Teaching Health Centers: Clinical Workforce
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  • Residency Match; Aging Physicians; Location; Reimbursement; Loan Accumulation; Physician Liability
  • A generation is shaped by similar world events and social forces. They have similar work habits and motivators. CAUTION: It is not appropriate to make assumptions about any particular individual based on age or gender and this research applies primarily to college graduates in white collar positions.
  • This generation tends to postpone gratification, are loyal to their jobs, are respectful of the hierarchy, and tend to be detail-oriented. Neil Baum, MD is a urologist in New Orleans and Robert Dowling, MD is a urologist in Dallas/Ft.Worth. Sharon Phelan, MD is professor of OB/Gyn at University of New Mexico in Albequerque.
  • James Brolin – Dr. Steven Kiley Boomers are driven, working long hours and missing many of their children’s firsts. However, if you pay your dues and wait your turn you are rewarded with advancement.
  • Chandra Wilson - Grey’s Anatomy Gen Xers are independent, resourceful, and comfortable with diversity and accepting of change. They have an expectation of a balanced lifestyle, and to this end they are changing the concept of a typical work week.
  • ROAD Radiology Opthalmology Anesthesiology Dermatology Recently revised to E-ROAD or ADORE to include Emergency Medicine Having grown up with cell phones, texting, tweeting, and social networking sites they are in a continuous state of partial attention. Speed is valued more than detail. Sometimes have difficulty filtering what they say due to limited face to face communication. May have difficulty developing sense of empathy for the same reason. They are the most ethnically and racially diverse cohort in US history and seem to be politically progressive.
  • So these differences in social attitudes and events during the formative years lead to inter-generational misinterpretations regarding life priorities (i.e. work ethic), commitment, loyalty, etc.
  • Primary care physicians includes General/Family Practice, Internal Medicine, and Pediatrics. It does not include OB/Gyn.
  • Why does gender matter? It matters because a much larger proportion of female physicians are selecting primary care. Primary care accounts for only 13 + 17 + 6 + 5 = 41% for male docs.
  • Primary Care accounts for 15 + 18 + 18 + 10 = 61% Internal medicine and family medicine are very similar but large differences in pediatrics and OB/Gyn with 3 times as many women in pediatrics and twice as many women in OB/Gyn.
  • Sanfey et al. (2006) Arch Surg Surveyed students about interest in surgical career. Both male and female students noted that surgery was not a career conducive to living a balanced life. (Sanfey et al., 2006)  


  • 1. 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.
    • 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. Primary Care and the Rural Physician Workforce
  • 4. Rural Oklahoma 2009
  • 5. Selected Socioeconomic & Demographic Comparison of Rural and Urban Oklahoma Rural Urban Mixed Oklahoma White 76% 71% 82% 74% Black 4% 12% 3% 7% Native American 11% 4% 6% 8% Hispanic 4% 7% 3% 5% Other 5% 6% 6% 6% % of Population 65+ Years Old 15% 11% 11% 13% Average Median Age (years) 38.2 32.7 36.3 37.8 % of Population Living in Poverty 17% 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.
    • 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. 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.
    • Personal Physician
    • Physician Directed Medical Practice Team
    • Whole Person Orientation
    • Case/Care is Coordinated and/or Integrated (HIE)
    • Quality and Safety (Evidenced Based Medicine and Patient Involvement)
    • Enhanced Access
    • Payment Improvement
    The Patient Centered Medical Home
  • 9. Challenges: Declining Interest in Primary Care
    • Distribution of Population & Primary Care Physicians in Oklahoma, 2007
  • 10. Challenges for Primary Care:
    • Declining interest
    • Location, location, location
    • Debt
    • Aging workforce
    • Compensation
  • 11. OSU CHS College of Osteopathic Medicine: The Rural Primary Care Focus
  • 12.
    • HRSA Pre-doctoral Grant
    • Nature
      • Recruit From Rural Areas of Need
      • Community Campus with help from OkAHEC
    • Nurture
      • ST udent O steopathic R ural M edical 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. OSU Rural Medical Education
  • 14. Encouraging Rural & Primary Care Practice Osteopathic Residency and Internship Programs, 2008
  • 15. Medical Center of Southeastern Oklahoma Durant, Oklahoma
  • 16. Welcome to Enid
  • 17. Tahlequah City Hospital & W.W. Hastings Indian Hospital Tahlequah, Oklahoma
  • 18. OSU Medical Center & OSU Health Care Center Tulsa, Oklahoma
  • 19. OSU CHS College of Osteopathic Medicine The Rural and Urban Primary Care Focus
  • 20. Challenges: Declining Interest in Primary Care
    • Source: OSU College of Osteopathic Medicine
  • 21.  
  • 22. St. Anthony Hospital OSU Health Care Center Medical Center of Southeastern Oklahoma Integris Southwest Medical Center OSU Medical Center University of Arkansas for Medical Sciences (AHEC – Pine Bluff) OSU College of Medicine Tahlequah City Hospital Freeman Health System INTEGRIS Bass Baptist Health Center - Enid 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:
  • 23. 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
  • 24. Comments about Primary Care Gender and Generation
  • 25.
    • “ 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.
    • 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.
    • 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.
    • 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.
    • 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. Generational Conflict
  • 31. Primary Care Physicians
  • 32. Specialty Choice by Gender
  • 33. Specialty Choice by Gender
  • 34.
    • 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. http://www.hrsa.gov/grants/apply/assistance/teachinghealthcenters/
  • 37. Traditional GME Model Traditional GME Model Traditional GME Model
    • Community Training Site
    • Teaching Hospital/ Academic Health Center (inpatient)
    • Residency Program
    • (continuity clinic)
    • Medicare GME $
    • Accreditation
  • 38.
    • Teaching Health Center
    • Residency
    • CHC
    THC Model
    • Community Training Sites
    • Hospital/ AHC
    • Medicare GME $
    • HRSA GME $
    • Accreditation
  • 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. For Additional Information… http://ruralhealth.okstate.edu 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
  • 44. 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 [email_address] Jeff Hackler, M.B.A., J.D. Director, Rural Grants & Research 918.584.4611 [email_address] Vicky Pace, M.Ed. Director, Rural Medical Education 918.584.4332 [email_address] Richard Perry, M.A. Director, OkAHEC 918.584.4378 [email_address] Stacey Knapp, D.O. Endowed Rural Health Professor (Clinton) 2010-2012 Denna Wheeler, Ph.D. Research & Evaluation Coordinator [email_address] 918.584.4323 Chad Landgraf, M.S. GIS Specialist 918.584.4376 [email_address] Corie Kaiser, M.S. Asst. Director, State Office of Rural Health 405.840.6505 [email_address] Toni Hart Program Coordinator 918.584.4368 [email_address] Morgan Farquharson Clinical Coordinator 918.584.1989 [email_address] Matt Janey Program Coordinator 918.584.4377 [email_address] Rod Hargrave FLEX Program Coordinator 405.840.6506 [email_address] Jan Barber Admin. Coordinator 918.584.4360 [email_address] Sherry Eastman Program Specialist 918.584.4375 [email_address] Stacy Huckaby Administrative Assistant 918.582.1989 [email_address] Billie Bowman Administrative Assistant 405.840.6502 [email_address] Debra Black Administrative Assistant 918.584.4387 [email_address] Augelica Burrell, M.H.R SW Regional Coordinator (Lawton) 918.401.0073 [email_address] Alexandra Bryant NE Regional Coordinator (Tahlequah) 918.401.0074 [email_address] Kelly Davie NW Regional Coordinator (Enid) 918.401.0274 [email_address] Kelby Owens SE Regional Coordinator (Durant) 918.401.0273 [email_address]
  • 45. 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
    • [email_address]