Transcript Slide 1
Teaching Health Centers: Clinical Workforce Oklahoma Primary Care Association 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 Oklahoma State University Center for Health Sciences Tulsa, Oklahoma October 22, 2010 © 2010 Oklahoma State University Content Outline • 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) © 2010 Oklahoma State University Primary Care and the Rural Physician Workforce © 2010 Oklahoma State University Rural Oklahoma 2009 © 2010 Oklahoma State University Selected Socioeconomic & Demographic Comparison of Rural and Urban Oklahoma Rural 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% $28,856 $37,247 $38,882 $29,943 23% 16% 18% 19% Average Median Household Income % of Population without a High School Diploma or G.E.D. Data Source: U.S. Census Bureau (2000) © 2010 Oklahoma State University Problems Facing Rural Healthcare Delivery • 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. © 2010 Oklahoma State University 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. © 2010 Oklahoma State University Challenges: Declining Interest in Primary Care • Distribution of Population & Primary Care Physicians in Oklahoma, 2007 © 2010 Oklahoma State University Challenges for Primary Care: • • • • • Declining interest Location, location, location Debt Aging workforce Compensation © 2010 Oklahoma State University OSU CHS College of Osteopathic Medicine: The Rural Primary Care Focus © 2010 Oklahoma State University What has the OSU Center for Health Sciences Done? HRSA Pre-doctoral Grant • Nature Recruit From Rural Areas of Need Community Campus with help from OkAHEC • Nurture STudent 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 © 2010 Oklahoma State University OSU Rural Medical Education © 2010 Oklahoma State University Encouraging Rural & Primary Care Practice Osteopathic Residency and Internship Programs, 2008 © 2010 Oklahoma State University Medical Center of Southeastern Oklahoma Durant, Oklahoma © 2010 Oklahoma State University © 2010 Oklahoma State University Tahlequah City Hospital & W.W. Hastings Indian Hospital Tahlequah, Oklahoma © 2010 Oklahoma State University OSU Medical Center & OSU Health Care Center Tulsa, Oklahoma © 2010 Oklahoma State University OSU CHS College of Osteopathic Medicine The Rural and Urban Primary Care Focus © 2010 Oklahoma State University © 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 Medical Center of Southeastern Oklahoma Integris Southwest Medical Center OSU Health Care Center OSU College of Medicine OSU Medical Center Freeman Health System © 2010 Oklahoma State University University of Arkansas for Medical Sciences (AHEC – Pine Bluff) INTEGRIS Bass Baptist Health Center - Enid Tahlequah City Hospital Internship/Residency Positions Fellowships • Anesthesiology • AOA Universal Application • Diagnostic Radiology • Cardiology • Emergency Medicine • Interventional Cardiology • Family Medicine affiliated with OSU-CHS • Pulmonology • General Surgery • Nephrology • Internal Medicine • Gastroenterology • Obstetrics/Gynecology • Oncology • Ophthalmology • Plastic and Reconstructive Surgery • Orthopedic Surgery • Otolaryngology/Facial Plastic Surgery • Pediatrics © 2010 Oklahoma State University Comments about Primary Care Gender and Generation © 2010 Oklahoma State University “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 Generational Generalizations • 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 Sources: Baum & Dowling, 2007; Phelan, 2010 © 2010 Oklahoma State University Generational Generalizations • 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 Sources: Baum & Dowling, 2007; Phelan, 2010 © 2010 Oklahoma State University Generational Generalizations • 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, lowtouch physicians Sources: Baum & Dowling, 2007; Phelan, 2010 © 2010 Oklahoma State University Generational Generalizations • 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 © 2010 Oklahoma State University Generational Conflict © 2010 Oklahoma State University Primary Care Physicians © 2010 Oklahoma State University Specialty Choice by Gender © 2010 Oklahoma State University Specialty Choice by Gender © 2010 Oklahoma State University What about the Millennials? • 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” © 2010 Oklahoma State University 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/ © 2010 Oklahoma State University Traditional TraditionalGME GMEModel Model Traditional GME Model •Accreditation •Teaching Hospital/ Academic Health Center (inpatient) •Residency Program •Medicare GME $ •(continuity clinic) •Community Training Site THC Model •Hospital/ AHC •Community Training Sites •Teaching Health Center •Residency •CHC •Accreditation •HRSA GME $ •Medicare GME $ 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 For Additional Information… Tulsa Office OSU Center for Health Sciences 1111 West 17th Street Tulsa, OK 74107-1898 Phone: 918.584.4310 Fax: 918.584.4391 Oklahoma City Office One Western Plaza 5500 North Western, Suite 278 Oklahoma City, OK 73118 Phone: 405.840.6502 Fax: 405.842.9302 http://ruralhealth.okstate.edu © 2010 Oklahoma State University Staff Contact Information William Pettit, D.O. Associate Dean & Associate Professor of Family Medicine 918.584.4379 [email protected] Val Schott, M.P.H. Director, Rural Policy & Advocacy 405.840.6500 [email protected] C. Michael Ogle, D.O. Director, OSU Physicians Rural Clinic Svcs. 580.977.5000 [email protected] Jeff Hackler, M.B.A., J.D. Director, Rural Grants & Research 918.584.4611 [email protected] Vicky Pace, M.Ed. Director, Rural Medical Education 918.584.4332 [email protected] Richard Perry, M.A. Director, OkAHEC 918.584.4378 [email protected] Stacey Knapp, D.O. Endowed Rural Health Professor (Clinton) 2010-2012 Denna Wheeler, Ph.D. Research & Evaluation Coordinator [email protected] 918.584.4323 Chad Landgraf, M.S. GIS Specialist 918.584.4376 [email protected] Corie Kaiser, M.S. Asst. Director, State Office of Rural Health 405.840.6505 [email protected] Toni Hart Program Coordinator 918.584.4368 [email protected] Morgan Farquharson Clinical Coordinator 918.584.1989 [email protected] Matt Janey Program Coordinator 918.584.4377 [email protected] Rod Hargrave FLEX Program Coordinator 405.840.6506 [email protected] Jan Barber Admin. Coordinator 918.584.4360 [email protected] Billie Bowman Administrative Assistant 405.840.6502 [email protected] Debra Black Administrative Assistant 918.584.4387 [email protected] Kelly Davie NW Regional Coordinator (Enid) 918.401.0274 [email protected] Kelby Owens SE Regional Coordinator (Durant) 918.401.0273 [email protected] Sherry Eastman Stacy Huckaby Program Specialist Administrative Assistant 918.584.4375 918.582.1989 [email protected] [email protected] Augelica Burrell, M.H.R SW Regional Coordinator (Lawton) 918.401.0073 [email protected] Alexandra Bryant NE Regional Coordinator (Tahlequah) 918.401.0074 [email protected] © 2010 Oklahoma State University Contact Information… Lora Cotton, D.O. OSU Physicians Department of Family Medicine 2345 Southwest Boulevard Tulsa, OK 74107-2705 Phone 918.561.8395 Fax 918.561.8525 [email protected] © 2010 Oklahoma State University