Work/Life Finding Balance in a Family Medicine Career Pat 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 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 to be 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

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)

Champions for:

Personal Physician

Continuity of Care

Patient-centered Medical Home

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

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

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

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

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 Concepts The 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

The 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

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

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

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

“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

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

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

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

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

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.

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

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

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

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

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?

Best wishes for your future [email_address] I welcome your input….Thank you

[email_address]

I welcome your input….Thank you