Working for Healthy Communities since 1972

Why Train Health Professionals in Community Health Centers?

David N. Katz, MD

“Training more Country Doctors” Video:

http://www.youtube.com/watch?v=lBN-EB3wlf8&NR=1      

Most of us like to play the notes that we already know.

Sometimes, we can do more than we think…

What is the PRIME Program? VIDEO: http://www.youtube.com/watch?v=EABi6pdB3Hs       

Don Hilty, M.D.Don Hilty, M.D.Director, Rural-PRIMEDirector, Rural-PRIME

Suzanne Eidson-Ton, M.D./M.S.Suzanne Eidson-Ton, M.D./M.S.Co-Director, Rural-PRIMECo-Director, Rural-PRIME

UC Davis Rural-PRIME: Curriculum Plan

2011-

Rural Prime Curriculum Wheel

University of California-Davis School of Medicine (SOM)

Rural-PRIME Orientation

Rural-PRIME Seminar Healthy Communities and Comm’y EngagementHealth Care Leadership, Technology, Equity & Advocacy

Advising: 3 Meetings With Director/Co-director

Evaluation: 3 Focus Groups With Dr. Rainwater & Annual Survey

Center for Virtual Care Sessions: Phlebotomy, Labor & BLS

Doctoring 1Environmental Health

Agricultural Health

Rural-PRIME Doctoring Sessions- Rural cases, co-teachers & standardized patients

Rural Physician Preceptors 6-week Break

Early August 2nd week JanuaryMid December Mid May

Metabolism/

Reproduction/

Endocrinology,

Pathophysiology

Pharmacology

Human Structure/Function

Year 1

Doctoring 2

Population-based Health

Rural Cases, Co-teachers & Standardized Patients

Rural Physician Preceptors

USMLE1

Neuroscience

Systemic Pathology &Pharmacology

CardiologyPulmonaryNephrology

Musculo-Skeletal

GI

HematologyOncology

Late June Mid Sept Mid Nov Mid Dec End Feb

Rural-PRIMESeminars: Healthy Communities & Community Engagement, Health Care Leadership, Health Technology, Health Equity, Health Advocacy,

Rural California (optional this year)Center for Virtual Care Sessions

Evaluation: 3 Focus Groups With Dr. Rainwater & Annual SurveyAdvising: 3 Meetings With Director/Co-director

Year 2

Surgery Peds Ob/GYN Primary Care

Standard Clerkship (OR 4 wk RURAL & 4 wk regular)&Spec/Gen Inpatient

4 wk RURAL rotation &Inpatient/ University OB/GYN Rotation

8 wk RURALrotation &

Doctoring 3Topics: Epidemiology, Toxicology, Population-based Health, Economics of Medicine, Doctor- Patient Communication, Cultural Sensitivity, & Clinical ReasoningRural Cases, Co-teachers & Standardized Patients (with multi-site group via telemedicine)

ATLS–Advanced Trauma Life Support

ALSO–Advanced Life Support in Obstetrics

4 wk RURAL rotation &Inpatient, PICU, Oral Health, & Child Ab.

Standard Clerkship or 4 wk RURAL & 4 wk regular&Telepsych

P/NALS–Ped./NeonatalAdvanced Life Support

Standard Clerkship &Telemedicine Consults & Visits to Subspec’ties

Introduction to Master’s Options/Alternatives: Group & Individual Meetings With Director/Co-director & Visitors, Then Student Completes Applications, Obtains Letters & Notifies Rural-PRIME of Plans

Evaluation: 3 Focus Groups With Dr. Rainwater & Annual Survey

Year 3

Telemedicine Consults & Visits to Subspec’ties

Medicine Psychiatry

ACLS-Advanced Life Support

Masters/alternative MA: Public Health, Medical Informatics or Other OR Research (e.g. T-32) OR Fellowship Locale: UC Davis or Other

Seminar Present One Another’s Projects (if on-site) Advising On- or Off-site

Coursework Didactics: In-Person or Distance Education Clinical: Skills Seminars and Volunteering

Field work Data Collection Other

Year 4

Year 5

Clinical RotationRequired 4-week Rural Clinically-based Rotation: Rural Site or, Telemedicine to Rural Site or Other Approved Rotation

AdvisingMSPE (“Dean’s Letter”) AdviceResidency SelectionCareer Planning

Selective: Must Choose One or More of the FollowingDoctoring 4 Facilitator for Rural-PRIME groupRural-PRIME Medical Student Leadership LiaisonConvert School required 4-wk Special Study Module (SSM) or Scholarly Project (SPO) to Rural FocusCurriculum Development for Rural-PRIME Seminar (e.g., 6 wks)Community Engagement Project Demonstrating LeadershipOther 4-wk Didactic Credit (e.g., Medical Informatics, Telemedicine, Handheld Devices, Electronic Health Record)Or Other Activity, Agreed Upon by Student and Director/Co-director

EvaluationEvaluation: 3 Focus Groups With Dr. Rainwater & Annual Survey

From the Medical School• “Academic--Community Partnerships are the present and the

future.  In the past, academics shared what they thought was important.  Now, the best academics talk at length, and do needs assessments, for research and educational collaborations.  The focus of quality medical education has shifted from giving good ideas to students, to showing students clinical skills.  In the future, linking those skills to actual patient outcomes in the community will be necessary.” Donald Hilty, MD UC-Davis School of Medicine, Professor of Clinical Psychiatry

• ”I was hugely excited about starting a program that would generate health care providers for people in rural areas. There are different amenities in rural and urban areas but health care is a basic need and everyone should be able to access it. “

Sneha Patel, MA, Manager, Rural-PRIME and UC Merced San Joaquin Valley PRIME.

CommuniCare Health Centers is a private, non-profit, comprehensive health care organization serving the low income, uninsured, underinsured, and ethnically diverse population of Yolo County and surrounding areas.

But first…Who is CommuniCare?

History in Brief

• Founded by Dr. John H. Jones in 1972 as the Davis Free Clinic

• Expanded to include clinic sites in Woodland and West Sacramento in 1994.

• Moved the Davis Community Clinic site on DHS campus in 1997.

• Became a Federally Qualified Health Center in 2007.

CommuniCare Locations

Yolo County

CommuniCare Health Centers operates a total of five clinics, three of which are primary care clinics geographically dispersed throughout Yolo County.

Black3.0%Hispanic

60.0%

Asian 4.0%

Native American0.5%

Other2.0%

Unknown0.5%

White30.0%

White Black Hispanic Native American Asian Other Unknown

Ethnicity of our Patients

Now back to the Question: How? We say, “I’d like to share my experience with

medical students and residents…while providing quality care to my patients.”

But some days we feel like this…

vs

Is this our choice?

Why, then, is training medical students and residents important to our

Community Health Centers, despite the difficulties?

?

Residency Match, 2010% of graduating US medical % of graduating US medical

students students choosing specialtieschoosing specialties

3.0%6.0%

10.0% 11.0%

30.0%

0%

5%

10%

15%

20%

25%

30%

35%

GIM FamMed AnesRadPath Surg MedSpec

From Tom Bodenheimer, MDUCSF Department of Family Medicine

Race/Ethnicity of California Physicians

47%

70%

32%4%

11%20%

7%3%3% 3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Physicians Population

White Latino

AsianPI/Other African-American

Other

From Tom Bodenheimer, MDUCSF Department of Family Medicine

The National Health Manpower SHORTAGE

• The shortage is hitting community clinics

• 13% vacancies for family physicians in FQHCs, higher in rural areas (Rosenblatt, JAMA 2006;295:1062)

• When it hits a clinic, panel sizes go up, with fewer clinicians per patient

• This reduces access and quality, and increases clinician dissatisfaction

• As clinician dissatisfaction increases, fewer clinicians will come to FQHCs

• A death spiral could developFrom Tom Bodenheimer, MDUCSF Department of Family Medicine

From Tom Bodenheimer, MDUCSF Department of Family Medicine

PATIENT CENTERED MEDICAL HOME ? Will we have the Health Manpower to avoid

health system collapse?

VS

“To Teach or Not to Teach…That is the Question.” W. S’peare, M.D.

The Medical School’s perspective: Goal #1

Increase Diversity in our Future Healthcare Workforce

Increasing the diversity of health sciences faculty and students will:

Enrich the learning environment for all participants

Enhance the overall education and cultural competence of health professionals

Improve access to care for medically underserved groups and communities

Help reduce racial/ethnic health disparities

The Case for Diversity in Health Care

Education

From Cathryn L. Nation, MDAssociate Vice President-Health SciencesUC Office of the President

The Medical School’s perspective: Goal #2

Increase medical student buy-in to careers in rural primary care

Present the CHC as a Role model: student exposure to our successful

health care teams

The Medical School’s perspective: Goal #3

The Community Clinic Perspective: Goal #1

For Our Mission: to pass on our experience and skills to the next generation of safety net healers

(It can’t hurt med students who will become specialists, either.)

The Community Clinic Perspective: Goal #2

Recruitment and Retention of community clinic clinicians For the satisfaction and intellectual challenge of being

a teacher hiring our own students and residents

The Community Clinic Perspective: Goal #3

• Collaboration with the university medical center and medical school bears secondary fruits. For us: TelemedicineIncreased scope of care through training at

the medical center, which providers can use to improve patient care

HCV managementHIV managementPsychiatryOpthamology

Thank you!

Visit our website to learn more about us:

http://www.communicarehc.org

Questions?