Montana Family Medicine Residency
The Coastal Research Group
Sixteenth National Conference on
Primary Health Care Access
April 10-12, 2005
The Eleventh J. Jerry Rodos Lecture:
Roxanne Fahrenwald, M.D., Director, Montana Family Medicine Residency:
“The man who says it cannot be done should not interrupt the man doingit.” Chinese proverb
http://www.coastalresearch.org/
Montana Family Medicine Residency:
http://www.aafp.org/residencies/240050001.html
Comment: For those of us frustrated with the relative lack of progress in our attempts at reforming health care, it is refreshing to hear an inspiring story for a change.
Very briefly, Dr. Fahrenwald reported on the successes in the past decade of the Montana Family Medicine Residency program. The program emphasizes equitable health care, including not only the insured but those without coverage or the resources to pay for care, and including those with access problems due to the rural distribution of a significant portion of the population. Training and services in mental health have been added to the program, not only because of current needs in Montana, but also to prepare family medicine physicians for their important role in improving mental health equity. The program ensures competencies in other clinical services, such as obstetrics, essential for rural communities without ready access to urban medical centers.
Quite gratifying is the fact that most of the physicians from this program go to regions where their services are needed, with many of them going to rural areas of Montana. Thus they are strengthening the primary care infrastructure that promotes quality improvement in a cost effective manner.
One concern is that the residency program has access to various funds that are not available to those in private practice. It can be very difficult for those physicians supporting health care equity if they cannot meet their expenses due to expanding problems with uninsurance and underinsurance. So we still need to establish equity in health care funding.
Which brings us back to the quote. We should not be deterred by those who say that comprehensive reform cannot be accomplished because it’s not politically feasible, even if such reform does make sense. We should ignore distracting interruptions as we move on with our task of establishing an equitable system of public financing of health care.
Dr. Fahrenwald recognized what she had to do and just did it. So can we. But, actually, we really do need the support of those who believe that reform makes sense. Maybe, instead, when they “interrupt” us, we should transform that encounter into an opportunity to include them in the process. With all of us working together, we can do it. By adhering to established principles of health policy science, all we have to gain is affordable, comprehensive, high quality care for everyone.