The Florida State University College of medicine

Educating and developing exemplary physicians who practice patient-centered health careThe 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

The Florida State University College of medicine

Educating and developing exemplary physicians who practice patient-centered health care

Healthcare ReformShift from caring for the sick to

maintaining health

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

The Florida State University College of medicine

Educating and developing exemplary physicians who practice patient-centered health care

Healthcare Needs

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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

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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.

6BMC Health Services Research, 2013

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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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.

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 existsProvider limitationsAlleviate provider shortagesEnhance recruitment and retentionMobile migrant population – more likely to

benefit from short term, problem focused solutions

Focus on preventionManage chronic conditionsConsistent with PCMH

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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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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

conditionsAttrition in the physicians workforce as current

practitioners retireExpanding diversity of the populationRole of the physician is changing

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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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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 model13

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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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 slots 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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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 PsychologyThe 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)

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!

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

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

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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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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The Florida State University College of medicine

Educating and developing exemplary physicians who practice patient-centered health care

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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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The Florida State University College of medicine

Educating and developing exemplary physicians who practice patient-centered health care

Affiliation AgreementFSUCOM

• 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

The Florida State University College of medicine

Educating and developing exemplary physicians who practice patient-centered health care

Benefits of PartnershipCHC

• 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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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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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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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…theremay be a medical school