UNC Health Talk

Called to Service

Cristen Page saw two viable career paths for herself: seminary or medical school. She wanted to serve, to build relationships, to make a long-term impact on people’s lives.

“As a family physician, I’m deeply focused on the science of medicine and clinical care.”

“As a family physician, I’m deeply focused on the science of medicine and clinical care. But I also provide support and counsel to the families I work with. So in some ways I have combined the two paths,” Page said. “Being able to help people during these critical moments in their lives is a great blessing and tremendous privilege.”

There were two transformative experiences that helped guide her to medicine. The first came in high school, when Page lost her father to skin cancer.

“That experience showed me how physicians can make a difference in people’s lives, even, in our case, when the outcome was not good,” Page said.

The second came during her undergraduate experience at UNC. As the recipient of the prestigious Morehead Scholarship, Page had exposure to multiple summer service opportunities. She spent one summer working at a mission hospital in Zimbabwe.

“I saw missionary doctors who had committed their lives to making a difference, which had a huge impact on me,” Page said. “Throughout that summer, I was convinced medicine was what I was supposed to do with my life.”

She’s never wavered.

In April, Page was named Chair of the UNC Department of Family Medicine, where she oversees the department’s extensive clinical care infrastructure, excellence in primary care research, and top-ranked training programs for residents and medical students. In our latest Five Questions feature, Page discusses her motivations, goals, and thoughts on the future of the family physician.

What is the role of family medicine and primary care in the changing world of health care?

Primary care is as important as ever. The emphasis on value-based care has drawn health systems across the country to rediscover the fundamental need for primary care. There’s a recognition that we have to take care of populations with an emphasis on quality and cost. It takes a strong primary care base to do that. We know that we need to shift the care of our patients from hospital-based care to more comprehensive, coordinated primary care to keep people healthy, in their homes, and out of the hospital.

“It’s what drew me to family medicine in the first place.”

But, as much as things are changing, the foundation of the discipline remains the same. It’s what drew me to family medicine in the first place. Family medicine, which is the cornerstone of primary care, is rooted in a commitment to service, a commitment to taking excellent care of all patients, with special attention to vulnerable patients, to being an advocate and building relationships with patients over the course of their lives.

How can UNC Family Medicine be a leader for change in the discipline?

First off, I’d say that we already are. We are well-known and recognized as one of the top departments in the nation. Part of what makes us unique is that in addition to the traditional department model, we are a statewide department. We have faculty partners across the state with whom we work and learn, which allows us to make a broad impact across the state. When I look at our faculty, I’m inspired. These are bright, talented people who are in this for the right reasons. With consistency and passion, they are willing to take the extra time with a patient, or to take the time to write a proposal for a new program or research study aimed at answering a critical question that matters to patients. It’s all rooted in making a difference.

“UNC Family Medicine is committed to action.”

UNC Family Medicine is committed to action. We know we don’t have all of the answers, but we are committed to being part of the solution. We have a data driven, results-oriented, and team-focused culture.

That attitude is evident in the transformation of our family medicine clinic here in Chapel Hill, which is shaping the future of primary care. We took into account the entire patient experience, from the moment they pull into the parking lot until they leave. The goal was to assess the typical patient experience and to redesign the care delivery to make the entire experience run as efficiently as possible. Patients are used to coming in, waiting, checking in, waiting, getting to a room, waiting. There’s a lot of wasted time with no value to the patient. What we did was make sure that when a patient comes in for an appointment, someone immediately takes them to their room. We can do the check-ins in the room, offer all their care, schedule their next appointment, all in that one room.

Since going to this model, our patient satisfaction scores are through the roof, higher than they have ever been. It’s not just this efficient process, though. Our care model is also extremely patient-centered. We have same day appointments and extended hours to meet patients’ needs. In addition to outreach to patients who are missing preventive services, every morning we track how many care gaps exist for patients who are scheduled for appointments that day, and plan in advance to close those gaps. If a patient is due for a mammogram or a vaccine, our medical assistant helps ensure the patient receives that vaccine or appointment within the visit. We have a coordinated team – behavioral health specialists, psychiatrists, social workers, sports medicine, physical therapy – coming together to offer care. It’s a high-quality comprehensive experience at a low cost, and has been cited as the highest functioning primary care teaching clinic in the nation. We are looking now at opportunities to further develop our model and continue to spread it nationally.

What do medical students need to learn now that their predecessors did not? What lessons remain vital?

Our students need a strong emphasis on considering the bigger picture of how an individual patient fits into the larger health care system and how their health fits into the context of their lives. We need to teach our students to help patients navigate a complex, ever-changing environment. Incorporating and learning to improve the social determinants of health is critical.

Part of that is changing medical rotation from the old block rotations to give medical students real responsibilities and real opportunities to build relationships with patients longitudinally.

For example, it’s important for a student to be involved in the delivery of a baby, and then have the opportunity to see that same mother and baby in follow up. Experiences like that help students understand the nuances of supporting people over time. Did that antibiotic work? Were their side effects? Did the patient really understand the instructions they received? You understand those things when you have the chance to follow patients earlier in medical school.

“Most importantly, we have to teach students the skills needed to lead change.”

Most importantly, we have to teach students the skills needed to lead change. When you think about the pace of change in healthcare and how far we still have to go, we need all physicians to be adaptable to change, but also to guide us through change. Being a physician comes with great responsibility. Communities need their physicians to be leaders, and students need to realize they will be seen as leaders whether they recognize it in themselves or not.

With all of that in mind, we do need to continue to focus on the lessons that will always be important. I’d say those are: listen fully, do your best to connect with the patient in front of you, discipline yourself to give your utmost to do what is in the best interest of your patient, putting aside your personal needs or pressures for the moment, and never forget what a privilege it is to be present for people in times of need.

Two years ago you helped to launch the FIRST Program at the UNC School of Medicine. What’s the story behind the program, and how do you think it is going?

If you follow the evidence, it’s clear that linking medical school to the residency pipeline and into post-graduate practice is important for maximizing the likelihood that these outstanding students actually go out to serve in rural and underserved communities. It’s important for students to be surrounded by people who are focused on service and care deeply about primary care for vulnerable populations.

“They see the high standard of excellence our residents have. That shapes the students in a very positive way.”

The FIRST Program was something I dreamed up long before I actually had the skills or the resources to make it happen. But, a few years ago, the stars aligned, we got support from the School of Medicine, The Duke Endowment, Piedmont Health Services, the Office of Rural Health, and other great partners like the North Carolina Academy of Family Physicians Students in the FIRST Program benefit from an accelerated, but enhanced curriculum. They have the same number of curricular weeks as the students in the traditional four-year curriculum; they just do it in three years, along with some specific enhancements related to continuity of care. Then, if they do well, they match in our family medicine residency program. The connection with the residency program has been outstanding. The students are raised in our culture, and have mentors and role models a little closer to where they are in their training. They see the high standard of excellence our residents have. That shapes the students in a very positive way. We will then help match them into underserved practice in NC after residency with loan repayment.

We are really thrilled with how the program is progressing. The first group of students is finding that they are getting significantly more opportunities in their rotations, and their earlier patient care experiences are putting them ahead of the curve. The outcomes have been excellent. We are slated to expand the program to the Brody School of Medicine at East Carolina University in the coming year, and other medical schools have also expressed interest in replicating the model.

What’s next for the Department?

In this next chapter, we will continue to push for excellence. Our faculty will continue their work as national leaders in clinical care delivery, primary care research, innovation, and education. Our missions around population health and expanding comprehensive, complex care in the outpatient setting will be critical. We will focus on expanding our research around care delivery and transforming health care to meet patient needs.

“There’s a huge need for family doctors in this state and we must continue to be part of the solution.”

In the educational arena, we will continue to grow our pipeline. Of course, not every student will go into primary care. But for those that are interested, we need to capture them early. We have come up with some creative ways to do that, and we must continue and expand those efforts. There’s a huge need for family doctors in this state and we must continue to be part of the solution.