The Duke Family Medicine Center

The Duke Family Medicine Center [FMC] is a practice that was established more than 30 years ago. We serve as the medical home for more than 13,500 patients or approximately 7% of the population of the city of Durham. We offer easy access, one-stop care for people of all ages.

The demographics of the practice are important as the practice is exceptionally diverse and well balanced. The diversity is an asset that many teaching practices do not enjoy. The age mix is 15% under the age of 18 and 13% over the age of 65. The practice stays young as we have about 120 prenatal patients per year. The gender mix in the practice reflects the large number of female providers: 65% female and 35% male. This mix also reflects the fact that women use health services more often then men. Our practice is ethnically diverse with 46% African American, 41% white, 3% Asian and the remainder unknown. We estimate the Latino population to be about 6%. Conversational Spanish is an asset in the practice.

The payor mix of the practice is also diverse. We have a practice population that is 20% Medicaid, 12% Medicare, 40% managed care [Duke Select], 20% BCBS and the remainder are other carriers such as Aetna, Cigna, United Healthcare, etc. We care for professors and high level administrators as well as indigent patients.

Our services are provided in teams of medical professionals that include faculty physicians, physician assistants, nurse practitioners, resident physicians, nurses, pharmacists, social workers, psychologist, and registered dieticians. We have 3 continuity teams that include faculty, residents, mid-level providers, and nursing staff. These teams provide the continuity care including acute, preventive and chronic disease care. We also have teams that focus on prenatal care, diabetes, hypertension and COPD from a systems and practice-wide perspective.

The chronic disease populations that we care for are significant in number. We care for 4,200 hypertension patients, 1,500 diabetics, 1,500 asthmatics, 350 COPD patients, 1,800 depressed patients and 250 congestive heart failure patients. We use the Wagner model of chronic disease care. Our QI system and clinical metrics largely focus on these diseases to assess care within the practice.

We provide a wide range of services to our practice population including:

  • Health maintenance exams for all ages
  • Women's health including endometrial biopsy, IUDs, colposcopy and LEEP
  • Prenatal and postpartum care
  • Sports medicine including joint injection
  • Minor surgery including elliptical excisions, punch and shave biopsies, and cryotherapy for moles, cysts, and other dermatologic lesions
  • Dental varnishing
  • Nutrition counseling
  • Coumadin clinic
  • Lab and radiology services
  • Acupuncture
  • Educational programs for diabetes, asthma and pregnancy
  • Psychological counseling

The practice has 32 exam rooms including 2 procedure rooms, and areas for group as well as individual patient care visits. Residents are always given 2 exam rooms and often 3 rooms to see patients. Over the 3 years of training residents will become increasingly efficient in their ambulatory care and will graduate being able to see at least 10-12 patients per session.

All exam rooms have a computer terminal and immediate access to the patient's medical record electronically. Lab results can be trended and x-rays digitally reviewed in the exam room with the patient. Consultant reports, surgery summaries, pathology and cytology reports are readily available. We are not quite 'paperless' but we are well on the way to that goal.

Our practice is a true medical home for patients. We enjoy a reputation of providing high quality, ever improving care to our practice. Our quality improvement program has been functioning for over 10 years, and we now track over 30 clinical and administrative metrics as we manage the practice. In an effort to remove the 'black box' secrecy around quality improvement, we now post our metrics in the waiting room for patients to review.

The development of an ambulatory specialist trained to enter practice 5 years from now requires resources from around the health system. The FMC is the center and focal point of that experience.