Spokane family physician Glen Stream, who sees patients part time at the Rockwood Valley Clinic, now plays a national role to promote his profession at a time when the number of such primary-care doctors is shrinking.

In September, Stream assumed a one-year term as president of the American Academy of Family Physicians. Based in Leawood, Kan., the organization represents more than 100,000 U.S. family physicians and medical students, and at its helm, Stream will advocate on behalf of those members, their patients, and health care issues.

"Surveys show most patients want a family doctor they identify with, they know, and they have faith and trust in, who can coordinate their care over time," Stream says. "We don't have enough family physicians."

The U.S. has about 353,000 primary-care doctors who are general practitioners, internists, pediatricians, and family physicians, a Wall Street Journal April 2010 article said. However, the Association of American Medical Colleges says the number of U.S. medical school graduates entering family medicine fell almost 27 percent between 2002 and 2007.

The American Academy of Family Physicians says the current work force needs to expand by at least 40,000 family physicians by 2020 to ensure health care access to all U.S. patients, and to meet the increasing medical service needs of an aging population. That equates to almost 4,500 new family physicians a year. For 2010, the academy's data for the number of training positions filled showed 2,476 new family medicine residents, or just over half of what's needed on an annual basis.

Stream says he sees a few main reasons for the decline in family physicians and in the number of medical students choosing that career. These factors include higher medical school debt, and the fact that primary-care physicians generally make less per year than medical specialists.

"Family doctors, once out in practice, they don't make as much money," Stream says. "It's a trend over the past few decades."

"$200,000 in debt for medical school is not unusual," he adds. "It's a barrier to entering family medicine, compared to entering a specialty that pays more money."

Stream also cites a general impression of medical specialists having more prestige, a factor that could influence medical students' career choices. While patients at times certainly need high-tech specialty care, he says, the role of a family or primary-care physician in providing coordinated, long-term care also is vital to keeping people healthy.

He adds, "Our health system values procedures over time spent with patients. I think that attitude is starting to shift."

There's also a commonly held perception that family physicians work harder and put in much longer hours, Stream says. While doctors in rural settings still face that challenge, family physicians in a team model of care with other health care professionals can experience more balanced workloads, he says.

In addition to seeing patients for two half days a week currently, Stream also is chief medical-information officer overseeing the electronic medical records system of Rockwood Clinic PS, the big Spokane-based doctors group now owned by Franklin, Tenn.-based Community Health Systems Inc. He's bringing that technology mindset into his new academy role, as well, being the first president to use Facebook and Twitter to communicate with the group's membership.

Mainly, Stream says his new leadership role is to work in support of family physicians and their patients, which will take him from talks with congressional members in Washington, D.C., to state chapter meetings. He has been a family physician for 26 years, including 20 of those with Rockwood Clinic in Spokane.

"I have patients in their 90s," Stream says. "The idea is to be able to care for the significant spectrum of care a person would need through their life. If we need to refer to a specialist, we do, and then we follow up."

Family medicine generally is defined as providing ongoing and comprehensive health care for the individual and family. The scope of family medicine encompasses all ages, both sexes, each organ system, and every disease entity.

"Family physicians are the specialists in the whole patient in the context of their entire family, and even their community," Stream says. "In some cases that care can be from childhood through the course of their entire lives."

"Most people who choose family medicine are interested in and enjoy that continuity relationship with people," he says. "It helps you take better care of that person because you really understand their personal values."

More practices and medical groups, as well as current health care reform initiatives, are promoting what's being called patient-centered medicine, a model of care that engages patients in their own care mostly in a family-physician or primary-care practice. The approach often uses electronic records and care coordination headed up by nurse, nurse practitioner, or designated health coach within the same practice.

"Some people think a family practice is about runny noses and ear infections," Stream says. In reality, he says, family physicians handle a wide range of medical procedures and play a crucial role in the patient-centered, preventive-care model.

"There's a large body of research that shows people are happier and health care costs are less if they have that model," he says. "A family physician or primary-care physician is a component of that in a team."

He adds, "In the past, the health care system has been visit-based."

As an example of the transition that's occurring, Stream says the Centers for Medicare and Medicaid Services recently launched an initiative to pay a monthly fee to primary-care practices for coordinating Medicare patient care. That ranges from helping patients with chronic diseases follow personalized care plans, to working with other doctors, including specialists, for better coordination. The fee will be in addition to the usual Medicare fees for Medicare-covered services.

Such primary-care incentive payments can help narrow the pay gap, Stream says.

He says another program that can help the profession grow is the National Health Service Corps. Upon graduation, scholarship recipients agree to serve as primary-care providers between two and four years in underserved areas, often a clinic in a rural setting, Stream says. Similar programs are offered through the Indian Health Service or the military.

The role of family doctor in a community often goes beyond the exam room, he adds. "I've been team doctor at football games. You go to the schools and talk about health issues. Family medicine isn't just the patient and family alone. It's involvement in the community as well."

Across its more than 100,000 members, the academy sees the same political diversity as seen nationally regarding health care reform, Stream says.

"Our approach now is the Affordable Care Act is the law of the land, so we want to engage in those pieces of the act that impact our membership," he says.

Those components include the patient-centered model approach, proposed incentives paying a Medicare bonus to primary-care physicians, and steps in the act toward Medicaid parity with Medicare payments through funding to states set to start in 2013. Stream says another part involves training more family physicians at federally qualified health care centers.

While he enjoys his own long-term relationships with patients, Stream says he sees his work in the technology administration and for the academy as equally important. "I see that as contributing to the care of a greater number of people than I can do individually," he says.

Stream graduated from the University of Washington with an undergraduate degree in microbiology, and then earned a medical degree from the University of Washington School of Medicine. He completed his family medicine residency at the Swedish Medical Center Family Medicine Residency program, also in Seattle.

Stream's wife, Anne Montgomery, is a family physician and clinical professor at Family Medicine Spokane. Next May, he will install her as president of the state chapter of the academy. The couple has two sons.