Response: Re: Trends in Physician House Calls to Medicare Beneficiaries

To the Editor: As a relatively recent family medicine residency graduate, I experienced firsthand how the Accreditation Council for Graduate Medical Education's (ACGME) requirement of 2 house calls was usually fulfilled. I and most of my fellow residents made our house calls late in our third year, and the training consisted of being told where the “house call bag” was and to make sure we documented the visit. This was certainly not sufficient preparation for incorporating house calls into practice but rather “checking the box” so as to not incur ACGME citations. I agree with the author that a national house call curriculum for family medicine residencies would be a wonderful resource. There seemed to be momentum for strengthening geriatric training in family medicine when, 10 years ago, Family Medicine published 4 articles on the state of geriatrics training.^1⇓⇓–4 Overall conclusions from these studies were that the Residency Review Committee's downgrading of geriatrics training requirements from “must” to “should” were met with the expected responses of deemphasizing geriatrics education. Barriers to geriatric education, not to mention house calls, include limited geriatric faculty and competing curricular demands.

Others have commented on the contrast between strict obstetrical educational requirements in residency, despite few graduates providing this service after graduation, and loose geriatric requirements despite the fact that nearly all graduates will care for the elderly.³ This holds true today; my own preliminary analyses of nearly 8000 physicians' responses to the practice demographic survey completed during registration for the American Board of Family medicine 2013 spring recertification examination found that 21.8% provided home visits, 91.8% saw patients older than 75 years of age, and 9.1% performed obstetrical deliveries.

The need for house calls will only increase in the future because of a growing population of elderly patients with multiple chronic conditions. But elderly patients are not the only population that may benefit from house calls. Small numbers of pediatric residencies are creating house call curricula to address the chronic care needs of children and to better understand the needs of patients.⁵

I agree with the author that family medicine residents should be taught the skills to provide effective house calls. The Society of Teachers of Family Medicine's Group on Geriatrics, who could champion and create a national house call curriculum, is the ideal group to take the lead on this issue.