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


• 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


Primary Care and the Rural Physician Workforce


Rural Oklahoma2009


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)


• 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


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.


Challenges: Declining Interest in Primary Care

• Distribution of Population & Primary Care Physicians in Oklahoma, 2007


Challenges for Primary Care:

• Declining interest• Location, location, location• Debt• Aging workforce• Compensation


OSU CHS College of Osteopathic Medicine:

The Rural Primary Care Focus


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?


OSU Rural Medical EducationOSU Rural Medical Education


Encouraging Rural & Primary Care PracticeOsteopathic Residency and Internship Programs, 2008


Medical Center of Southeastern OklahomaDurant, Oklahoma



Tahlequah City Hospital

&W.W. HastingsIndian Hospital

Tahlequah, Oklahoma


OSU Medical Center &

OSU Health Care Center

Tulsa, Oklahoma


OSU CHS College of Osteopathic Medicine

The Rural and Urban Primary Care Focus



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


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


Comments about Primary Care Gender and Generation


“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


• 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


• 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




• 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




• 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 Conflict


Primary Care Physicians


Specialty Choice by Gender


Specialty Choice by Gender


• 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


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



•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


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…


Staff Contact InformationWilliam Pettit, D.O.

Associate Dean & Associate Professor of

Family Medicine918.584.4379

[email protected]

Val Schott, M.P.H.Director,

Rural Policy & Advocacy

[email protected]

u

C. Michael Ogle, D.O.Director,

OSU Physicians Rural Clinic Svcs.

[email protected]

Jeff Hackler, M.B.A.,

J.D. Director,

Rural Grants & Research

[email protected]

du

Vicky Pace, M.Ed.Director,

Rural Medical Education

[email protected]

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

[email protected]

Corie Kaiser, M.S.Asst. Director,

State Office of Rural Health

[email protected]

du

Toni HartProgram Coordinator

[email protected]

Morgan

FarquharsonClinical Coordinator

[email protected]

Matt JaneyProgram Coordinator

[email protected]

Rod HargraveFLEX Program Coordinator

405.840.6506 rod.hargrave@okstate

.edu

Jan BarberAdmin. Coordinator

[email protected]

u

Sherry EastmanProgram Specialist

918.584.4375sherry.eastman@oksta

te.edu

Stacy HuckabyAdministrative

Assistant918.582.1989

[email protected]

Billie BowmanAdministrative Assistant

[email protected]

Debra BlackAdministrative

Assistant918.584.4387

[email protected]

Augelica Burrell,

M.H.RSW Regional Coordinator

(Lawton)918.401.0073

[email protected]

Alexandra Bryant NE Regional Coordinator(Tahlequah)

[email protected]

du

Kelly DavieNW Regional Coordinator

(Enid) 918.401.0274

[email protected]

Kelby OwensSE Regional Coordinator

(Durant) 918.401.0273

[email protected]


Contact Information…

Lora Cotton, D.O.OSU PhysiciansDepartment of Family Medicine2345 Southwest BoulevardTulsa, OK 74107-2705Phone 918.561.8395Fax [email protected]

Teaching Health Centers: Clinical Workforce

Documents

rural oklahoma

rural primary care focus

primary care source

primary care providers

contribution of primary

primary care collaborative

osu rural medical education

osu center