By Lt. Kevin Bernstein, M.D., M.M.S., Family Medicine Resident at Naval Hospital Pensacola, Fla.
Medical residency years- three crucial, challenging, yet completely rewarding years of medical education. As I begin the first of my residency years, it is difficult to personally quantify how demanding this year is going to be. I find it reassuring, however, to be a part of an excellent family medicine residency program in the U.S. Navy, where primary care is understood, valued and appreciated.
It is refreshing to be a part of an environment that believes primary care is the central part and foundation of health care delivery to its patients. I believe that the civilian world does not value primary care as much as it should or could. The system is fragmented and heavily reliant on sub-specialty-driven procedural services. It rewards medical interventions to stop diseases from progressing rather than preventing their causes. Because of this, many institutions that support residency programs through graduate medical education (GME) funding have little incentive to expand training for primary care. This puts many primary care training programs at risk for extinction, a very volatile environment to train future family physicians and a very risky environment to commit to when choosing medical training options. When looking at all of these risk factors, training and practicing family medicine in the Navy was one of the easiest decisions I ever made.
I learned how much primary care is valued in the Navy after several short weeks at my family medicine residency at Naval Hospital Pensacola, Fla. Right at the start, I felt welcomed into my Medical Home Port team (shout out to the Blue Team). Practicing in the Medical Home Port (the Navy’s version of the patient- and family-centered medical home model of primary care delivery) allows all members of our team to collaborate and coordinate care to our patients while practicing medicine to the fullest extent of our licenses. As a new family medicine resident I find this very exciting, especially after dedicating so many years to pre-medical and medical education! It also makes a lot of sense – everybody on the team has trained very hard in their respective disciplines and has so much to offer.
This is not to say that there are no civilian programs that provide adequate training in evidence-based medicine (EBM) and preventive medicine within the patient- and family-centered medical home model. There are some that do this very well. However, in the spirit of the federal government’s proposed budget cuts (including a large portion of GME funding), primary care remains scattered in our fragmented system – valued in some regions and undervalued in others.
The Navy’s dedication to primary care, however, is uniform and central to its overall mission. We practice preventive EBM rather than reactive and defensive medicine. As a former civilian medical student, this is something I have never had the chance to see in action before. It is a beautiful thing.
I am looking forward to the next few years of family medicine residency training as well as the many years to follow as a family physician in the Navy. As a new contributor to Navy Medicine Live, I am excited to share my experiences while training in the Medical Home Port as well as focusing on the Navy’s efforts in preventive health and primary care.