The Financial Status of Departments of Family Medicine at US Medical Schools
WJ Hueston; AG Mainous III; X Ye

Background: This report examined the financial health of departments of family medicine in US allopathic medical schools. Methods: We conducted a survey of departments of family medicine at US medical schools, using academic year 1997–1998 as the index year. A total of 52 (46%) of medical schools that have a department of family medicine responded to the survey. The survey examined sources of revenue and categories of expenditures. Analysis assessed the overall financial status of departments at that period of time. Results: Responding departments of family medicine received 32% of their funding from state or university sources and an additional 32% of funding from clinical services. Grants and hospital support comprised another 17% each. Departments in public institutions received higher levels of support from hospitals (22% of revenue versus 8% for private schools). The overall balance sheets for departments of family medicine showed that 56% of departments have financial reserves, while 19% had no reserves but no debt. Twenty-five percent of all departments were in debt, including 2% with debt exceeding $1 million. Conclusions: The majority of departments of family medicine remain fiscally healthy, but these departments are dependent on funds from state and medical school sources. A substantial proportion of departments are in debt. Lower levels of grant support and the difficulty in increasing clinical revenue may create future funding problems for primary care faculty as medical schools increase dependence on these sources of income.

(Fam Med 2001;33(3):166-70.)

The Ballint Movement in America
Alan H. Johnson, PhD

Michael Balint’s (1896–1970) career evolution from general practitioner (1918) to psychoanalyst (1926) and subsequently to general practitioner educator (1950) began at his home in Budapest and then moved from London to sites in the United States. His frequent visits to America, together with his wife Enid, were an influential force in promoting and training US-based Balint group leaders. Michael and Enid Balint’s influence, together with the support of US physicians, South African physicians who became US citizens, and behavioral scientists, laid the foundation for the formation of an American Balint Society in 1990. The Society’s educational and research efforts occurred primarily in family practice residencies and have grown over the past 10 years. The Society is presently working to standardize credentialing of Balint group leaders to assure continued quality growth in the American Balint movement.

(Fam Med 2001;33(3):174-7.)

The Effect of a Global Multicultural Track on Cultural Competence of Preclinical Medical Students
Michael A. Godkin, PhD; Judith A. Savageau, MPH

Background: We evaluated the effect of an elective (the Global Multiculturalism Track), including international and domestic immersion experiences, on the cultural competence of preclinical medical students. Methods: A self-assessment instrument was used to measure cultural competence, and it was administered to Track participants and nonparticipating class cohorts at the beginning and the end of the preclinical years. Results: Track participants (n=26) had a higher level of cultural competence both at the beginning and at the end of the program. At the end of their second year, students participating in the Track had, for the first time, greater knowledge of certain aspects of local cultures, more tolerance of people of other cultures not speaking English, and more comfort with patients of these cultures, compared with non-Track participants. Conclusions: The results are based on a small sample size, but the suggestion that a multiculturalism track could provide a model for development of cultural competence warrants further research.

(Fam Med 2001;33(3):178-86.)

Patients' Perceptions of Medical Students in a Longitudinal Family Medicine Clerkship
Michael D. Prislin, MD; Elizabeth Morrison, MD, MSEd; Mark Giglio, MD; Patrick Truong; Stephen Radecki, PhD

Background: Although educational characteristics of ambulatory clinical environments are becoming clearer, less is known concerning patient opinions about participating in medical student instruction in ambulatory settings. Such perceptions may have an important influence on recruitment and retention of community faculty. Methods: Surveys were administered to 121 patients seen by medical students during a longitudinal family medicine clerkship. The survey explored patients’ opinions regarding the extent of direct student involvement in their care, students’ competence, and patient feelings about participating in medical student instruction. Results: Patients felt that students were highly involved in providing care and that they performed competently and professionally. Patients found participation in medical education enjoyable, not excessively time-consuming or disruptive, and believed that students’ participation improved the quality of care they received. Conclusions: Patients in our family medicine clerkship do not have negative perceptions about their participation in medical student education. In fact, this study suggests that such participation may actually enhance patient satisfaction.

(Fam Med 2001;33(3):187-91.)

Redefining the Need for Faculty in Family Medicine: Results of a 5-year Follow-up Survey
Richard L. Holloway, PhD; Anne M. Marbella, MS; Peter M. Layde, MD, MSc

Background and Objectives: A study was conducted in 1994 to determine the need for faculty in family medicine. This paper reports a comparative follow-up study in 1999. Methods: This follow-up study determined faculty positions filled in the last 5 years, new faculty positions currently available, replacement faculty positions currently available, and new faculty positions anticipated to be available in the next 3 years. In addition, comparisons were made with the previous study regarding time available for clinical, educational, and research activities. Results: In the 1994 survey, respondents reported 496 open faculty positions and anticipated that 677 would become available during the subsequent 3 years, for a total of 1,173 positions. The 1999 survey data indicated that the actual number of positions filled or still open since 1994 was 1,072. In contrast, new positions open in 1999 or anticipated to be open in the subsequent 3 years were 604. For both residencies and departments, most positions in both surveys were for clinicians. Conclusions: Despite a decrease in the number of available positions for family medicine faculty reported between the 1994 original survey and 1999 follow-up survey, there are still more than 600 faculty positions currently available, and additional new positions are anticipated over the next 3 years.

(Fam Med 2001;33(3):192-7.)

From Petting Zoos to Electronic Classrooms: Meeting the Technology Learning Needs of Family Medicine Teachers
Nancy B. Clark, MEd; Harry Strothers, MD; Frank A. Hale, PhD

Background and Objectives: To meet the need for faculty development in the use of information technology for its membership, the Society of Teachers of Family Medicine (STFM) Program Committee implemented a pilot, fee-supported, electronic classroom format at STFM’s 2000 Annual Spring Conference. We assessed the characteristics of those who attended the sessions, the satisfaction of participants with the venue both from expressed satisfaction and enrollment, the financial viability of electronic classrooms, and whether participants used acquired skills 6 months after the conference. Methods: An evaluation instrument was used to collect the demographic data on attendees and their satisfaction with the sessions they attended. This data was compiled and compared with the demographics of overall conference attendees. The enrollment and revenues for the electronic classrooms were totaled and compared with expenses. A 6-month post-conference phone survey was conducted to assess continued use of learned skills. Results: Attendees were more likely to be physicians from community-based residencies. The program was filled to 80% capacity. Survey results indicated that the program was satisfying to attendees. Registration fees covered costs. Most participants were still using their new skills 6 months after the program. Conclusions: The electronic classroom pilot was successful and provides skills that participants use months after the program. This program can be used to meet the educational technology training needs of STFM members.

(Fam Med 2001;33(3):198-202.)

Predictors of Patient Referrals by Primary Care Residents to Specialty Care Clinics
Klea D. Bertakis, MD, MPH; Edward J. Callahan, PhD; Rahman Azari, PhD; John A Robbins, MD, MHS

Background and Objectives: Physician referral patterns significantly impact costs, quality of care, and access to the health system. This paper examines factors predictive of patient referrals to specialists by primary care residents. Methods: New adult patients (n=509) were randomly assigned to primary care residents at a university medical center. Patient referrals to specialists were monitored for 1 year of care. Self-reported patient health status, sociodemographic information, number of primary care visits, and physician practice style behaviors were incorporated into statistical analyses predicting specialty referrals. Results: Patients who were referred to specialty care were significantly older, had poorer physical health, and saw their primary care physicians more often than patients who were not referred. Patients were most frequently referred to surgical specialty clinics. After controlling for physical health status, gender, and age, more frequent visits to a primary care resident physician who had a technically oriented style of care was associated with a greater total number of specialty clinic referrals. Conclusions: Patient variables, as well as physician practice style, have an important impact on the specialty referral process. Although the appropriateness of referrals was not evaluated, these findings have implications for health care delivery.

(Fam Med 2001;33(3):203-9.)