teaching health centers: clinical workforce
TRANSCRIPT
© 2010 Oklahoma State University
Teaching Health Centers: Clinical Workforce
Oklahoma Primary Care Association
October 22, 2010
Oklahoma State UniversityCenter for Health Sciences
Tulsa, Oklahoma
William J. Pettit, D.O.Associate Dean for Rural Health
Lora D. Cotton, D.O.Assistant Professor of Family Medicine
Associate Program Director, Family Medicine Residency
© 2010 Oklahoma State University
• Brief summary: Primary Care and the Rural Physicians’ Workforce
• OSU CHS – COM– Rural Medical Education at OSU CHS– Residency Training in Primary Care OSU CHS
• THC– Current Information from HRSA (8/31/10)
Content Outline
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Primary Care and the Rural Physician Workforce
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Rural Oklahoma2009
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Selected Socioeconomic & Demographic Comparison of Rural
and Urban OklahomaRural Urban Mixed Oklahoma
White 76% 71% 82% 74%
Black 4% 12% 3% 7%
Native American 11% 4% 6% 8%
Hispanic 4% 7% 3% 5%
Other 5% 6% 6% 6%
% of Population 65+ Years Old 15% 11% 11% 13%
Average Median Age (years) 38.2 32.7 36.3 37.8
% of Population Living in Poverty 17% 13% 10% 15%
Average Median Household Income $28,856 $37,247 $38,882 $29,943
% of Population without a High SchoolDiploma or G.E.D. 23% 16% 18% 19%
Data Source: U.S. Census Bureau (2000)
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• Persistent need for primary care providers and other healthcare professionals.
• Shortage of medical sub-specialties.
• Existing medical sub-specialties must cover large geographic areas.
• Patient transportation and access to care.
• Emergency medical services must also cover large geographic areas.
• Large population without health insurance coverage.
• Lower revenue base.
• Aging hospital facilities.
Problems Facing Rural Healthcare Delivery
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Why Focus on Primary Care?
“…a greater emphasis on primary care can be expected to lower the costs of care, improve health through access to more appropriate services, and reduce the inequities in the population’s health.” (pg. 458-459)
Source: Starfield, B., L. Shi, and J. Macinko. 2005. “Contribution of Primary Care to Health Systems and Health,” The Milbank Quarterly. 83(3): 457-502.
“Research studies in countries where patient-physician relationships focus on primary care consistently show that people live longer, populations are healthier, patients are more satisfied with their care and everyone pays less.”
Source: Patient Centered Primary Care Collaborative. Patient Centered Medical Home. 2009. Available at: (http://pcpcc.net/content/patient-centered-medical-home) Accessed 13 September 2009.
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Challenges: Declining Interest in Primary Care
• Distribution of Population & Primary Care Physicians in Oklahoma, 2007
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Challenges for Primary Care:
• Declining interest• Location, location, location• Debt• Aging workforce• Compensation
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OSU CHS College of Osteopathic Medicine:
The Rural Primary Care Focus
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HRSA Pre-doctoral Grant• Nature
Recruit From Rural Areas of Need
Community Campus with help from OkAHEC
• NurtureSTudent Osteopathic Rural Medical Club (STORM)
Early Clinical Experience: 1st & 2nd Years
Rural Health Elective Curriculum Option: 1st & 2nd Years
Rural Core Rotations: 3rd Year
Required Rural Rotations: 3rd and 4th Years
What has the OSU Center for Health Sciences Done?
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OSU Rural Medical EducationOSU Rural Medical Education
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Encouraging Rural & Primary Care PracticeOsteopathic Residency and Internship Programs, 2008
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Medical Center of Southeastern OklahomaDurant, Oklahoma
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Tahlequah City Hospital
&W.W. HastingsIndian Hospital
Tahlequah, Oklahoma
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OSU Medical Center &
OSU Health Care Center
Tulsa, Oklahoma
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OSU CHS College of Osteopathic Medicine
The Rural and Urban Primary Care Focus
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© 2010 Oklahoma State University
The Osteopathic Medical Education Consortium of Oklahoma (OMECO) is a consortium of eight partner institutions whose mission is to support and promote excellence in the continuum of osteopathic medical education in Oklahoma, Arkansas and Missouri.
There are currently 20 residency programs and 7 fellowship programs within OMECO.
Our Partner Institutions Include:
St. Anthony Hospital
OSU Health Care Center
Medical Center of Southeastern Oklahoma
Integris Southwest Medical Center
OSU Medical Center
University of Arkansas for Medical Sciences(AHEC – Pine Bluff)
OSU College of Medicine
Tahlequah City HospitalFreeman Health System INTEGRIS Bass Baptist
Health Center - Enid
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Internship/Residency Positions
• Anesthesiology
• Diagnostic Radiology
• Emergency Medicine
• Family Medicine affiliated with OSU-CHS
• General Surgery
• Internal Medicine
• Obstetrics/Gynecology
• Ophthalmology
• Orthopedic Surgery
• Otolaryngology/Facial Plastic Surgery
• Pediatrics
• AOA Universal Application
• Cardiology
• Interventional Cardiology
• Pulmonology
• Nephrology
• Gastroenterology
• Oncology
• Plastic and Reconstructive Surgery
Fellowships
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Comments about Primary Care Gender and Generation
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“Each generation imagines itself to be more intelligent than the one that went before it, and wiser than the one that comes after it.”
George Orwell
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• Traditionalists– Born between 1925 and 1945– Low-tech, high-touch physicians– Value professional loyalty and
commitment over personal ambition
– More often have solo practice or partnership
– Accepted and expected sacrifices to family life and leisure time
Generational Generalizations
Sources: Baum & Dowling, 2007; Phelan, 2010
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• Baby Boomers– Born between 1946 and 1964– Career committed but seek
lower personal cost– Highly autonomous, values over
rules, may not respect authority– Seek practice models that allow
the benefits of a group with independent control
Generational Generalizations
Sources: Baum & Dowling, 2007; Phelan, 2010
© 2010 Oklahoma State University
• Generation X (a.k.a. Gen Xers)– Born between 1964 and 1980– Seek positions that promote life-
work balance– Eager to use technology, high-
tech, low-touch physicians
Generational Generalizations
Sources: Baum & Dowling, 2007; Phelan, 2010
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• Millennials (a.k.a. Trophy Kids)– Born between 1982 and 2001– Team-oriented, civic-minded, tech savvy,
and self-confident– Prefer ROAD specialties that allow more
“controllable” lifestyle– Work to live rather than live to work– Willing to accept lower compensation for
lifestyle friendly positions
Generational Generalizations
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Generational Conflict
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Primary Care Physicians
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Specialty Choice by Gender
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Specialty Choice by Gender
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• Sanfey et al. (2006) surveyed 1365 students at nine US medical schools and concluded that gender and generation influence decisions to pursue a surgical specialty
– “I want to enjoy my career; however, I also want to enjoy my life outside my professional setting. That includes, for me, having adequate time to pursue outside interests”
– “I have my priorities straight, so I will make my life balanced whichever residency I pursue”
What about the Millennials?
Teaching Health Centers
Frederick Chen, MD, MPH
Bureau of Health Professions
Health Resources and Services Administration
U.S. Department of Health and Human Services
© 2010 Oklahoma State University
http://www.hrsa.gov/grants/apply/assistance/teachinghealthcenters/
Traditional GME Model
•Community
Training Site
•Community
Training Site
•Teaching Hospital/
Academic Health Center
(inpatient)
•Residency Program
•(continuity clinic)
•Medicare GME $
•Accreditation
Traditional GME Model
Traditional GME Model
•Community Training Sites•Community Training Sites
•Hospital/ AHC
•Hospital/ AHC
•Medicare GME $
•HRSA GME $
•Accreditation
•Teaching Health Center•Residen
cy
•CHC
THC Model
Summary• HC-trained physicians 3.4 times more likely to work in a HC (controlling for years from training, gender, FTE)
• 2.7 times more likely to work in underserved setting
• No difference in training preparation for practice, spectrum of practice, and practice satisfaction
What is a Teaching Health Center?
• “Community based, ambulatory patient care center”
• “Operates a primary care residency program”
• Specifically Includes– FQHC– Community mental health clinics– Rural health clinics– IHS or tribal health centers– Title X clinics
What is a Teaching Health Center?
• Primary care residency program includes
– Family medicine– Internal medicine– Pediatrics– Medicine-pediatrics– Obstetrics-gynecology– Psychiatry– General and pediatric dentistry– Geriatrics
Stressed:• First goal to expand existing Teaching Health Center – who are … “listed as sponsoring institution by the relevant accrediting body…”• Will be development for new• Guidance out at the end of December 2010
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Tulsa OfficeOSU Center for Health Sciences1111 West 17th StreetTulsa, OK 74107-1898 Phone: 918.584.4310Fax: 918.584.4391
Oklahoma City OfficeOne Western Plaza5500 North Western, Suite 278Oklahoma City, OK 73118 Phone: 405.840.6502 Fax: 405.842.9302
http://ruralhealth.okstate.edu
For Additional Information…
© 2010 Oklahoma State University
Staff Contact InformationWilliam Pettit, D.O.
Associate Dean & Associate Professor of
Family Medicine918.584.4379
Val Schott, M.P.H.Director,
Rural Policy & Advocacy
u
C. Michael Ogle, D.O.Director,
OSU Physicians Rural Clinic Svcs.
Jeff Hackler, M.B.A.,
J.D. Director,
Rural Grants & Research
du
Vicky Pace, M.Ed.Director,
Rural Medical Education
u
Richard Perry, M.A.Director, OkAHEC
918.584.4378richard.r.perry@okstat
e.edu
Stacey Knapp, D.O.Endowed Rural Health
Professor(Clinton)
2010-2012
Denna Wheeler, Ph.D.Research & Evaluation
Coordinator [email protected]
u918.584.4323
Chad Landgraf,
M.S.GIS Specialist918.584.4376
Corie Kaiser, M.S.Asst. Director,
State Office of Rural Health
du
Toni HartProgram Coordinator
Morgan
FarquharsonClinical Coordinator
Matt JaneyProgram Coordinator
Rod HargraveFLEX Program Coordinator
405.840.6506 rod.hargrave@okstate
.edu
Jan BarberAdmin. Coordinator
u
Sherry EastmanProgram Specialist
918.584.4375sherry.eastman@oksta
te.edu
Stacy HuckabyAdministrative
Assistant918.582.1989
Billie BowmanAdministrative Assistant
Debra BlackAdministrative
Assistant918.584.4387
Augelica Burrell,
M.H.RSW Regional Coordinator
(Lawton)918.401.0073
Alexandra Bryant NE Regional Coordinator(Tahlequah)
du
Kelly DavieNW Regional Coordinator
(Enid) 918.401.0274
Kelby OwensSE Regional Coordinator
(Durant) 918.401.0273
© 2010 Oklahoma State University
Contact Information…
Lora Cotton, D.O.OSU PhysiciansDepartment of Family Medicine2345 Southwest BoulevardTulsa, OK 74107-2705Phone 918.561.8395Fax [email protected]