Elena Reyes, PhD, Associate Professor & Director of Behavioral Medicine, Florida State University College of Medicine, Regional Director Southwest Florida

1. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Interprofessional Education:
Transforming Care Through Team Work
How are we preparing the workforce?
Elena Reyes, PhD
Latino Health Forum
10-9-14

2. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Healthcare Reform
Shift from caring for the sick to
maintaining health

3. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Healthcare reform emphasizes:
• Primary care
• Family-centered
• Patient-centered
• Team-based
• Evidence-based
• Culturally competent
• Prevention –oriented
• Population and public health focus

4. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Healthcare Needs
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5. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Today’s system treats medical and behavioral
health as if they occur in two different
domains, rather than same person.
Mental illness often goes undetected and
undertreated by healthcare providers.
Integrated care has the potential for
decreasing significantly healthcare spending
and improving health outcomes 5

6. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Primary Care & Behavioral Health
• More behavioral health is seen in primary care than
in any other setting,
• Health center clients have greater behavioral health
needs than typical primary care patients.
• After health center expansion, more than 27,000 full
time behavioral health providers will be needed to
serve 40 million medical patients,
• Grantees will need to increase behavioral health staff
more than four-fold.
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BMC Health Services Research, 2013

7. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Primary Care + Behavioral Health =
Integrated Care
• In fully integrated care, patients become accustomed
to behavioral health care as a “routine part” of
primary care.
• Integrated care reduces stigma for patients, increase
patient engagement, and reduces attrition after care
is initiated .
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8. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Primary Care + Behavioral Health =
Integrated Care
• Underserved areas benefit since shortages
of behavioral health providers create long
wait times for patients needing appointments
• For the Latino underserved community, the
model serves to overcome barriers to access
to mental health services as well as
successfully addressing complex heath issues.

9. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Integration: an opportunity for CHC?
A cohesive delivery system already exists
Provider limitations
Alleviate provider shortages
Enhance recruitment and retention
Mobile migrant population – more likely to
benefit from short term, problem focused
solutions
Focus on prevention
Manage chronic conditions
Consistent with PCMH
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10. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Who will be the providers of integrated
care?
•> 50% of counties in US do not have a
psychologist, psychiatrist or social worker
•Challenges in recruiting & retaining
professionals
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11. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Workforce Needs
• Nation faces shortage of 91,500 physicians in
the next decade as a consequence of
Aging patient population with multiple chronic
conditions
Attrition in the physicians workforce as current
practitioners retire
Expanding diversity of the population
Role of the physician is changing
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12. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
What is the difference? A physician is a
physician is a physician…?
This is NOT an “I am the doctor and I call all the
shots” model!
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13. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Medical Schools Responding to Workforce Needs
• 2005 – LCME fully accredited a new medical school for the
first time since 1986 (FSUCOM). Total schools=125
• Today – 141 schools + increased enrollments (30% by 2016)
• New schools’ curricular innovations:
– Early clinical experiences for students
– Integration of basic & clinical sciences
– Emphasis on inter-professional training
– Case-based learning
– Emphasis on primary care and community service
– Culturally appropriate care
• Graduate Medical Education – incorporating PCMH model
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14. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
More Residencies Needed
•Without increase in GME training positions
(now frozen at 1996 levels), increase in
admissions will not address the shortage
•Good opportunity for CHC’s to address
workforce needs
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15. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Recent Congressional bills to
expand physician training
• Increase residency slo ts by 15,000 over next
five years
• Half would go to shortage specialties
• Priority to states with new medical schools
and hospitals that emphasize training in CHC,
community-based settings, hospital
outpatient departments
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16. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
What is Clinical Health Psychology doing?
Primary Care Psychology
The application of psychological knowledge and
principles to common physical and mental
health problems experienced by patients and
families throughout the lifespan and presented
in Primary Care
(McDaniel, Hargrove, Belar, Schroeder & Freeman, 2004)

17. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
What’s the difference? A psychologist is a
psychologist is a psychologist…?
This is NOT a behind closed doors
psychotherapy for months model!

18. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care Workforce Development: Primary Care
Psychology Competencies APA, 2014
• Mental health concerns
• Wellness
• Prevention
• Heath promotion
• Acute & chronic condition management
• Family participation
• Care coordination
• Ways to increase access
• Work with higher volumes of patients
• Team based care
• Diverse and aging population needs 18

19. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Psychology Workforce
• Shortage of internship sites
• Need for more specialized training in health
psychology

20. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
GROW OUR OWN
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21. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Community-based Medical Education
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22. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
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23. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
FSUCOM – Healthcare Network Partnership
• Rotations for medical students (both required and
electives)
– Summer Clinical Practicum
– Spring break outreach
– 3rd Year – Pediatrics, Family Medicine, Internal Medicine,
Community Medicine, Geriatrics
– 4th Year electives: FM – Underserved Populations; Medical
Spanish; Behavioral Medicine, Women’s Health
• Primary care Psychology Postdoctoral Fellows
• Family Medicine Residents rotations
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24. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Affiliation Agreement
FSUCOM
• Provides building
• Pays clinic for running the
building
• Provides faculty
administrator for
educational programs
• Recruits trainees
• Oversees educational
programs
• Provides faculty
development for clinic
providers
Healthcare Network
• Runs clinical operation
including billing
• Recruits physicians willing
to teach
• Provides housing for
students
• Quarterly incentive for
physicians who precept a
medical student
• Joint administrative
planning / meetings for
operations 24

25. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Benefits of Partnership
CHC
• Enhanced recruitment &
retention of providers
• Enhanced job satisfaction for CHC
staff with teaching roles
• Enhanced reputation as a
teaching site
• Access to resources (research, IT,
CME’s, staff training, etc)
• Services enhanced because of
educational needs
(e.g. behavioral skills)
• Enhanced community relations
• Joint grant opportunities for
program expansion
Medical School
• Access to mission population for
students
• Role models for students
• Research opportunities
• PCORI
• Opportunity to shape the clinical
environment without the
administrative burden of running
the clinic
• Physicians trained in CHCs 3X
more likely to work in
underserved areas
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26. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Partnership Opportunities for Implementation
of Evidenced–Based Practices
• Embedding clinician researchers into the CHC
to develop internal capacity to adapt EBP’s
• Evaluate clinical impact of adoption using local
data
• Availability of timely, locally collected
outcomes data should help promote EBP’s
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27. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
Attracting the new Generation of
Physicians & Psychologists
• New graduates expect what they received in
training
– Colleagues available for collaborative work – new
model (esp. Peds & FM)
– Academic environment – research opportunities
that are community based- translational research
– Opportunity to teach
– Opportunity for their own professional growth
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28. The Florida State University College of medicine
Educating and developing exemplary physicians who practice patient-centered health care
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CHC’s …
Look down the
street…there
may be a medical
school