These are challenging times for health care, with dramatic disparities in access to and outcomes of care, increasing numbers of individuals without health insurance and a reimbursement system with significant inequity in rewarding contributions to population health.

Family physicians have a critical role in providing personalized care, advocacy and pathfinding that patients need in the complex maze of health-care delivery. We also have the responsibility with our colleagues in other disciplines to restructure our processes of care to more effectively address lifestyle issues that contribute to a high prevalence of chronic disease, and to choose the full breadth of therapies that are in the best interests of our patients.

We are now on the brink of measuring quality as a routine part of the process of care, with electronic medical records. The Department of Family and Community Medicine at EVMS has provided leadership within the school in the transition to electronic record-keeping, as the pilot site for implementation and the first department to incorporate resident physicians in its use in ambulatory care, leading in the linkage of the electronic record with quality measurement and improvement.

Largely because of progress in our residencies, we are now a national demonstration site for our electronic record provider. Residents are part of this endeavor, as they work with faculty on progressive implementation of the system for optimal patient care, and to develop the most effective methods for training new residents to use and improve the system.

During this academic year, residents in the department will be part of implementing other aspects of the New Model of family medicine in addition to the electronic medical record, as envisioned in the Future of Family Medicine (FFM). These include new models for patient support and practice efficiency: the group prenatal visit and the group medical visit; and for communication with patients, the patient portal. Residents' quality improvement projects will help to point the way toward new ways of improving health outcomes for our patients. The FFM task force on education advocated flexibility in curriculum and scheduling for residency education, of which our 10-year-old, 4-year Combined Family Medicine/Internal Medicine residency program is a current model; our proposed 4-year Early Start (beginning in fourth year of medical school) FM residency program is another example.

The EVMS Department of Family and Community Medicine offers three distinctive residency programs, including the family medicine programs at Ghent and Portsmouth; and the Combined Family Medicine/Internal medicine program, for which the continuity patient site is Ghent. The programs share faculty resources, including overlap in their core curriculum didactic series and faculty expertise in areas such as the EHR, quality improvement, geriatrics, women's health, procedural skills, behavioral medicine, clinical pharmacy, community service-learning opportunities and multiple other FM content areas; and the family medicine obstetrics program at the Portsmouth Health Department and Maryview Medical Center. These shared strengths and the programs' unique approaches combine to produce exceptional educational options for candidates who want to prepare for leadership as competent and compassionate family physicians in the future of medicine.

Christine C. Matson, M.D.
Glenn R. Mitchell Chair,
EVMS Department of Family and Community Medicine
October 2006