Dr. Rodney:
As I sit here in my office at 10pm, after a pretty brutal day of inpatient medicine admissions, I received your email that you just sent through the stfmprocedures listserv. Your email is very thought provoking, and made me think of an email I sent to my residency director here 2 days ago (an excerpt is included below). I'd love to hear your thoughts and your take on this email. On a daily basis, I'm feeling like the training that I LOVED and made me the doctor I believe I am today is becoming progressively more extinct. I'm sad for this generation of residents (and thrilled I graduated in 2002, not 2012).
My concern is that the ACGME, I believe, is slowly taking programs like ours [Ventura] and diluting them so much that they can no longer offer the kind of training that we have traditionally offered.
"With the name "Family Physician" on my resume, nobody would know (without investigating further) whether I am a full-spectrum physician or if I am an "outpatient specialist". We all have the same name, across the most heterogeneous training that one can find in any specialty. I believe that ALL of the difficulties that Family Physicians have — credentialing for OB and hospitalist privileges being the biggest — come from the heterogeneous definition of what a Family Physician is. What is a Family Physician? Someone who does ICU and hospitalist medicine? Yes. Someone who does outpatient clinic alone? Yes. Someone who does OB including surgical OB? Yes.
Fundamentally, the TRAINING for each of those descriptions is VASTLY different, but the ACGME is viewing us as all one entity (the "outpatient specialist" identity). They are ruining the training for all of the other identities.
My friend (former resident here, Franchot van Slot) really came up with the idea — to have the programs like ours (and Martinez and Salinas and Santa Rosa and Greeley, etc.) have a different set of training standards. His name for the idea was to call us "Comprehensivists", and to call the training "Comprehensive Medicine". If we continue on the current course, I believe we will not have enough time to train our residents well. Would love to chat with you about this at some point..."
Mark LePore MD
WMR REPLIES:
First, we need to maintain our unity in this cause. The STFM listserv has produced a focal point thanks to Stu Forman and the Phoenix Task Force.. Second, we have to speak out, create new models, and publish.
The family medicine obstetrics and the family medicine ER fellowships, started in 1992, were low hanging fruit to test the prediction, that residencies would be pressured to retreat from founding principles, and that a substantial number of family physicians would seek a stronger professional identity. Sad to say, but this prediction has come true.
The fact that we have established a competing board certification process is HUGE!!! BCEM and BFMOB are the only things that ever got the attention of ACGME. Currently ACGME is trying to assassinate and discredit these entities, but the ABPS has been in existence since 1948, and has an airtight legal structure. We have options. Encourage your Grads to grandfather in. This is the plan we are preparing for others.
Third,do not allow more required time (ie the 4 year program requirement) in the hands of educators who do not deliver a quality product. Lobby against the four year residencies, and lobby for the one year fellowships in BCEM and BFMOB. These lead to certifications which produce value internationally and here in the USA. Furthermore, as a fellow, the learner is freed from the artificial restrictions of the 56 hour week.
Chairs and Residency Directors still have the administrative authority to do amazing things. But, you need a vision and a plan. The Dean at Texas Tech single-handedly resuscitated the accelerated residency program in family medicine. It was presented at STFM 2011. To negotiate these shark infested waters, is very very difficult. But, I apply for one Chairmanship a year with hopes of negotiating this vision. It remains a viable strategy. Another strategy is to use international settings as model projects which demonstrate competence and quality but with much lower costs in time and money. Do you still manage Hospitalito Santiago Atitlan?
There are many things which can be done.
Your comments are appreciated.
Index--Family Medicine training ideals
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