Teaching Health Centers: Clinical Workforce

© 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

© 2010 Oklahoma State University

Primary Care and the Rural Physician Workforce

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Rural Oklahoma2009

© 2010 Oklahoma State University

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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© 2010 Oklahoma State University

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

© 2010 Oklahoma State University

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

© 2010 Oklahoma State University

• 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

© 2010 Oklahoma State University

• 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

© 2010 Oklahoma State University

• 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

© 2010 Oklahoma State University

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

william.j.pettit@okstate.edu

Val Schott, M.P.H.Director,

Rural Policy & Advocacy

405.840.6500val.schott@okstate.ed

u

C. Michael Ogle, D.O.Director,

OSU Physicians Rural Clinic Svcs.

580.977.5000rockino@hotmail.com

Jeff Hackler, M.B.A.,

J.D. Director,

Rural Grants & Research

918.584.4611jeff.hackler@okstate.e

du

Vicky Pace, M.Ed.Director,

Rural Medical Education

918.584.4332vicky.pace@okstate.ed

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 denna.wheeler@okstate.ed

u918.584.4323

Chad Landgraf,

M.S.GIS Specialist918.584.4376

chad.landgraf@okstate.edu

Corie Kaiser, M.S.Asst. Director,

State Office of Rural Health

405.840.6505corie.kaiser@okstate.e

du

Toni HartProgram Coordinator

918.584.4368toni.hart@okstate.edu

Morgan

FarquharsonClinical Coordinator

918.584.1989morganf@okstate.edu

Matt JaneyProgram Coordinator

918.584.4377matt.janey@okstate.edu

Rod HargraveFLEX Program Coordinator

405.840.6506 rod.hargrave@okstate

.edu

Jan BarberAdmin. Coordinator

918.584.4360jan.barber@okstate.ed

u

Sherry EastmanProgram Specialist

918.584.4375sherry.eastman@oksta

te.edu

Stacy HuckabyAdministrative

Assistant918.582.1989

staci.stewart@okstate.edu

Billie BowmanAdministrative Assistant

405.840.6502billie.bowman@okstate.edu

Debra BlackAdministrative

Assistant918.584.4387

debra.black@okstate.edu

Augelica Burrell,

M.H.RSW Regional Coordinator

(Lawton)918.401.0073

augelica.burrell@okstate.edu

Alexandra Bryant NE Regional Coordinator(Tahlequah)

918.401.0074xan.bryant@okstate.e

du

Kelly DavieNW Regional Coordinator

(Enid) 918.401.0274

kelly.davie@okstate.edu

Kelby OwensSE Regional Coordinator

(Durant) 918.401.0273

kelby.owens@okstate.edu

© 2010 Oklahoma State University

Contact Information…

Lora Cotton, D.O.OSU PhysiciansDepartment of Family Medicine2345 Southwest BoulevardTulsa, OK 74107-2705Phone 918.561.8395Fax 918.561.8525cotpay@okstate.edu