1. © 2010 Oklahoma State University Teaching Health Centers: Clinical Workforce Oklahoma Primary Care Association October 22, 2010 Oklahoma State University Center for Health Sciences Tulsa, Oklahoma 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

2. © 2010 Oklahoma State University 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) Content Outline

3. © 2010 Oklahoma State University Primary Care and the Rural Physician Workforce

4. © 2010 Oklahoma State University Rural Oklahoma 2009

5. © 2010 Oklahoma State University Selected Socioeconomic & Demographic Comparison of Rural and Urban Oklahoma RuralUrbanMixedOklahoma White76%71%82%74% Black4%12%3%7% Native American11%4%6%8% Hispanic4%7%3%5% Other5%6% % of Population 65+ Years Old15%11% 13% Average Median Age (years)38.232.736.337.8 % of Population Living in Poverty17%13%10%15% Average Median Household Income$28,856$37,247$38,882$29,943 % of Population without a High School Diploma or G.E.D. 23%16%18%19% Data Source: U.S. Census Bureau (2000)

6. © 2010 Oklahoma State University 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. Problems Facing Rural Healthcare Delivery

7. © 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.

8. © 2010 Oklahoma State University 1.Personal Physician 2.Physician Directed Medical Practice Team 3.Whole Person Orientation 4.Case/Care is Coordinated and/or Integrated (HIE) 5.Quality and Safety (Evidenced Based Medicine and Patient Involvement) 6.Enhanced Access 7.Payment Improvement The Patient Centered Medical Home

9. © 2010 Oklahoma State University Challenges: Declining Interest in Primary Care Distribution of Population & Primary Care Physicians in Oklahoma, 2007

10. © 2010 Oklahoma State University Challenges for Primary Care: Declining interest Location, location, location Debt Aging workforce Compensation

11. © 2010 Oklahoma State University OSU CHS College of Osteopathic Medicine: The Rural Primary Care Focus

12. © 2010 Oklahoma State University 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: 1 st & 2 nd Years  Rural Health Elective Curriculum Option: 1 st & 2 nd Years  Rural Core Rotations: 3 rd Year  Required Rural Rotations: 3 rd and 4 th Years What has the OSU Center for Health Sciences Done?

13. © 2010 Oklahoma State University OSU Rural Medical Education

14. © 2010 Oklahoma State University Encouraging Rural & Primary Care Practice Osteopathic Residency and Internship Programs, 2008

15. © 2010 Oklahoma State University Medical Center of Southeastern Oklahoma Durant, Oklahoma

16. © 2010 Oklahoma State University

17. Tahlequah City Hospital & W.W. Hastings Indian Hospital Tahlequah, Oklahoma

18. © 2010 Oklahoma State University OSU Medical Center & OSU Health Care Center Tulsa, Oklahoma

19. © 2010 Oklahoma State University OSU CHS College of Osteopathic Medicine The Rural and Urban Primary Care Focus

20. © 2010 Oklahoma State University Challenges: Declining Interest in Primary Care Source: OSU College of Osteopathic Medicine

21. © 2010 Oklahoma State University

22. 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 OSU Health Care Center Medical Center of Southeastern OklahomaIntegris Southwest Medical Center OSU Medical Center University of Arkansas for Medical Sciences (AHEC – Pine Bluff) OSU College of Medicine Tahlequah City HospitalFreeman Health SystemINTEGRIS Bass Baptist Health Center - Enid

23. © 2010 Oklahoma State University Internship/Residency Positions Anesthesiology Diagnostic Radiology Emergency Medicine Family Medicine affiliated with OSU-CHS General Surgery Internal Medicine Obstetrics/Gynecology Ophthalmology Orthopedic Surgery Otolaryngology/Facial Plastic Surgery Pediatrics AOA Universal Application Cardiology Interventional Cardiology Pulmonology Nephrology Gastroenterology Oncology Plastic and Reconstructive Surgery Fellowships

24. © 2010 Oklahoma State University Comments about Primary Care Gender and Generation

25. © 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

26. © 2010 Oklahoma State University 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 Generational Generalizations Sources: Baum & Dowling, 2007; Phelan, 2010

27. © 2010 Oklahoma State University 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 Generational Generalizations Sources: Baum & Dowling, 2007; Phelan, 2010

28. © 2010 Oklahoma State University 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, low- touch physicians Generational Generalizations Sources: Baum & Dowling, 2007; Phelan, 2010

29. © 2010 Oklahoma State University 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 Generational Generalizations

30. © 2010 Oklahoma State University Generational Conflict

31. © 2010 Oklahoma State University Primary Care Physicians

32. © 2010 Oklahoma State University Specialty Choice by Gender

33. © 2010 Oklahoma State University Specialty Choice by Gender

34. © 2010 Oklahoma State University 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” What about the Millennials?

35. Teaching Health Centers Frederick Chen, MD, MPH Bureau of Health Professions Health Resources and Services Administration U.S. Department of Health and Human Services

36. © 2010 Oklahoma State University http://www.hrsa.gov/grants/apply/assistance/teachinghealthcenters/

37. Traditional GME Model Community Training Site Teaching Hospital/ Academic Health Center (inpatient) Residency Program (continuity clinic) Medicare GME $ Accreditation Traditional GME Model

38. Community Training Sites Hospital/ AHC Medicare GME $ HRSA GME $Accreditation Teaching Health Center Residency CHC THC Model

39. 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

40. 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

41. 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

42. 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

43. © 2010 Oklahoma State University Tulsa Office OSU Center for Health Sciences 1111 West 17 th 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 For Additional Information…

44. © 2010 Oklahoma State University Staff Contact Information William Pettit, D.O. Associate Dean & Associate Professor of Family Medicine 918.584.4379 william.j.pettit@okstate.edu Val Schott, M.P.H. Director, Rural Policy & Advocacy 405.840.6500 val.schott@okstate.edu C. Michael Ogle, D.O. Director, OSU Physicians Rural Clinic Svcs. 580.977.5000 rockino@hotmail.com Jeff Hackler, M.B.A., J.D. Director, Rural Grants & Research 918.584.4611 jeff.hackler@okstate.edu Vicky Pace, M.Ed. Director, Rural Medical Education 918.584.4332 vicky.pace@okstate.edu Richard Perry, M.A. Director, OkAHEC 918.584.4378 richard.r.perry@okstate.edu Stacey Knapp, D.O. Endowed Rural Health Professor (Clinton) 2010-2012 Denna Wheeler, Ph.D. Research & Evaluation Coordinator denna.wheeler@okstate.edu 918.584.4323 Chad Landgraf, M.S. GIS Specialist 918.584.4376 chad.landgraf@okstate.edu Corie Kaiser, M.S. Asst. Director, State Office of Rural Health 405.840.6505 corie.kaiser@okstate.edu Toni Hart Program Coordinator 918.584.4368 toni.hart@okstate.edu Morgan Farquharson Clinical Coordinator 918.584.1989 morganf@okstate.edu Matt Janey Program Coordinator 918.584.4377 matt.janey@okstate.edu Rod Hargrave FLEX Program Coordinator 405.840.6506 rod.hargrave@okstate.edu Jan Barber Admin. Coordinator 918.584.4360 jan.barber@okstate.edu Sherry Eastman Program Specialist 918.584.4375 sherry.eastman@okstate.edu Stacy Huckaby Administrative Assistant 918.582.1989 staci.stewart@okstate.edu Billie Bowman Administrative Assistant 405.840.6502 billie.bowman@okstate.edu Debra Black Administrative Assistant 918.584.4387 debra.black@okstate.edu Augelica Burrell, M.H.R SW Regional Coordinator (Lawton) 918.401.0073 augelica.burrell@okstate.edu Alexandra Bryant NE Regional Coordinator (Tahlequah) 918.401.0074 xan.bryant@okstate.edu Kelly Davie NW Regional Coordinator (Enid) 918.401.0274 kelly.davie@okstate.edu Kelby Owens SE Regional Coordinator (Durant) 918.401.0273 kelby.owens@okstate.edu

45. © 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 cotpay@okstate.edu