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ⅷ Objective To determine the extent to which current changes in the American health care system might adversely effect the willingness of community physicians to volunteer to teach medical students. ⅷ Design Surveys in the form of 2 mailings were sent to 466 physicians in the Pacific Northwest who volunteer to teach first-and second-year medical students. The physicians were categorized into medical specialty or primary care, urban or rural location, and type of practice. ⅷ Participants A total of 333 physicians completed the surveys on which responses were analyzed. ⅷ Results Respondents noted that clinical and nonclinical workloads had increased (n=211 [63%] and n=276 [83%], respectively) in the past 5 years. One hundred eighty-six respondents (56%) said that they had less time for teaching medical students. Forty-five physicians (14%) indicated that they had discontinued their volunteer teaching activities altogether. During the past 5 years, solo practitioners had the lowest dropout rate (7% [4/57]), and physicians at health maintenance organizations had the highest (23% [7/30]). Primary care physicians were more likely to indicate that they had decreased time for each patient encounter (P=0.006). ⅷ Conclusions Increasing nonclinical workload demands and higher patient loads are a substantial threat to the recruitment and retention of volunteer faculty. In particular, the involvement of urban, HMO, and primary care physicians may decrease disproportionately in the future.Medical schools have long relied on volunteer clinical faculty to assist in teaching medical students. 1 Community physician preceptors are often recruited to help teach basic physical examination and history-taking skills to medical students and to provide early exposure to clinical practice for students in their preclinical years. As medical education continues to move from the tertiary care teaching hospital to the ambulatory care setting, 2,3 such preceptors will be called on even more to provide educational experiences. However, even as medical schools are becoming more dependent on volunteer clinical faculty, these faculty are experiencing increasing demand for their skills and time. [4][5][6][7] Many fear that the current trend in medicine for increased productivity and the growing pressure of nonclinical responsibilities may begin to hinder community physician involvement in medical education. Skeff and colleagues 8 theorized that if current pressures for clinical productivity continue, academic institutions will survive financially, but the educational experience may suffer. They described a possible "national tragedy" in which physicians are no longer able to continue the medical tradition of passing on what they have learned. The University of Washington School of Medicine, Seattle, depends heavily on volunteer physician faculty and shares this concern. Although an accurate historical dropout rate is not known, the staff coordinators of the preclinical programs included in this study noted that the dropout rate among our ...

Cooperative health care clinics (CHCCs), or shared medical appointments, are a healthcare innovation that can improve access and expand physicians' capacity to manage common geriatric conditions. This report describes a pilot program and working model for extending CHCCs to patients with dementia. Three cooperative dementia care clinics (CDCCs) met monthly for up to 1 year, drawing participants from a dementia clinic roster of patients and caregivers who had required continued specialty care for at least 3 months. Twenty-six of 33 eligible patient-caregiver dyads expressed interest, and 21 enrolled; five whose clinical status changed during the year withdrew and were replaced with new members. Brief introductory socialization, individualized clinical management, and an educational focus selected from problems of patients and caregivers were common to all sessions. Most participants required several types of clinical intervention and educational support. One group ended after reaching a natural termination point, and two others are ongoing at the request of participants. CDCCs can be a viable approach to increasing dementia care capacity in health systems. Formal service intervention trials to evaluate the generalizability and comparative effectiveness and economic viability of this model versus usual care are an appropriate next step.