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Work/Life
Finding Balance in a
Family Medicine CareerPat Fontaine, MD MS
Tonight’s Talk Why am I talking about balance in a family
medicine career? Why you can feel good about choosing
family medicine Work versus Life - finding balance
Why am I talking about balance?
Some days I don’t feel like the poster child for balance…
But I have had the incredible opportunity tobe a family doc and a mom for 3 decades
“Home and hearth” – a reminder
Why you can feel good about choosing family medicine
You will make a difference – to society as well as to your patients
You can find amazing mentors and role models
Role models:Family physicians can be champions
Champions for:
Personal Physician
Continuity of Care
Patient-centered Medical Home
Family of David Hutchinson (MAFP Past President and Duluth Family Medicine Residency Faculty)
Activated Leadership
Leading efforts for health reform Transformation through
Health Care Home Initiatives
Reinvigorating the primary care work force
Aligning financial systems to support HCH
Making a difference It’s a given: Family Medicine has never
been more important to the health of our state and nation
Central role of primary care is undisputed for providing Better health outcomes Lower costs Care to vulnerable populations => lessening
health disparities
Barbara Starfield, MD,Professor of Health Policy & Management at John Hopkins(Health Affairs, March 15, 2005)
In the US, a 20 % increase in the number of primary care physicians is associated with a 5 percent decrease in mortality.
Adding 1 more FP per 10,000 is associated with 70 fewer deaths per 100,000, a 9 percent reduction in mortality
Of course, there are challenges…
Woo B. N Engl J Med 2006;355:864-866
Percent Change between 1998 and 2006 in the Percentage of U.S. Medical School Graduates Filling Residency Positions in Various Specialties
Potential Solutions: What will actually make it into Health Care Reform legislation?
Bonus payments for primary care services 5% bonus, 10% if services are provided in a
physician shortage area Improved reimbursement to programs in
graduate medical education Financial assistance to medical students and
residents in family medicine and other primary care specialties
Medical Home ConceptsThe 2007 Joint Principles Personal Physician Team Care Whole person, all stages of
life Coordinated across settings Quality & Safety Enhanced Access Payment to recognize the
added value of the PC-MH
The IHI Triple Aim Health Quality Patient Experience Cost Savings
Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof. ~John Kenneth Galbraith
Minnesota’s Health Care Home: Recent Developments May 2008 MN HC reform legislation passed Dec-July Certification criteria developed Sept 2009 Letter of intent to apply for
Certification as HCHs Jan 2010 Payment system completed July 2010
Payments to providers for public programs and state employees begins
Private plans must include HCH in network, pay care coordination fee for enrollees who choose HCH
A MN Certified HCH will Focus initially on patients with complex or
chronic conditions “Emphasize, enhance and encourage the
use of primary care” “consistent, ongoing contact” A personal clinician A care coordinator and team Patient and family-centered care plan
“Ensure the use of health information technology and systematic follow-up” Registries
24/7 access to a basic patient profile
Tracking for tests, referrals, discharge summaries
An electronic record is not mandatory at this time
Focus on high-quality, efficient and effective health services Provide “scientifically based health care,” i.e.
evidence based A HCH collaborative will be established
and HCHs must participate in QI and best practices Select a QI project: measure, track, analyze Send a representative to the collaborative
Continuity gives us roots; change gives us branches … to reach new heights.
~Pauline R. Kezer
Core Values Continuity and comprehensiveness
All ages, across the lifespan The Personal Physician
Minnesota excels in these areas, but we must keep our edge
Building a Practice with Young Families
1/3 of US children are cared for by family physicians
Providing OB care gives opportunities to build a “family practice” from its beginnings
Do Family Physicians Still Deliver? 23% of FPs report they do routine OB North Central US (MN) highest at 45% Range for other regions = 8% to 29% Biggest reason for NOT doing OB?
No hospital department Liability concerns Not desired
. Source: American Academy of Family Physicians, Practice Profile I Survey, Table 34, July 2008
The “Maternity Cascade”: Percentage of Prenatal Visits by FPs 1980 – 17.3% 1995 – 12.6% 2004 – 6.1% In rural areas, decreased from 38.6% to
12.9% between1995-2004
Cohen D. Declining trends in the provision of prenatal care visits by family physicians.
Ann Fam Med 2009;7:128-133.
How can anyone do all this and still have a balanced life?
What is balance?Intellectual
Emotional
Spiritual
Physical
Staying on center Know what motivated you to enter
medicine as a career “Healer” versus “Technician” Think about your childhood dreams, family
stories Stay aligned with your truest goals
Nurturing balance Be conscious of your
sources of stress and support
Have realistic expectations
Work versus Life is a false dichotomy
It’s about self-realization in both spheres
Balance over the long haul = burnout prevention
Balance = Burnout-prevention Signs of professional burnout overlap with
signs of depression Lack of self care, energy Less pleasure, humor, enthusiasm Withdrawing from relationships
“Compassion fatigue” Blaming the patient for their problems Not willing to “go the extra mile”
Substance overuse
Women in Medicine 1970 - 8% of practicing physicians were women 2010 – physician workforce will be 30% women More likely than men to experience career/family
conflicts Hours worked survey on MomMD.com
30-40 hrs/wk – very satisfied with balance 40-100 hrs/wk – very dissatisfied Most satisfied specialty – FAMILY MEDICINE
Marital status and numbers of children Division of household responsibilities
Questions?