Re: Trends in Physician House Calls to Medicare Beneficiaries

To the Editor: What stood out most in this important and informative article¹ was that while the number of home visits by physicians doubled between 2000 and 2006, family medicine (FM) physicians showed the smallest increase compared with other physicians. This is despite the fact that the top 5 billed diagnoses are conditions that are easily managed by FM physicians: hypertension, congestive heart failure, diabetes, COPD, and Alzheimer's disease. Moreover, physicians making home visits are growing older in age.

This suggests that although there is growing societal need for home visits, we are not educating a new generation of FM physicians to confidently practice in the patient's home. The Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME) requires FM residents to complete a mere 2 home visits during residency.² This is not a sufficient number to build competence, much less proficiency in anything. Moreover, it is currently not uncommon for residency programs to lack formal, structured instruction and training on home visits. An online search via Google and PubMed does not yield any articles mentioning home visit curricula for FM residents, except for a letter to the editor in Family Medicine from 2006³ and a mention in Canadian Family Physician dated from 1996.⁴

FM residents need to be deliberately and specifically taught the necessary skills to competently perform effective home visits so that they see the value of home visits and experience the satisfaction they can bring, both to the patients and the physician. They should be learning how to manage an interdisciplinary team to help take care of patients at home. A structured curriculum with clear learning objectives and direct experiences using a practical model should be part of FM residency. By making it a natural part of their training, FM residents will be able to incorporate them more efficiently and effectively after they graduate. More importantly, society will benefit from a multilayered social support system that enables patients, especially elderly ones, to live independently with an emphasis on maintaining a high quality of life.