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Doctors for the People: Training Physicians to Work in Under-served Urban Communities

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.

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Doctors for the People: Training Physicians to Work in Under-served Urban Communities

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  1. 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

  2. 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.

  3. 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.

  4. 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

  5. Locating Programs • Google Search for websites; Google Scholar for articles • Snow-balling technique (referrals) • HRSA funded programs (1999-2000) to promote Primary Care

  6. 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

  7. 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

  8. 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)

  9. 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

  10. 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

  11. Residency Programs (sample) New York • Residency Program in Social Medicine (FM,IM,PED) Washington • University of Washington, Tacoma Family Medicine

  12. 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)

  13. 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

  14. Educational Philosophy • Emphasis on Primary Care • Work in communities, specifically underserved communities • Work in Community Health Centers

  15. Recruitment/Retention • Pairing with college-level pipeline programs • Trainees expected to share program vision of working in underserved communities • Special mentorship & assistance

  16. 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

  17. 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

  18. 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.

  19. 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

  20. 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

  21. 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)

  22. 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.

  23. 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?

  24. Thank You Contacts: Matthew Anderson, MD, MS bronxdoc@gmail.com

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