HEALTH
People have begun to rediscover the fa m ily physician at a tim e w hen he was b e co m in g a va nishing breed. M a n y have c o n clu d e d , o fte n after the cost and fru stra tio n o f m aking the rounds o f specialists, th a t th e y needed som e one w h o co u ld treat the w h o le being and the w h o le fam ily. There is, conse q ue n tly, a national m o ve m e nt to increase the su pp ly o f fa m ily physicians. In O h io , the legislature has p ro v id e d fin an cia l incentives fo r the state-supported m edical schools to create fa m ily p ractice p ro grams. A nd c o m m u n itie s are b e g in n in g to fin d ways to encourage yo un g d octo rs to take up fa m ily practice in th e ir areas. Fairview General H ospital, a p riva te c o m m u n ity hospital serving 22,000 patients a year fro m C leveland and its w estern suburbs, has taken the lead in establishing one o f the firs t fa m ily prac tice residency program s in G reater Cleveland. It d id so after n o tin g th a t its fa m ily physicians w ere g ro w in g o ld and d yin g off. In a decade, the n um be r on the active staff had d eclin e d fro m 61 to 15, and the mean age cre p t up to 61, despite the trem endous p o p u la tio n g ro w th in th a t part o f m e tro p o lita n C leveland. A fte r care fu l study, the board o f trustees n o t o n ly pushed fo r creation o f the residency program b u t au th o rize d a substantial investm ent by fu rn ish in g a fa m ily practice c lin ic , adding fu ll-tim e teach ing and clin ica l staff, and a ttractin g lecturers o f regional and national stature. The D e p artm en t o f Family Practice also a ffilia te d w ith the Case W estern Reserve U niversity School o f M e d icin e . A local w om a n physician was e m p loye d to d ire c t the program . A fte r years o f private prac tice, she was w illin g to turn her patients over to residents, thereby accelerating the im p le m e n ta tio n o f the new program . In re co g n itio n o f her c o n trib u tio n , she has been named 1978 “ c lin i 32
cian o f the y e a r" by the C leveland A cad e m y o f M e d icin e . The program began w ith tw o residents in the sum m er o f 1976, added three in 1977, and ex pects to add at least tw o fu ll-tim e and tw o parttim e residents in 1978. Each resident spends three years at the hospital, caring fo r a b o u t 75 fam ilie s in the firs t year and 150 in the re m ain ing tw o . U n d e r staff supervision, each resident keeps o ffic e hours at the c lin ic and makes hos p ita l rounds, house calls and nursing hom e vis its. A resident does e ve ryth in g fro m d e live rin g babies to easing the aches and pains o f grand m others. In the process, he b u ild s a p ro file on the genetic and e n v iro n m e n ta l ills o f the fam ily, and observes h o w the fa m ily lives and interacts affects the physical and e m o tio n a l w e ll-b e in g o f its m em bers. Fairview G eneral hopes th a t at the end o f the three years m ost residents w ill take th e ir pa tients w ith them and set up p riva te practice e ith e r on the w est side o f C leveland o r in such u n d e rsu p p lie d suburbs as Bay V illa g e o r N orth O lm sted. W ith little m ore p ro m o tio n than w o rd o f m o u th , the program n o w has m ore than 200 fam ilie s on its w a itin g list. But it has fallen short o f its goal to a ttract six new residents a year. The n atio n al p o o l may n o t be as large as a n tic i pated and m any m edical school graduates may still p re fe r residencies in the large teaching hos pitals w h ic h em phasize specialties. Fairview General intends to rem ain choosey. It w ill not accept graduates o f fo re ig n m edical schools, b u t it is b e g in n in g to re c ru it at schools o f osteo pathy. In the long run it expects th a t its ow n residents w ill be its best recruiters. Such a program has substantial start-up costs. F a ir v ie w G e n e r a l a lr e a d y has c o m m it t e d