should include the practice of surgical obstetrics. Documentation of training in obstetrics obstetrics. Documentation of training in obstetrics should include a case log listing all obstetrical cases should include a case log listing all obstetrical cases completed in the previous two years. Applicants completed in the previous two years. Applicants should demonstrate that their volume of obstetrical should demonstrate that their volume of obstetrical medicine is sufficient to maintain competence .medicine is sufficient to maintain competence ...
Applicants should have performed a minimum of 100 vaginal Applicants should have performed a minimum of 100 vaginal deliveries within the last 5 years.deliveries within the last 5 years.
Applicants should have performed a minimum of 50 cesarean Applicants should have performed a minimum of 50 cesarean sections within the last 5 years.sections within the last 5 years.
Fellowship Track to ABFMOBFellowship Track to ABFMOBApplicants who have satisfactorily completed a 12-month, full-time Applicants who have satisfactorily completed a 12-month, full-time fellowship that is recognized by the ABFMO will be considered eligible to fellowship that is recognized by the ABFMO will be considered eligible to sit for the written exam. The applicant should have completed their sit for the written exam. The applicant should have completed their fellowship training within the last five years (8/2002). A list of fellowship fellowship training within the last five years (8/2002). A list of fellowship programs that are currently recognized by the ABFMO is attached. programs that are currently recognized by the ABFMO is attached. Applicants who have completed a fellowship program that has not been Applicants who have completed a fellowship program that has not been recognized by the ABFMO may ask their program to submit materials for recognized by the ABFMO may ask their program to submit materials for consideration.consideration.
For Fellows who have completed a recognized fellowship, the For Fellows who have completed a recognized fellowship, the fellowship director must submit an original signed letter of fellowship director must submit an original signed letter of verification attesting to the applicant’s satisfactory completion of verification attesting to the applicant’s satisfactory completion of the program.the program.
The requirements for Fellowship training are outlined in the The requirements for Fellowship training are outlined in the document “Guidelines for Recognition of Fellowship Programs by document “Guidelines for Recognition of Fellowship Programs by the ABFMO” and include the following minimum numbers of the ABFMO” and include the following minimum numbers of procedures.procedures.
– A minimum of 100 vaginal deliveries.A minimum of 100 vaginal deliveries.– A minimum of 50 cesarean sections, with a case log that is externally A minimum of 50 cesarean sections, with a case log that is externally
validated by one of the following: Medical Records, Medical Staff validated by one of the following: Medical Records, Medical Staff Office, Medical Director or Department Chair.Office, Medical Director or Department Chair.
ABFMOB Oral ExaminationABFMOB Oral Examination
After successful completion of the written examination, After successful completion of the written examination, applicants are also required to submit verification of applicants are also required to submit verification of competency in operative obstetrics and complete an oral competency in operative obstetrics and complete an oral examination. This portion of the examination will have an examination. This portion of the examination will have an additional fee. The process is as follows:additional fee. The process is as follows:– The applicant must submit the names of three active Diplomates of The applicant must submit the names of three active Diplomates of
an ABPS, ABMS, or AOA-recognized board of certification who will an ABPS, ABMS, or AOA-recognized board of certification who will observe, or who have observed, the applicant during the care of observe, or who have observed, the applicant during the care of Obstetrical patients, including at least 5 cesarean sections, and Obstetrical patients, including at least 5 cesarean sections, and who will be willing to attest to the applicant’s surgical skills.who will be willing to attest to the applicant’s surgical skills.
– The Board will ask one or more of these physicians to complete The Board will ask one or more of these physicians to complete and sign a notarized Statement of Evaluation regarding the and sign a notarized Statement of Evaluation regarding the applicant’s level of independence and surgical skill, to view applicant’s level of independence and surgical skill, to view click here..
– Those applicants who successfully complete the attestation Those applicants who successfully complete the attestation process will be eligible to sit for the oral examination.process will be eligible to sit for the oral examination.
OB FELLOWSHIP OUTCOMES 1992-OB FELLOWSHIP OUTCOMES 1992-2010:WHERE DO THEY GO, WHO STOPS 2010:WHERE DO THEY GO, WHO STOPS
DELIVERING AND WHY?DELIVERING AND WHY?
Wm. MacMillan Rodney MD, Conchita Martinez Wm. MacMillan Rodney MD, Conchita Martinez MD, Millard Collins MD, Greg Laurence MD, Carl MD, Millard Collins MD, Greg Laurence MD, Carl Pean MD, Joe Stallings MDPean MD, Joe Stallings MD– Acknowledgments:Acknowledgments: Charles E. Couch, M.D., Charles E. Couch, M.D.,
ACOG[deceased], James Weber MD[deceased]; Eugene ACOG[deceased], James Weber MD[deceased]; Eugene Felmar MD[deceased]Felmar MD[deceased]
Address Correspondence to:Address Correspondence to:
Procedural Skills and Office Technology; Procedural Skills and Office Technology; www.psot.com www.psot.com
The Fellowship Solved Other The Fellowship Solved Other ProblemsProblems
Regained financial control and ability to self fund a model office with Regained financial control and ability to self fund a model office with open access appointments, EMR, all procedural equipment. The open access appointments, EMR, all procedural equipment. The university “dumbs down” family medicine by forcing it to abandon university “dumbs down” family medicine by forcing it to abandon skills. skills. Retained alliances with ALSO statewide coalition, surgery lab, Retained alliances with ALSO statewide coalition, surgery lab, ultrasound course, and AAFP.ultrasound course, and AAFP.Established osteopathic and allopathic alliances with Oklahoma Established osteopathic and allopathic alliances with Oklahoma State, the University of Arkansas, Louisiana, and rural locations in .State, the University of Arkansas, Louisiana, and rural locations in .FundedFundedDeveloped alliance with previous faculty who had left academia for Developed alliance with previous faculty who had left academia for private practice. They provide selectives in GI endoscopy and Derm.private practice. They provide selectives in GI endoscopy and Derm.Established 501c3 and began endowment.Established 501c3 and began endowment.Implemented global outreach with fellowship rotations in Kenya, Implemented global outreach with fellowship rotations in Kenya, Ghana, Ecuador, Guatemala, and others.Ghana, Ecuador, Guatemala, and others.Trained leadership capable physicians who went on to colonize Trained leadership capable physicians who went on to colonize previously hostile environments. One hospital system welcomed previously hostile environments. One hospital system welcomed fellowship trained family physicians into the department of fellowship trained family physicians into the department of Obstetrics.Obstetrics.
Health Services ResearchHealth Services ResearchThe electronic medical record and a digital xray system The electronic medical record and a digital xray system created efficiencies and improved care.created efficiencies and improved care.The OB call group 24/7 365 staffed an open access The OB call group 24/7 365 staffed an open access appointment system leading to improved service and appointment system leading to improved service and 63,000 visits in 2009. Gross revenue topped $ 5 Million.63,000 visits in 2009. Gross revenue topped $ 5 Million.Published over 10 Studies and funded other research. Published over 10 Studies and funded other research. See bibliography www.psot.comSee bibliography www.psot.comDeveloped an internet based and PDA available Developed an internet based and PDA available prenatal-delivery database for the management of risk. prenatal-delivery database for the management of risk. >4,000 deliver>4,000 deliverDeveloped a curriculum in Office and Obstetrical Developed a curriculum in Office and Obstetrical surgery.surgery.– Cognitive preloading for psychomotor skills: Cognitive preloading for psychomotor skills: – The role of the live animal laboratory as simulator for repair of The role of the live animal laboratory as simulator for repair of
complex lacerations and inadvertent bladder entry.complex lacerations and inadvertent bladder entry.– Ultrasound assessment as a means of avoiding Cesarean Ultrasound assessment as a means of avoiding Cesarean
Hysterectomy.Hysterectomy.
Transfer of Technology Transfer of Technology ProjectsProjects
Medicos-- A Mission Hospital Simulation in Medicos-- A Mission Hospital Simulation in TennesseeTennesseeMinor Surgery, Urgent Care, and Minor Surgery, Urgent Care, and
some ER reengineered in the officesome ER reengineered in the office
Diagnostic services: ECG,CXR, and Diagnostic services: ECG,CXR, and basic lab reengineered for the Officebasic lab reengineered for the Office
Colposcopy 1984- establishedColposcopy 1984- established– Electrosurgery and cryosurgery came with this Electrosurgery and cryosurgery came with this
American Board of Family Medicine American Board of Family Medicine ObstetricsObstetrics
Board Certification in Family Medicine Board Certification in Family Medicine Obstetrics—An Opportunity for GoodObstetrics—An Opportunity for Good
Wm. MacMillan Rodney MD, FAAFP, FACEPWm. MacMillan Rodney MD, FAAFP, FACEPProfessor and Chair, Medicos para la FamiliaProfessor and Chair, Medicos para la Familia
Memphis, Nashville, and InternationalMemphis, Nashville, and International
Editor, American Journal of Clinical MedicineEditor, American Journal of Clinical Medicine
American Board of Family Medicine ObstetricsAmerican Board of Family Medicine Obstetrics
WONCA 2010; Cancun, Mexico; PresentingWONCA 2010; Cancun, Mexico; Presenting The Family Medicine Obstetrics Curriculum and DataThe Family Medicine Obstetrics Curriculum and Data
Medicos: A Success in Expanding Services at a Lower Medicos: A Success in Expanding Services at a Lower Cost.Cost.
Eliminating Barriers to Family Planning: Eliminating Barriers to Family Planning: Hysteroscopic Tubal Occlusion without AnesthesiaHysteroscopic Tubal Occlusion without Anesthesia
References Supporting References Supporting Cesarean Training in Family Cesarean Training in Family
MedicineMedicineNothnagle,Nothnagle, M M; Sicilia,; Sicilia, J J; Forman,; Forman, S, et al, Rodney WM. S, et al, Rodney WM. Required Procedural Required Procedural Training in Fammily Medicine Residency: A Consensus Statement. Fam Med Training in Fammily Medicine Residency: A Consensus Statement. Fam Med 2008;40(4):248-52.2008;40(4):248-52.
24)Kelly24)Kelly B, B, Sicilia Sicilia J, J, FormanForman S. S. Advanced Procedural Training in Family Advanced Procedural Training in Family Medicine: A Consensus Statement Fam Med 2009;41(6):398-404.Medicine: A Consensus Statement Fam Med 2009;41(6):398-404.
25)Norris25)Norris T, T, Reese,Reese, J, J, PiraniPirani M M, et al. Are Rural Family Physicians , et al. Are Rural Family Physicians Comfortable Performing Cesarean Sections? J Fam Pract 1996;43:455-460.Comfortable Performing Cesarean Sections? J Fam Pract 1996;43:455-460.
26)Deutchman26)Deutchman M, M, Connor Connor P, P, Gobbo Gobbo R, R, FitzSimmons FitzSimmons R. R. Outcomes Of Outcomes Of Cesarean Sections Performed By Family Physicians And The Training They Cesarean Sections Performed By Family Physicians And The Training They Received: A 15-Year Retrospective Study. J Am Board Fam Pract 1995; 8:81-Received: A 15-Year Retrospective Study. J Am Board Fam Pract 1995; 8:81-90.90.
27)Eidson-Ton W27)Eidson-Ton WS, S, NuovoNuovo J, J, SolisSolis B, B, et al; An Enhanced Obstetrics Track for et al; An Enhanced Obstetrics Track for a Family Practice Residency Program: Results from the First 6 Years. J Am a Family Practice Residency Program: Results from the First 6 Years. J Am Board Fam Pract 2005;18:223-8.Board Fam Pract 2005;18:223-8.
28)Pecci28)Pecci C, C, LeemanLeeman L, L,WilkinsonWilkinson J, J, Family Medicine obstyetrics Fellowship Family Medicine obstyetrics Fellowship Graduates: Training and Post-fellowship Experience. Fam Med Graduates: Training and Post-fellowship Experience. Fam Med 2008;40(5):326-32.2008;40(5):326-32.
29)Heider29)Heider A, A, NeelyNeely B, B, BellBell L. L. Cesarean Delivery Results in a Family Medicine Cesarean Delivery Results in a Family Medicine Resedency Using a Specific Training Model. Fam Med 2006;38(2):103-9.Resedency Using a Specific Training Model. Fam Med 2006;38(2):103-9.
BibliographyBibliography1. Morgan WC, Rodney WM, Hahn RG, Garr DA, O'Brien J. Echografie bij Verloskunden en 1. Morgan WC, Rodney WM, Hahn RG, Garr DA, O'Brien J. Echografie bij Verloskunden en gynaecologie in de praktijruiute: Een ondersteuning voor Luisartsenverloskunde (Office-based gynaecologie in de praktijruiute: Een ondersteuning voor Luisartsenverloskunde (Office-based ultrasound as a support for family centered obstetrics), Huissarts Nu (HANU) 1987; 16:277-280.ultrasound as a support for family centered obstetrics), Huissarts Nu (HANU) 1987; 16:277-280.2. Morgan WC, Rodney WM, Garr DA, Hahn RG. Ultrasound for the primary care physician: 2. Morgan WC, Rodney WM, Garr DA, Hahn RG. Ultrasound for the primary care physician: Applications in family-centered obstetrics. Postgrad Med 1988; 83(2):103-107Applications in family-centered obstetrics. Postgrad Med 1988; 83(2):103-1073. Hahn R, Ornstein S, Davies TC, Rodney WM, et al. Obstetric ultrasound training for family 3. Hahn R, Ornstein S, Davies TC, Rodney WM, et al. Obstetric ultrasound training for family physicians: results from a multi-site study. J Fam Pract 1988; 26:553-558.physicians: results from a multi-site study. J Fam Pract 1988; 26:553-558.4. Hahn RG, Davies TC, Rodney WM. Diagnostic ultrasound in general practice. Fam Pract--An 4. Hahn RG, Davies TC, Rodney WM. Diagnostic ultrasound in general practice. Fam Pract--An International Journal 1988; 5(2):129-135.International Journal 1988; 5(2):129-135.5. Rodney WM, Prislin MD, Hahn RG. Family practice obstetrical ultrasound in an urban 5. Rodney WM, Prislin MD, Hahn RG. Family practice obstetrical ultrasound in an urban community health center: Birth outcomes and examination accuracy of the initial 227 cases. J community health center: Birth outcomes and examination accuracy of the initial 227 cases. J Fam Pract 1990; 30:163-168.Fam Pract 1990; 30:163-168.6. Rodney WM, Hahn RG, Hartman KJ, Deutchman ME. Obstetric ultrasound by family 6. Rodney WM, Hahn RG, Hartman KJ, Deutchman ME. Obstetric ultrasound by family physicians. J Fam Pract 1992; 34:186-200.physicians. J Fam Pract 1992; 34:186-200.7. Deutchman ME, Hahn RG, Rodney WM. Maternal gallbladder assessment during obstetric 7. Deutchman ME, Hahn RG, Rodney WM. Maternal gallbladder assessment during obstetric ultrasound: results and technique. J Fam Pract 1994; 39:33-37.ultrasound: results and technique. J Fam Pract 1994; 39:33-37.8. Euans DW, Hahn RG, Rodney WM. A comparison of manual and ultrasound measurements of 8. Euans DW, Hahn RG, Rodney WM. A comparison of manual and ultrasound measurements of fundal height. J Fam Pract 1995; 40:233-236.fundal height. J Fam Pract 1995; 40:233-236.9. Rodney WM. Historical observations from the RRC 1994-2000: Maternity care[OB] training in 9. Rodney WM. Historical observations from the RRC 1994-2000: Maternity care[OB] training in FP. J Am Board Fam Pract 2002;15:255-56.FP. J Am Board Fam Pract 2002;15:255-56.10. Dresang LT. Rodney WM, Dees J. Teaching OB ultrasound to family practice residents. Fam 10. Dresang LT. Rodney WM, Dees J. Teaching OB ultrasound to family practice residents. Fam Med 2004; 36: 98-107. Med 2004; 36: 98-107. 11.Dresang LT, Rodney WM, Leeman L, Dees J, Koch, P, Palencio M. ALSO in Ecuador: 11.Dresang LT, Rodney WM, Leeman L, Dees J, Koch, P, Palencio M. ALSO in Ecuador: Teaching the Teachers. J Am Board Fam Practice. 2004;17(4): 276-282. Teaching the Teachers. J Am Board Fam Practice. 2004;17(4): 276-282. http://www.jabfp.org/cgi/content/full/17/4/27612. Dresang LT, Rodney WM, Rodney KMM. Prenatal Ultrasound: A tale of two cities. J Nat Med 12. Dresang LT, Rodney WM, Rodney KMM. Prenatal Ultrasound: A tale of two cities. J Nat Med Association Feb 2006; 98: 167-171.Association Feb 2006; 98: 167-171.
Challenges—Civil RightsChallenges—Civil Rights
Political stability and the threat of mandatory Political stability and the threat of mandatory consultation for things like labor at 36 weeksconsultation for things like labor at 36 weeks
The threat of a “bad case”.The threat of a “bad case”.
Medicos para la Familia example:Medicos para la Familia example:– No maternal deaths or morbidity, n=3000 + No maternal deaths or morbidity, n=3000 +
plexus injury; retained placentas, over 1000 plexus injury; retained placentas, over 1000 Cesareans, abruptio; HELLP; American nursing Cesareans, abruptio; HELLP; American nursing politics,staff squabblespolitics,staff squabbles
– One lawsuit, and medical malpractice insurance has One lawsuit, and medical malpractice insurance has doubled to $30,000/year since 1999. Year one cost doubled to $30,000/year since 1999. Year one cost is $12,000.is $12,000.
International Medicine vs. USAInternational Medicine vs. USATwice the service at a tenth of the Twice the service at a tenth of the
costcost50 bed hospital Destin Fla50 bed hospital Destin Fla
Comprehensive women’s health program Comprehensive women’s health program to cost $ 12 million for start up.to cost $ 12 million for start up.
Currently 500 women in the county Currently 500 women in the county deliver each year.deliver each year.
Start up $24,000 per delivery. Hospital Start up $24,000 per delivery. Hospital charges $4-5 k/delivery “We’re not-for-charges $4-5 k/delivery “We’re not-for-profit.”profit.”
Reference The Destin Log. May 7, 2005. pA14Reference The Destin Log. May 7, 2005. pA14
