Meet Michigan Medicine: Department of Family Medicine
Did you know that nearly 90 percent of patients with diabetes never see an endocrinologist? Or that almost 500 babies are delivered per year at Michigan Medicine by physicians other than obstetricians?
Indeed, most of those patients are seen and treated by faculty members in the Department of Family Medicine, a one-stop shop for health care services across the lifespan, from birth until death.
In honor of National Primary Care Week, here’s a closer look at one of the departments providing primary care at Michigan Medicine — and why the team is so important.
Eyes on the mission
When most people think of family medicine, they often think of the clinical aspect of the department’s work. But that’s far from all this team offers.
“Our department spans all aspects of the organization’s mission, from patient care to education and research,” said Phillip Zazove, M.D., the George A. Dean, M.D., Chair of Family Medicine. “And I’m proud of the work we perform and the collaborations we have forged with specialists from every area of Michigan Medicine.”
The department is large — with more than 100 faculty and countless support staff — and has members assisting patients in hospitals, ambulatory and community-based clinics; working as fellows or residents; carrying out continuing education courses; or participating in groundbreaking research.
A central point of contact
As previously mentioned, clinical care is the most visible aspect of family medicine. But what type of care does this team provide, exactly?
“We try to take care of patients over the whole course of their lives, from cradle to grave,” said David Serlin, M.D., who heads outpatient operations for the department. “That means we serve as the central point of contact with patients to assist with all of their health care needs.”
Physicians help patients manage chronic conditions such as birth defects and other disabilities, heart burn, diabetes, depression, anxiety and heart disease, along with acute injuries and illnesses. The team also offers geriatric and palliative care.
“Many of these chronic conditions have aspects that patients deal with every day, and our team can help them with that,” Serlin said. Often, that means discussing diet, exercise and lifestyle changes that can help prevent poor health outcomes.
“If more severe problems do flare up, we can refer them to a specialist here at Michigan Medicine,” Serlin added. “By using this model, we keep specialists available to treat the most severe conditions and better help our patients.”
Family physicians also treat pregnant women and offer both pre- and post-natal care and deliver babies.
“Think about how seamless that can be for our patients,” Serlin said. “They are seen by a family physician for prenatal care, who can then deliver their child. After birth, that same doctor will check up on the mother and provide care to the baby and entire family as they grow older.”
When family medicine patients are admitted to the hospital for any number of reasons, they can also be seen on the inpatient side by their physicians.
“We have two inpatient services, one at St. Joseph Mercy Chelsea and one at University Hospital,” said William Chavey, M.D., M.S., leader of the inpatient side of family medicine. “Hospitalized patients who we see in the outpatient setting and who do not need to be in an ICU or treated by a subspecialist will be seen by family physicians.”
Reaching out in the community
For family medicine, it’s all about meeting patients where they are — in both the inpatient and outpatient setting. Ambulatory family medicine services are offered at six clinical sites across the region, two in Ann Arbor and one each in Chelsea, Livonia, Dexter and Ypsilanti.
On top of that, certain clinics reach out to certain populations.
“We have a Japanese Family Health Program that takes care of the Japanese population and a Latino health clinic, Programa de Salud Familiar, that serves that specific community,” Serlin said. “In Dexter, we also have the Deaf Health Clinic so that those who are Deaf or have hearing loss can get the care they need.”
Family medicine also created the first food pantry at Michigan Medicine to aid patients for whom food insecurity is an obstacle to health and well-being and faculty, residents partner with local school districts to help provide health care with the Regional Alliance for Healthy Schools and care for underserved patients volunteering at the Corner Health Center and Hope Clinic.
Indeed, the department is committed to advancing diversity, equity and inclusion (DEI) for patients, learners, faculty, staff and the community. That vison is part of the department’s strategic plan.
“In the clinical arena we staff the Luke Clinic in Detroit, providing pregnancy care, including delivery on our Family-Mother-Baby service, and newborn care to at risk mothers and their children,” said Ebony Parker-Featherstone, M.D., director of diversity, equity and inclusion for family medicine. “We are also active in education by holding a health-equity quality conference that provides a whole-patient review and we have faculty who help lead the institution’s efforts on inclusive teaching on the principles of health equity and justice.”
Finally, the team held departmentwide anti-racism training in 2020, and the research areas are part of the Population Health Assessment Engine (PHATE) pilot which looks to incorporate data into clinical practice to inform care, launched the Anti-Racism and Health Equity Program (AREP) which seeks to promote health equity through anti-racist research and research practices, and leads efforts toward inclusion in accessibility through the MDisability program.
Training current and future generations
On top of the DEI training efforts, family medicine team members impact both the current generation of health care professionals and the next in a myriad of ways. For instance, medical students rotate through the department, and there is a robust residency program, fellowships and continuing medical education courses.
“The unique thing about our residency program is that our residents become primary care physicians for specific patients throughout their three years at Michigan Medicine,” said Eric Skye, M.D., associate chair for education. “They’ll be assigned to a patient in Year 1 and follow them all three years.”
The program is open to 13 residents a year who are divided into two sites, one at the Chelsea Health Center and the other at the Ypsilanti Health Center. Twelve of the residents are on a traditional path, while one is on a Spanish-language path to help develop culturally-competent physicians. The department also runs a sports medicine fellowship and five graduate medical education fellowships, while three other fellowships at Michigan Medicine may involve family medicine physicians, but are housed in other areas.
Finally, three major CME programs are carried out by family medicine, two held in Ann Arbor and one in Northern Michigan, and the team offers faculty development courses.
“Whether you go through our residencies, fellowships, CME trainings or even faculty development courses, we take pride in developing highly-competent primary care doctors,” Skye said. “They can take the skills they learn here and bring them back with them to communities across the country.”
Putting research into practice
Nearly two dozen faculty members focus more of their efforts on research rather than patient care. That research often takes the form of investigating the most effective ways to treat common conditions.
“For example, we know that diet and exercise can help lessen the risks and dangers of heart disease,” said Caroline Richardson, M.D., the Dr. Max and Buena Lichter Research Professor of Family Medicine and the associate chair for research programs. “But what are the most effective ways to get patients to actually adopt these changes? That’s the type of research we perform.”
The team also looks at best practices when it comes to clinical care and how clinicians can better build alliances with patients to ensure changes stick.
“Oftentimes strategies are out there, but we look for ways to implement those strategies on a large scale,” Richardson said.
The department’s research side now serves as an industry leader. Richardson, for instance, is the editor-in-chief of the Annals of Family Medicine, the top primary care research journal in the world.
“The work we do here at Michigan Medicine can make an impact on all of our patients here at home but also for millions of others across the globe,” Richardson said. “And no matter what role you play in our department — that’s incredibly exciting.”
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