COMMENTARY

How Can Busy Family Docs Take on Another Role?

Kenneth W. Lin, MD, MPH

Disclosures

July 02, 2019

Editorial Collaboration

Medscape &

This transcript has been edited for clarity.

Hi, everyone. I'm Dr Kenny Lin. I am a family physician at Georgetown University Medical Center, and I blog at Common Sense Family Doctor.

After completing my family medicine residency 15 years ago, I was trained to provide comprehensive care to patients from cradle to grave, in outpatient and inpatient settings. I delivered babies, examined newborns, and provided a range of office procedures, from suturing to ingrown toenail removal to x-ray interpretation and splinting and casting. Over time, I aligned my scope of practice with my interests and the needs of the community I serve. I continue to provide women's preventive health services but no longer do prenatal or newborn care. I limit my time on the hospital wards to 1 month out of the year. Although I still see infants and toddlers on occasion, my established patients are mostly adolescents or adults. My practice reflects national trends in family medicine: Fewer family physicians are providing obstetric care and primary care for children.[1,2]

As I narrowed my scope of patient care, I developed interests in health policy and population health. Nine years after my residency, I earned a master of public health degree to better evaluate and improve the health of populations. I am a faculty advisor for our school's Population Health Scholar Track, which provides eight to 12 students per class with additional training and scholarly experiences in population health. I believe that to eliminate health disparities and improve health overall, we must train future healthcare professionals to engage with communities outside of healthcare settings.[3]

Naturally, I read with great interest a recent exchange of public correspondence regarding the role of family physicians in population health. In a commentary in the October 2018 issue of Family Medicine, Drs Joyce Hollander-Rodriguez and Jennifer DeVoe[4] proposed that residency programs equip trainees to become "experts in population health," adding curricula in community organizing, patient empowerment, relational leadership, informatics, data analysis, and advocacy. They argued that training family physicians to practice what they term "clinical population medicine" is consistent with the specialty role definition created by the Family Medicine for America's Health initiative.[5] They did not explain how this additional training would be incorporated into an already jam-packed set of learning objectives. Although a few programs have piloted extending the length of residency to 4 years to allow for extra training in areas of concentration, most programs remain 3 years long.

Given this limitation, and that many family physicians will not use all of these skills in practice, Drs Doug Campos-Outcalt and Ronald Pust[6] responded in a letter to the editor that "recognition and respect for the various competencies of other professionals, and collaboration with them, is preferable to trying to take over their roles" in population health. Instead, they proposed a more limited set of basic competencies, consisting of collaboration with health agencies, clinical prevention, and cost-effective stewardship of healthcare resources.

Having known both Dr DeVoe and Dr Campos-Outcalt for years, I greatly respect what each has accomplished in family and population medicine and the value of their perspectives. My view is that medical schools and residency programs should offer a scope of population health training that falls somewhere in between Dr DeVoe's aspirational goals and Dr Campos-Outcalt's minimum objectives, consistent with their institutional mission statements, faculty resources, and existing connections with community organizations. For example, over the past several years, my students and family medicine residents have benefited from classroom and experiential learning from faculty in Georgetown's Department of Health Systems Administration, its law school, and its school of public policy. Each year we raise the bar for population health in undergraduate medical education so that our graduates will be able to utilize population health skills in residency and, if desired, incorporate them into their future practices.

It's important to note that family physicians are hardly the only medical specialty with an interest in population health. From pediatricians working to keep lead out of municipal water supplies, to trauma surgeons working to reduce gun violence, and to cardiologists and preventive medicine physicians advocating for transparent nutrition labels and healthy, affordable foods in supermarkets, all doctors can and should step outside of healthcare to improve the health of the public.

This has been Dr Kenny Lin for Medscape Family Medicine. Thank you for listening.

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