Growing the Health Workforce: Community Based Residency

Training

Allen L. Hixon, MDAssociate Professor and Vice Chair

University of HawaiiDepartment of Family Medicine and

Community Health

Social Determinants of Health

Social determinants of health are:

• the conditions in which people are born, grow, live, work and age, including the health system.

• these circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.

• mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.

» WHO CSDH

How we receive care

N Engl J Med 2001; 344:2021-2025 June 28, 2001

Neighbor Island Health

• Poor health outcomes• Access to care • Drastic shortage of primary care

– Current shortage 150 primary care physicians to meet national physician to population ratios

– With aging/retirement of workforce demand will increase

• Withy/Sakamoto

Hawaii Island Rural Residency Program

• Problem – Physician/provider shortage, limited access to care, rural neighbor island focus

• Proposed solution – Increase physician/provider pipeline by developing a rural interdisciplinary FM residency program and collaborative training site

• 12 residents (four per year) based in Hilo Hawaii• Collaboration

– Hilo community/Hilo Medical Center– UH SONDH– UH College of Pharmacy

Hawaii Island Rural Residency

• Principles– Meet real needs of community– Interdisciplinary team based – Financially sustainable– High quality teaching and patient outcomes

Collaboration

• Needs Assessment – SHPDA– Workforce Data– NHHS– FQHC– Alliance– Mayor’s Office– Others

• Planning– Academic partnersJABSOMSchool of Nursing and Dental

HygieneCollege of Pharmacy

• Funding– CMS– HRSA– HMSA– Tri-West– State of Hawaii– HMC Foundation– Shipper’s Wharf– Individuals

• Implementation– HMC– UCERA– JABSOM– Steering Committee with

community partners

Residents

Foundation

Rural Residency

Family MedicineFaculty School of Nursing

JABSOM

Hilo Medical Center

Medical Students/Learners

Medical Staff

CMS

HMSA

TriWest

HRSA

Hawaii State Legislature

Patients/Community

College of Pharmacy

Progress to date

• Collaborative clinical practice site

• 2 family physicians (one more coming)

• 1 APRN

• 1 PharmD

• 1 RN

• 1 GYN consultant

• Telepsychiatry program

Next steps

• ACGME FM accreditation

• Build clinical practice and teaching

• Develop interdisciplinary curriculum

• Patient Centered Medical Home

• Quality initiatives

What we did well

• Solution oriented

• Messaging re: workforce shortage and critical need

• Created public-private partnership for funding

Barriers to collaboration

• Underestimated level of complexity• Created expectations

– Timeline– Cost

• Did not fully understand objectives, expertise or limitations of the various partners

• At times communicated poorly with partners

Engaging the Community

• Social determinants are the conditions that exist in the community that promote or undermine good health

• Program success linked to level of community support

• Be informed

• Advocate with lawmakers