Family medicine
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This paper reflects a vision of how family medicine residency training will be redesigned to prepare graduates to meet the health care needs of their patient populations and regional communities. Family physicians are needed to serve as personal physicians and as the patient's usual source of care, as recognized in historic documents that have defined the specialty's enduring role in society as the foundation of the health care system. Modern residency practices will include residents as junior partners and members of multidisciplinary faculty teams. ⋯ Also included will be emerging expectations of family physicians, including team roles, expanded care through telehealth and patient portals, identifying and intervening in modifiable social determinants of health, addressing structural racism, closing gaps of inequitable care for their patient populations, managing addiction as a treatable chronic illness, improving performance through clinical data registries, personalized medicine, and leadership. Wellness and assurance of a satisfying career will be a priority focus of preparation for career-long practice. Residents will become competent in the comprehensive scope of practice needed to serve in the role of continuous personal physician on multidisciplinary teams that serve as the usual source of care for populations in regions where the residencies are located.
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The training family medicine residents receive will have a lasting impact on how they deliver care in the future. Evidence demonstrates an imprinting effect based on the training environment itself. Thus, residency training represents a critical time for establishing clinical experiences that embody core primary care principles and ensure excellent care delivery. ⋯ Next, we examine the six C's of primary care in context of current care. These six C's inform our recommendations for residency training standards to create the family physicians of the future. The overarching theme of these recommendations is the need to measure and report on what we want to ultimately improve.
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Because graduate medical education (GME) is largely publicly funded, it should be judged on how well it addresses the public's health needs. However, the current system distributes GME resources inequitably by specialty and geography, and neglects to focus on training physicians adequately in the care of populations while reducing health disparities. Instead, GME continues to concentrate training in hospital-based academic centers and in subspecialties, which often exacerbates disparities in health outcomes and access to care. GME can be more socially accountable by shifting incentive structures to support primary care, creating more equitable distribution of residency slots and funding, and promoting training programs that focus on social and structural determinants of health.