Some older physicians have been known to be, shall we say, change-resistant. Chances are some of the operational practices they learned fresh out of medical school are what they're still using today. Who needs electronic medical records when you've got 5x7 note cards, a unique flair for penmanship, and a sturdy manila folder?
The problem is that the way medical care is delivered has to change quickly to adapt both to a shortage of physicians and an aging and chronically sicker demographic. This is particularly true in rural America.
A big catalyst for changing healthcare delivery in the future will be in the hands of the residents being trained today. Understanding the difficulty of teaching old docs new tricks, the University of Kansas School of Medicine has opened a new medical home program at its Smoky Hills Family Medicine Residency Program in Salina, 90 miles north of Wichita. The hope is that three years of residency under a medical home model will ingrain lessons that include the proactive coordinated care for chronic illnesses, with patients taking a role in their treatment plan; managing staff, building teams, and delegating responsibilities within the doctor's office; and cultivating technophilia, especially for electronic medical records and other areas of health information technology and linkage.
"The adoption of the medical home model at the residency level is particularly important because the office practices physicians learn in residency—good or bad—tend to translate into their 'real life' practice upon graduation," says Rick Kellerman, MD, professor and chair of the Department of Family and Community Medicine at the KU School of Medicine-Wichita.
"We're integrating all of the different components of the medical home. There are a lot of different practices that do certain elements, but to put them all together has never been done," he says.
The Smoky Hill medical home will steer 12 family practice residents—four residents per annual class—away from the traditional mindset of providing acute care and toward proactive management of chronic illnesses. "One of the big pushes in the medical home concept is not just waiting until the patient shows up in the office, but to identify those who are at risk or out of control and reaching out to them," says Terry McGeeney, MD, president and CEO of TransforMED, a subsidiary of the American Academy of Family Physicians, which is coordinating Smoky Hill's move toward the medical home model. "That is a very different model from what most of us have trained in, where we wait for the patients to show up with a problem and you take care of them and then wait until they show up the next time."