doctors for the people: training physicians to work in under-served urban communities
DESCRIPTION
Doctors for the People: Training Physicians to Work in Under-served Urban Communities. Sherenne Simon, MPH, Matthew Anderson, MD, MS, Pablo Joo, MD. Department of Family & Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine. Project Aim. - PowerPoint PPT PresentationTRANSCRIPT
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Doctors for the People:Training Physicians to Work in Under-served Urban Communities
Sherenne Simon, MPH, Matthew Anderson, MD, MS,Pablo Joo, MD
Department of Family & Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine
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Project Aim
Montefiore’s Residency Program in Social Medicine (RPSM), established in 1970, trains clinicians to work in underserved communities.
In order to improve our own work we set about to examine similar programs which train clinicians to work in underserved communities.
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Why do we need such programs?
Higher Education is funded and organized by the US ruling class:– Weill-Cornell Medical School– Charles H. Greenberg Pavilion @ NYH– Belfer Building @ AECOM– Interlocking corporate academic directorships
Medical Students are a very privileged group.
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Contextual Factors
Well recognized problem for rural areas
US government has attempted to address through HRSA, NHSC
Literature on financial incentives and specific curricular elements
Efforts going on at the undergraduate level:– High School, College, Post-baccalaureate
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Locating Programs
Google Search for websites; Google Scholar for articles
Snow-balling technique (referrals)
HRSA funded programs (1999-2000) to promote Primary Care
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Literature Review
Inclusion Criteria– Medical Schools & Residency Programs– Mission to accept minority/working class students
and/or train for underserved communities– Published literature about program outcomes
Exclusion criteria:– High School or College enrichment programs– Rural Programs– Traditionally African American Medical Schools
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Interviews (phone/email/website)
How and why program was created
How the program is financed and its cost to students
Educational philosophy & curriculum
Recruitment & retention policies
Evaluation methods of graduates long term success & programmatic success
Relationship to more traditional training programs
Barriers and successes
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Medical Schools
Sophie Davis School of Biomedical Engineering (CUNY)
Charles R. Drew Program (UCLA) UC/PRIME programs (5 programs - 1 is rural) A.T. Still University School of Osteopathic
Medicine (SOMA) Baylor College (Texas)
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Residency Programs (sample)
Arizona University of Arizona Family & Community Medicine
California UCLA/Harbor Family Medicine Residency UCSF/San Francisco General Hospital: Family &
Community Medicine
Florida University of Miami/Jackson Memorial Family
Medicine & Community Health Miller School of Medicine: Jay Weiss Residency in
Global Health Equity & Internal Medicine. Also at Jackson Memorial
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Residency Programs (sample)
Illinois Cook County Internal Medicine Primary Care
Maryland Johns Hopkins Bloomberg School of Public
Health, General Preventive Medicine Residency (PM)
Massachusetts U Mass, Worcester: Family Medicine &
Community Health Lawrence Family Medicine Residency
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Residency Programs (sample)
New York Residency Program in Social Medicine (FM,IM,PED)
Washington University of Washington, Tacoma Family Medicine
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Justifications offered by programs
US population increasingly diverse
Minority/working class students face growing barriers getting into medical school
Geographical maldistribution of physicians: both urban & rural
Minority and working class populations have worse health care access & outcomes (health disparities)
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Structure of Programs
Medical school programs typically associated with traditional MS, but offer enhanced curriculum (ie. disparities, community health)
Training often occurs in community settings, particularly community health centers
Service training sites are in underserved areas
Requirement for research/paper/project/Masters degree
Special mentorship
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Educational Philosophy
Emphasis on Primary Care
Work in communities, specifically underserved communities
Work in Community Health Centers
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Recruitment/Retention
Pairing with college-level pipeline programs
Trainees expected to share program vision of working in underserved communities
Special mentorship & assistance
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Methods of evaluation within programs
Racial/Ethnic/Class composition of trainees (or) graduates
Intention vs. actual practice in underserved communities
Practice in primary care
Traditional academic metrics: board scores, specialization rates; graduates who are faculty or involved in public health administration
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Evaluation Techniques
Use of AAMC survey data on where students intend to practice
– Measured at 3 time points: MCAT, entrance and exit to medical school
AMA master file of clinicians to determine practice sites of graduates
HPSA (Health Professional Shortage Areas)
Follow-up surveys of trainees– Such surveys are uncommon and cost money
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Evaluation: Charles R. Drew Medical Education Program
Ko M, Edelstein RA, Heslin KC, Rajagopalan S, Wilkerson L, Colburn L, et al. Impact of the University of California, Los Angeles/Charles R. Drew University medical education program on medical students' intentions to practice in underserved areas. Acad Med. 2005 Sep;80(9):803-8.
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Outcomes
Programs report high levels of training minority and/or working class physicians
High level of work by graduates in primary care and underserved areas
Successful academic outcomes
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Caveats
Those who make it to medical school are the “lucky few.”
Selection bias: Students entering these programs know what they are getting into
What are appropriate comparison groups for these programs?
These programs are all small, almost “boutique” programs
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Caveats (Contextual issues)
We are losing this battle now….– Barriers to getting into medical school appear to
have increased since the 1990’s.– Decreasing number of US students choose
primary care.
These programs rely on funding for Primary Care training programs (Title VII)
A mission to serve the underserved does not currently characterize most of US academic medicine (neither does an interest in PC)
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Conclusions
Successful programs exist that train clinicians to work in underserved communities.
Shared elements– Mission to serve the underserved (caveat: this
was a selection criteria)– Training in underserved communities.– Community & Primary Care orientation
These findings are similar to those in rural health programs.
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Next Steps/Discussion points
How might this project inform our own work?
What are its broader implications for academic medical institutions?– Is the medical school responsible for the
composition of its classes & the future careers of its doctors?
What are the broader implications for US education if professional careers are unavailable to large sections of the population?