Category Archives: Medically underserved areas
Arthur Kellermann, MD, MPH, FACEP, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. He wrote an article in the November issue of Health Affairs calling for a new class of health care provider—the primary care technician—to improve accessibility to and affordability of primary care.
Human Capital Blog: What is the thrust of your idea?
Arthur Kellermann: We’ve had a decades-long shortage of primary care physicians in this country and, up until now, it has defied solution. One definition of insanity is to continue to do the same thing over and over again and expect a different result. My article suggests a rethinking, and literally a reengineering, of how we deliver primary care in this country. It makes the case for a new class of providers—primary care technicians (PCTs)—who would work remotely, under the online supervision of primary care physicians or nurse practitioners (NPs), to manage stable chronic disease patients, treat minor illnesses and injuries, and provide basic preventive services. These PCTs would make primary care more accessible, more convenient, and more affordable to Americans, wherever they live.
By Santa J. Ono and Greer Glazer
Santa J. Ono, PhD, is president of the University of Cincinnati. Greer Glazer, PhD, is dean and Schmidlapp professor of nursing at the University of Cincinnati College of Nursing, and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This piece first appeared in the Cincinnati Enquirer; it is reprinted with permission from the newspaper.
The children of poor Cincinnati neighborhoods are 88 times more likely to require hospitalization to treat asthma than their peers across town. That’s an urban health disparity born of unequal access to the kind of consistent, attentive, high-quality health care that renders asthma a controllable condition.
In academic medicine, we chart the credentials of our staff and the test scores of our students. We tout the wizardry of the medical technology we bring to bear on exotic maladies. But too often we lose sight of the fact that the ultimate test of an academic medical center isn’t what’s inside the building, it’s what’s outside. If we are improving the health of the communities we serve, then we are truly succeeding.
By that score, we are falling short.
Telepresence robots are expanding access to specialists in rural hospitals experiencing shortages of physicians, and in other hospitals throughout the country, reports the Associated Press.
Devices such as the RP-VITA, introduced earlier this year, can be controlled remotely with a desktop computer, laptop, or iPad, allowing physicians to interact with patients through video-conferencing via a large screen that projects the doctor's face. An auto-drive function allows the robot to find its way to patients' rooms, and sensors help it avoid obstacles. It also gives the physician access to clinical data and medical images.
Dignity Health, a hospital system with facilities in Arizona, California, and Nevada, started using telepresence robots five years ago to promptly evaluate patients who had potentially suffered strokes. Dignity now has robots in emergency rooms and intensive care units at about 20 California hospitals, giving them access to specialists in areas such as neurology, cardiology, neonatology, pediatrics, and mental health.
Ryan Greysen, MD, MHS, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, and an assistant professor of medicine at the University of California, San Francisco (UCSF), Division of Hospital Medicine. He works closely with the Global Health Hospitalist program at UCSF to help train fellows and conduct research in quality improvement for hospitalized patients in developing settings. Phuoc Le, MD, MPH, is an assistant clinical professor of medicine and pediatrics at UCSF. He co-directs the Global Health-Hospital Medicine Fellowship at UCSF, directs the Global Health Pathway for the Pediatric Residency, and is director of international rotations for the Internal Medicine Residency.
U.S. medical education has entered a golden era of growth in global health interest and involvement, but surprisingly little is known about global health after training is completed. In 1978, only 6 percent of graduating medical students reported experiences in global health (GH), but today more than 25 percent participate in global health activities during medical school, and 66 percent plan to participate in GH work during their career. Since this "surge" has started with trainees, many of the recent studies on global health work have focused on medical students or residents.
Interestingly though, we have much less information on what happens after the trainees become full-fledged physicians. Do they continue to engage globally either as professionals or volunteers? If so, do they focus on clinical work, education, research, or health policy? We recently conducted a pair of surveys to answer these questions in two specific groups of doctors: those who have received research and leadership training through the longest- program of this kind in the U.S. (the RWJF Clinical Scholars program) and those who have joined the ranks of the medical profession's fastest-growing sub-specialty: hospitalists.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. These are some of the stories in the November issue:
For decades, experts have called for more team-based care but the movement has gained traction in recent years with more health professions schools incorporating interprofessional education into their coursework. Proponents say this kind of education will prepare students to practice in coordinated, well-functioning health care teams, which in turn will help meet increasing, and increasingly complex, patient needs. Officials in several professions are considering making interprofessional education and training a requirement for accreditation for health professions colleges and universities.
Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.
Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?
Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.
We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.
Richard Rieselbach, MD, is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program and a professor emeritus and health policy consultant for the University of Wisconsin Medical Foundation.
In the last decade, the nation’s community health centers (CHCs) have doubled their capacity. They now provide care for more than 22 million underserved children and adults in every state. But they’re going to need to do it again. By 2019, some 40 million patients will be in need of care.
The United States does not have enough primary care providers to serve these new patients, and our public investment in health professions education—graduate medical education (GME)—is failing to produce the pipeline we need. Medical students are choosing specialties over primary care at an alarming rate, and a policy vacuum keeps the GME program from being held accountable.
An initiative was launched in 2011 that I think holds great promise: the Teaching Health Center Graduate Medical Education initiative. This five-year, $230 million program was funded by the Affordable Care Act and created to increase the number of primary care graduates trained in community settings.
My colleagues and I have proposed a modified and expanded version of this initiative, called “CHAMP” Teaching Health Centers (CHAMP THCs). Our teaching model would pair CHCs with academic medical centers to develop a THC track that would encourage students to graduate in primary care and practice in urban and rural underserved areas.
The news media has recently covered some innovative programs that are influencing the choices and attitudes of the next generation of doctors.
American Medical News reports on the Buddy Program, which pairs first-year medical students with early-stage Alzheimer’s patients and their caregivers. The program empowers patients, and also serves as a valuable learning tool for the students, heightening “their sensitivity and empathy toward people with the disease.” The program was developed at the Northwestern University Alzheimer’s Disease Center in Chicago; Boston University, Dartmouth College, and Washington University have replicated it.
NPR reports on a program at the University of Missouri School of Medicine that is encouraging more young doctors to pursue primary care in rural areas. During the summers, the school has been sending medical students to work alongside country doctors. While school officials caution they can’t be sure about the reasons, they have discovered that students who took part in the summer program were more likely to become primary care doctors who practice family medicine. Some 46 percent of participants are choosing to work in the country after completing their medical training.
Cindy Anderson, PhD, RN, WHNP-BC, FAHA, FAAN, is a professor and associate dean for research at the College of Nursing & Professional Disciplines, University of North Dakota. A Robert Wood Johnson Nurse Faculty Scholar, she received a Bachelor of Science degree in Nursing from Salem State College, and both a Master of Science degree in parent-child nursing and a PhD in physiology from the University of North Dakota. This is part of a series of posts looking at diversity in the health care workforce.
I was born and raised in the Boston area which we always referred to as the “melting pot.” My grandparents emigrated from Eastern Europe and I grew up hearing stories of the “Old Country” which included both fond memories and atrocities that drove them to leave their homes and find a better way of life in America. As a second-generation American, I have always embraced the common and unique perspectives of others from a variety of backgrounds.
I began my career as an Air Force nurse, advancing my opportunity to engage with others from varied backgrounds and cultures. In the course of my career, I found myself stationed at the Grand Forks Air Force Base in North Dakota. My initial perceptions were based upon the stereotype that North Dakota was a rural, isolated state with little diversity. My misperceptions were quickly reversed when I had a chance to engage with the community. My awareness and respect for the unique diversity of rural North Dakota has steadily grown over the last three decades which I have been fortunate to spend in this great state.
Graduate Medical Education Funding Is Not Helping Solve Primary Care, Rural Provider Shortages, Study Finds
From 2006 to 2008, 158 of the country’s 759 residency sponsoring institutions and teaching sites did not produce any primary care graduates, according to a study published online last week by Academic Medicine. Less than one-quarter of medical school graduates entered primary care during those years.
The study also found that physician shortages in rural and underserved areas persist; only 4.8 percent of 2006-2008 graduates practice in rural areas. Nearly 200 institutions produced no rural physicians, more than half produced no Health Service Corps graduates, and 283 produced no physicians practicing at Federally Qualified Health Centers or Rural Health Clinics.
Graduate medical education (GME) distribution is uneven, the researchers found, and provides more support to subspecialty programs than to primary care programs. The top 20 primary care producing institutions (where 41 percent of graduates were in primary care) received $292 million in total Medicare GME payments, while the bottom 20 (where only 6.4 percent of graduates were in primary care) received $842 million in these funds.