1. Strengthening ties to the university: Initial progress toward development of rural Teaching Community Health Centers Peter G. Beatty, Ph.D. Eugene Bailey, MD Department of Family Medicine SUNY Upstate Medical University

2. Session Objectives Identify necessary Community Health Center organizational characteristics Identify necessary Community Health Center organizational characteristics Identify key characteristics of the relationship between the Community Health Center and the Academic Health Center Identify key characteristics of the relationship between the Community Health Center and the Academic Health Center Identify financial, organizational and clinical barriers Identify financial, organizational and clinical barriers

3. The rural physician workforce has issues Age distribution Age distribution Medically underserved areas Medically underserved areas Declining interest in primary care Declining interest in primary care

4. Age distribution: Primary care doc replacement In central NY In central NY 26% over next 5-10 years26% over next 5-10 years 59% over next 15-20 years59% over next 15-20 years In northern NY In northern NY 27% over next 5-10 years27% over next 5-10 years 63% over next 15-20 years63% over next 15-20 years Source: Center for Health Workforce Studies, University at Albany

5. Age distribution For obstetrics/gynecology, general surgery, adult psychiatry and child psychiatry as of 2002 greater than 25% of the active practitioners were age 60 or older. --Excellus Health Policy Report No. 5, July 2003 For obstetrics/gynecology, general surgery, adult psychiatry and child psychiatry as of 2002 greater than 25% of the active practitioners were age 60 or older. --Excellus Health Policy Report No. 5, July 2003 Recruiting more difficult for rural areas Recruiting more difficult for rural areas

9. Medical school admissions picture Changes unfavorable for rural applicant admissions pool Changes unfavorable for rural applicant admissions pool Out-of-state admissions increased from 4% to 20% over past 5 yearsOut-of-state admissions increased from 4% to 20% over past 5 years 100% tuition increase over 5 years100% tuition increase over 5 years MCAT and GPA scores creeping higherMCAT and GPA scores creeping higher

10. Response Advocate for admission policy changes Advocate for admission policy changes Proactive recruiting from rural areas Proactive recruiting from rural areas EXPAND RURAL TRAINING EXPERIENCES EXPAND RURAL TRAINING EXPERIENCES Focus on 2 rural Community Health CentersFocus on 2 rural Community Health Centers More placements in rural-based private practicesMore placements in rural-based private practices Track and recruit after graduation Track and recruit after graduation

11. Focus on 2 rural CHCs Both well established and stable Both well established and stable Both have hosted our students on occasional basis Both have hosted our students on occasional basis Clinical services: 1 centralized, 1 decentralized Clinical services: 1 centralized, 1 decentralized Goals: Goals: Increase student presence from 1-2 per year to 8 per year Increase student presence from 1-2 per year to 8 per year Shift the mindset of the organizations Shift the mindset of the organizations

12. How to define a Teaching Community Health Center Organizational characteristics Organizational characteristics Relationship with Academic Health Center Relationship with Academic Health Center

13. Organizational Characteristics Education of new health professionals considered part of mission Education of new health professionals considered part of mission Genuine interest and support of CHC staff at all levels Genuine interest and support of CHC staff at all levels Teaching time built into clinician schedules Teaching time built into clinician schedules Acceptance of students by patients Acceptance of students by patients Adequate clinical and technology infrastructure Adequate clinical and technology infrastructure

14. Relationship with the Academic Health Center Common interests and goals Common interests and goals Agreed on expectations Agreed on expectations Formal educational affiliation agreement Formal educational affiliation agreement Clinical faculty appointments Clinical faculty appointments Functional relationship between clinical instructors and academic faculty Functional relationship between clinical instructors and academic faculty Faculty development Faculty development Incorporation of CHC clinical strengths and special programs into student learning Incorporation of CHC clinical strengths and special programs into student learning

15. Progress Execution of contracts ($25k per CHC) Execution of contracts ($25k per CHC) Initial meetings with administrators and medical directors Initial meetings with administrators and medical directors Benefits offered to organizations Benefits offered to organizations Clinical strengths / special programs identified Clinical strengths / special programs identified Potential financial, organizational and clinical barriers Potential financial, organizational and clinical barriers Plan to generate student interest Plan to generate student interest

16. Initial Meetings Executive Directors and Medical Directors Executive Directors and Medical Directors Identify common interests and goals Identify common interests and goals Clarify expectations Clarify expectations Focus on benefits to the organization, especially for the medical staff Focus on benefits to the organization, especially for the medical staff Confirm their interest and commitment Confirm their interest and commitment Review clinical facilities Review clinical facilities

17. Initial Meetings Board of Directors Board of Directors Focus on vision of recruitment and retention of medical staff Focus on vision of recruitment and retention of medical staff Discuss specific benefits to medical staff Discuss specific benefits to medical staff Remind about contract Remind about contract Scheduled meetings with support staff Scheduled meetings with support staff Everyone in the organization contributes to the learning environment Everyone in the organization contributes to the learning environment

18. Benefits to Medical Staff Volunteer clinical faculty appointments Volunteer clinical faculty appointments Access to Health Sciences Library resources Access to Health Sciences Library resources Multiple Databases (Cochrane, UptoDate, InfoRetriever) Multiple Databases (Cochrane, UptoDate, InfoRetriever) Ovid Ovid Textbooks Textbooks Free tuition to annual Family Medicine Refresher course Free tuition to annual Family Medicine Refresher course Planned faculty development workshops Planned faculty development workshops Improve teaching skills Improve teaching skills Increase efficiency of teaching Increase efficiency of teaching

19. CHCs enhance our clerkship Strengths Strengths Rural Health Rural Health Multi-disciplinary approach within the health centers Multi-disciplinary approach within the health centers Community-responsive health care Community-responsive health care Special Programs Special Programs Chronic illness model with Diabetes Chronic illness model with Diabetes School based health care centers School based health care centers Dental care Dental care "X-press Clinic" for walk-ins "X-press Clinic" for walk-ins Specialty services including orthopedics, chiropractor, mental health, physical therapy Specialty services including orthopedics, chiropractor, mental health, physical therapy Minor surgery - "especially fishhooks" Minor surgery - "especially fishhooks"

20. Potential Barriers Financial Financial Reduced productivity when students present Reduced productivity when students present Commuting costs for students Commuting costs for students Organizational Organizational Staff development Staff development Faculty development Faculty development Student learning environment - EMR, computer access Student learning environment - EMR, computer access Logistics of multiple centers Logistics of multiple centers Clinical Clinical Space for students Space for students Patient acceptance Patient acceptance Appropriate variety of patients and experiences Appropriate variety of patients and experiences Incentives Incentives

21. Generating student interest Early, early exposure Early, early exposure AHEC program (rural providers more likely to come from rural backgrounds) AHEC program (rural providers more likely to come from rural backgrounds) Develop a "pipeline" for health careers in rural schools Develop a "pipeline" for health careers in rural schools Early exposure for medical students Early exposure for medical students Primary care student interest groups Primary care student interest groups Broader scope: rural training track? Broader scope: rural training track? Incentives Incentives Identify student interest via letter Identify student interest via letter

22. Caveats Title VII funding is shaky Title VII funding is shaky Contract amounts may need to be adjusted if targets are beyond host capacity Contract amounts may need to be adjusted if targets are beyond host capacity No guarantee of funding beyond 3 years No guarantee of funding beyond 3 years