Work Life Balance

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Work Life Balance

  1. 1. Work/Life Finding Balance in a Family Medicine Career Pat Fontaine, MD MS
  2. 2. 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
  3. 3. Why am I talking about balance? Some days I don’t feel like the poster child for balance…
  4. 4. But I have had the incredible opportunity to be a family doc and a mom for 3 decades
  5. 5. “Home and hearth” – a reminder
  6. 6. 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
  7. 7. 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)
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. Of course, there are challenges…
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15.  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
  16. 16. 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
  17. 17. 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
  18. 18.  “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
  19. 19.  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
  20. 20.  Continuity gives us roots; change gives us branches … to reach new heights. ~Pauline R. Kezer
  21. 21. Core Values  Continuity and comprehensiveness  All ages, across the lifespan  The Personal Physician Minnesota excels in these areas, but we must keep our edge
  22. 22. 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
  23. 23. 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
  24. 24. 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.
  25. 25. How can anyone do all this and still have a balanced life?
  26. 26. What is balance? Intellectual Emotional Spiritual Physical
  27. 27. 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
  28. 28. Nurturing balance  Be conscious of your sources of stress and support  Have realistic expectations
  29. 29. Work versus Life is a false dichotomy It’s about self-realization in both spheres Balance over the long haul = burnout prevention
  30. 30. 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
  31. 31. 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
  32. 32. Questions?
  33. 33. Best wishes for your future  pfontaine@umphysicians.umn.edu I welcome your input….Thank you

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