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