This document discusses finding balance in a family medicine career. It begins by explaining why the author chose to talk about balance after practicing family medicine and raising a family for 30 years. It then discusses why one can feel good about choosing family medicine, noting that family physicians can make a big difference in society and health outcomes while finding mentors. The document also covers some of the challenges of practicing family medicine today and potential solutions to address these challenges, such as policies to improve reimbursement for primary care. It ends by emphasizing the importance of balance, continuity of care, and preventing burnout over the long career as a family physician.

1. Work/Life
Finding Balance in a
Family Medicine Career
Pat Fontaine, MD MS

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. Why am I talking about balance?
Some days I don’t feel like the poster child for balance…

4. But I have had the incredible opportunity to
be a family doc and a mom for 3 decades

5. “Home and hearth” – a reminder

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. 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. 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. 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. 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. Of course, there are challenges…

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. 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. 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.  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. 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. 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.  “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.  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.  Continuity gives us roots; change gives us
branches … to reach new heights.
~Pauline R. Kezer

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. 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. 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. 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. How can anyone do all this and still
have a balanced life?

26. What is balance?
Intellectual
Emotional
Spiritual
Physical

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. Nurturing balance
 Be conscious of your
sources of stress and
support
 Have realistic
expectations

29. Work versus Life
is a false dichotomy
It’s about self-realization in both spheres
Balance over the long haul = burnout prevention

31. 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

32. 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

33. Questions?

34. Best wishes for your future
 pfontaine@umphysicians.umn.edu
I welcome your input….Thank you