December 1, 1996
"Remember Marcus Welby?" asks James Corrigan, dean of the School of Medicine, conjuring an image of the kindly general medical practitioner and icon of 1970s television. "Well, Tulane hasn't been turning out many of these kinds of doctors. We've been turning out excellent internists, hematologists and specialists of all kinds, but not many primary care people."
In October, the medical center's board of governors approved a plan to graduate more "Dr. Welbys" through a new Department of Family and Community Medicine at the medical school. With the new department, Tulane is joining a national movement to educate more primary care physicians, Corrigan says. In a report earlier this year from the Institute of Medicine, a committee headed by former medical center chancellor Neal Vanselow said that changes in the organization and financing of healthcare are forcing a shift away from specialists and toward primary care physicians who can diagnose and treat a wide range of health problems.
The report listed family medicine, general internal medicine and general pediatrics as primary care fields. "Our students currently get excellent training in pediatrics and internal medicine, but not in family practice," Corrigan says. "This new department builds on our primary care base." A family medicine physician three decades ago would have been thought of as a general practitioner, or a "Jack-of-all-trades," according to Corrigan.
"A general practitioner in the old days really had limited training because there wasn't a heck of a lot of training to get," he says. "On the other hand, family practice today is at the point where physicians are very good at general medicine, general pediatrics and obstetrics. Most of them also do minor surgery and minor orthopedic procedures." Family practice physicians became a rare breed in the last few decades with the rise in specialty medical practice, he adds. "We got used to the fact that there weren't many primary care doctors around," Corrigan says, "so we when we got a stuffed nose and clogged sinuses, we automatically went to the ear, nose and throat doctor rather than our primary care doctor, who could have taken care of it under most circumstances."
The changing healthcare environment has resurrected the family medicine practitioner--a physician who can address the majority of healthcare needs of children and adults, who practices in the community and who keeps in regular, continuous contact with patients. "Historically, Tulane has been a tertiary care medical facility, meaning that we were noted for and did quite well in specialty medicine," Corrigan says. "When I came here as vice dean in 1990, the attitude started to change."
Corrigan became dean of the medical school in 1994 and in the summer of 1995 formed a committee to evaluate the possibility of developing a family medicine department. The committee found that faculty members and students were interested in the program and spoke with representatives of Columbia/HCA, the company that formed a partnership with Tulane in early 1995 to run the hospital and clinic. Columbia/HCA agreed to contribute part of the cost of running the department--approximately $2 million for the first three years, Corrigan says.
The committee also recommended combining family medicine with the school's program in community medicine, a 20-year-old program that, among other things, exposes medical students to working in a community-based primary care setting such as the St. Thomas Health Clinic. Corrigan says that the new department will add three more faculty positions to the school. The first step is finding a chair for the department, and Jules Puschett, professor and chair of the Department of Medicine, is heading the search committee. Corrigan estimates that the new chair will be on board by the next academic year.
The chair will set up a family medicine practice where medical students can train during their junior and senior years of clerkship rotations, Corrigan says. Although the department's academic office will probably reside in the Primary Care Center on the downtown campus, the Central Business District isn't a likely location for the clinic, Corrigan adds. "The rule of medicine is to go where the patients are and primary care patients don't really like to come downtown for their flu shot or to get their annual physical," he says. "In fact, the clinic doesn't have to be in New Orleans. One of our most popular training areas is in Pineville, where students train in obstetrics."
The department will also offer a residency program for students after their undergraduate medical education. "Down the road, the new department will mean we have more emphasis on primary care, which is what medical schools are trying to do right now," Corrigan says. "Primary care physicians aren't transplant gurus and they aren't the people you see on E.R., but it's a very good, reasonable lifestyle, and people who are in that practice like it a lot."
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