Family Medicine Residency Anniversary Addresses Changing Climate of Health Care

By Juliana Bunim

As the United States marks the second anniversary of the passage of national health care reform, the UCSF Family and Community Medicine Residency Training Program at San Francisco General Hospital and Trauma Center (SFGH) will celebrate another milestone, its 40th anniversary.

And its theme could not be more apropos: Preparing Family Physician Leaders in Health System Change.

Kevin Grumbach, MD

Kevin Grumbach, MD

As the U.S. Supreme Court prepares to consider constitutional questions in the Patient Protection and Affordable Care Act on Monday, those on the frontlines of primary care are exploring the challenges posed by a greater demand on family medicine as the previously uninsured seek primary care physicians to gain access to the health care system. 

“It’s an exciting time and a wonderful opportunity to help shape the direction of the whole health system,” said Kevin Grumbach, MD, chair of the UCSF Department of Family and Community Medicine at SFGH. “We’re developing new models of team-based care, where family doctors are working with nurses and community health workers, pharmacists and social workers to provide a comprehensive team model of care.”

The UCSF SFGH program has an emphasis on training residents and students to work in partnership with patients. “The UCSF SFGH Family and Community Medicine Residency has a distinctive mission to prepare family physicians to care for families and underserved populations,” said Grumbach. “It marries the best of the academic attributes of UCSF with a mission-driven ethos of commitment to the public and health disparities that are part of SFGH and the San Francisco Department of Public Health.”

In addition to serving as a reunion to celebrate the accomplishments of the program’s graduates, a symposium on Saturday will provide an opportunity for alumni to weigh in on how to train the next generation of family physician leaders in delivering patient-centered, effective and affordable care.

The symposium also will draw leaders in primary care from across the country to learn about the future of primary care, training, community engagement and education. Keynote speaker Mary Wakefield, PhD, RN, the administrator in the Health Resources and Service Administration (HRSA) in the U.S. Department of Health and Human Services, will explain how HRSA works to fill in the health care gaps for people who are uninsured, isolated or medically vulnerable.  

Educating Future Primary Care Physicians 

With plummeting numbers of U.S. medical school graduates going into primary care fields, it’s more important than ever to support the specialty in a robust way.

“We need to rebuild what had been an inadequately supported primary care structure in the U.S.,” said Grumbach. “The last five years there has been a big wave of renewal of primary care and it is what feels like a Renaissance in family medicine. But before that there was a lack of investment in innovative models of modernizing care in primary care and things were languishing.”

People are very mindful of the lessons of Massachusetts when then they passed the Universal Coverage Act of 2006, according to Grumbach. “All these people were insured, but couldn’t find a primary care doctor or nurse practitioner to gain entry into the system. Now we have a potential influx of patients seeking care and we’re seeing this kind of medical homelessness where people are insured but can’t find a medical home to coordinate their care needs.”

Having a primary care doctor not only streamlines access for patients, but helps deliver a better value to the entire health care system. Understanding patients by taking a comprehensive medical history and performing thorough exams results in family practitioners knowing a patient’s underlying issues and understanding their physical and mental health. That, in turn, reduces extraneous testing and emergency services. “It’s about improving a patient’s wellbeing while reducing unnecessary costs,” Grumbach said.

Grumbach has seen the evolution of family medicine since his early days at UCSF when he was a resident in 1985. He still has a patient who was one of the first babies he delivered during his residency. “I’ve stayed all these years because I love the blend of the academic culture of UCSF with feeling so powerfully moved by attachment to people at SFGH,” he said.  “It’s one of the main things that keeps me here.”