Transcript Bringing Residencies to Florida

Bringing Residencies to Florida
George Smith MD
Medical Director
Escambia Community Clinics Inc.
Pensacola FL.
overview
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Introduction
The Florida AHEC Network
Patient Centered Medical Home
National Workforce Statistics
Florida Workforce Trends
Recommendations
Acknowledgements
Escambia Community Clinic
• Non-profit in Pensacola, Florida
• Originally sponsored and owned by
Sacred Heart Health System and
Baptist Health Care
• Established in January 1991
• Opened in November 1992.
• Relocated in June 1994
• Federally Qualified Community
Health Center (FQHC) in
September 2007
Mission Statement
• The mission of ECC is to provide quality
outpatient primary and acute health care
services to citizens of Escambia County and
surrounding area. Escambia Community
Clinics has a special focus to provide access to
care for the under insured, uninsured,
indigent and the medically needy regardless of
their ability to pay for services.
Services
• Acute Care - Family Practice Services
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Routine family medicine
Hypertension control
Diabetic control
Women’s Health
Full laboratory services and x-ray
School, sports and work physicals
Workers comp
• Escambia Community Clinics
– Accepts most major insurances
– Provides "walk-in" patient care
– Appointments available
The 4 Functions of a Primary Care
Medical Home
1. First Contact Care: “the door the patient
knocks on to initiate help.”
2. Comprehensive: offering preventive, acute,
chronic health care needs
3. Longitudinal: provides sustained
relationships with people
4. Home Base: the place “from which other
accommodations –specialists and other
caregivers—are arranged.”
AAFP Medical Home
• www.vcall.com/replay
• 2071134629
We Need Doctors
• Escambia Community Clinics, Inc., a non-profit
outpatient primary care/ambulatory care
facility is expanding and seeks a BC/BE Family
Practitioner to join the medical staff. An
excellent opportunity for exceptional personal
and professional lifestyle. Position offers
competitive salary, paid malpractice, paid
vacation, paid CME and additional benefits.
AHEC
• Extending Academic Resources to Medically
Underserved Communities
AHEC
• The concept of service/learning is now extensively used by AHEC as a
means to accomplish its educational objectives for health professions
students while delivering services to underserved populations. An AHEC
service/learning program is accomplished through the extension and
outreach efforts of academic faculty and students to community-based
health programs that provide care to underserved
populations.
• Student enrichment activities are designed to influence
underrepresented and/or disadvantaged youth to embrace the
concepts of community health, diversity, individual health promotion and
the potential for pursuing health careers.
• By having a presence in local communities, AHECs have been able to
promote community health and serve as vehicles for matching the
educational needs of health professions faculty and students with the
health care needs of local communities. Through these academiccommunity partnerships, AHECs have been able to produce a significant
number of needed health services and community health projects.
The North Carolina Model
• Since 1974, AHEC has created 339 primary
care residency positions
–220 were in family medicine
–67% of the family medicine graduates stayed in the state to
practice!
• Residents trained at AHEC are more likely to
practice in an underserved or rural
community!
North Carolina’s
Growth in Rural Doctors
1970 - 1995
Primary Care Workforce Sept 2007
(1)
• 97,752 family physicians/general practitioners
(1 for every 3, 081 persons; 14.4% of the
physician workforce).
• 92,257 general internists (1 per 2,443 adults)
and 48,930 general pediatricians (1 for 1,548
children and adolescents).
• 238,939 primary care physicians (1 for every
1,260 persons).
Version 1.3 -2008
15
US Primary Care Health Professional Shortage Areas
By County (2006)
Legend
A Full PC HPSA (n=1381, 44.0%)
A Partial PC HPSA (n=667, 21.2%)
Not A PC HPSA (n=1093, 34.8%)
Data Source: HRSA (08/03/2006)
Prepared by The Robert Graham Center
COGME: Students and Residents
• January 2005: Council of Graduate Medical Education:
– A 15.0% expansion of allopathic medical student
positions,
– A 12.5% increase in residency positions over 10 yrs,
• In 2006 AAMC increased the call to a 30% expansion
• It is notable that the overall physician workforce grew at a
rate twice that of the US population for the last decade and
is projected to continue to outpace US population growth,
without medical school expansion
http://www.cogme.gov/report16.htm
Version 1.3 -2008
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Trends in Medical Schools
• TREND 1: Decline of students from rural areas
accepted into med school
• 47% decline from 1976 – 2000
– Rural students applied at the same rate
– Rural students are more likely to match in family
medicine than urban students.
• TREND 2: Residencies are seeing an increased
number of US osteopathic students and students
from non-US medical schools.
Minorities in Medicine
• PREVIOUSLY:
– Minorities were more likely to enter primary care
and treat underserved populations
• TREND:
– Like their white peers, these groups are now
choosing specialty careers over primary care
Internal Medicine Residents
• Decreased interest in primary care
• 50% drop from 1998 to 2003
• Increased desire to sub-specialize
• 1998 54% chose primary care careers
• 2003  27% made a similar choice
The Florida situation
• Florida is one of the fastest growing states.
• Population has increased 222 % from 1960 2000
• Projected growth of 9.5 mil from 2000 -2030
• Population of elderly to grow by 124 %.Most
likely to be in need of medical services
• Largest increase in the elderly in Southeast
Florida
The Florida Situation
• Physicians practice where they
attend residency
• Nationally, Florida is ranked 46th
for residency programs per
100,000 people in the state and
37th in number of med students
• To meet the national ratio,
Florida would need 2,700 more
allopathic and osteopathic
residency positions
• Practically all Florida residency
positions are filled.
If You Build It, They Will Come . . .
• Nationally, 47% of residency graduates stay in
state
• In Florida, 60.5% stay in state
– 2nd only to California
Practice Path Followed by 2003 Community Hospital
Education Program (CHEP) Completers
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%
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%
Immediately
Entering
Practice
205
68%
95
32%
Continuing
Training
112
63%
66
37%
*NOTE: 43 did not practice or continue training anywhere.
FSU COM
• The Florida State University College of Medicine will educate and develop
exemplary physicians who practice patient-centered health care, discover
and advance knowledge, and are responsive to community needs,
especially through service to elder, rural, minority, and underserved
populations.
• The curriculum is comprehensive, preparing students for any medical
specialty and setting. Course content reflects the college’s mission, with
special attention given to primary care, geriatrics, cultural diversity, and the
needs of underserved populations. In addition, concentrated learning
opportunities are offered for those students interested in rural health. All
courses make use of the latest instructional technology, and medical
informatics is integrated throughout the curriculum.
Rural Medical Education Track
• The FSU College of Medicine recruits students
into the "rural track" designed to send
students to small rural communities for their
third year and to encourage their return after
graduation. Because of its strong medical
community, Marianna, Florida was selected as
the first rural community to begin this track.
“… Primary Care is the least expensive and
most effective form of health care. It is key
to addressing:
1. Disparities in health status and access to health
care experienced by low income and/or
underserved communities;
2. The epidemic of chronic diseased, all
preventable, in underserved communities; and
3. The requirement that any restructuring in the
health care system be designed to address rising
healthcare costs by preventing expensive and
avoidable emergency room visits and
hospitalizations….”
Recommendations
• Invest in the development of a primary care
workforce
• Training and education programs need to be
linked to primary care sites like CHC’s.
• Medical school curriculum should be designed
or revised to expose students to primary care
and the primary care medical home model
• Provide primary care role models to mentor
and preceptor med students and residents.
Recommendations
• Make primary care more attractive for med
students by increasing reimbursement
• Foster relationships between CHC’s and
residency programs
• Create new primary care residency programs
using CHC’s as training sites.
Acknowledgements
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Dr. David Nguyen
Sarah Cooke Third year med student FSU
Robert Graham Center
Laying the Foundation : The Primary care
Imperative in New York Health reform