SCEP THE OFFICE OF STATEWIDE CLINICAL EDUCATION PROGRAMS

ANNUAL REPORT 2010

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The Offi ce of Statewide Clinical Education Programs (OSCEP) is a unit of the Carver College of Medicine’s administration. Established in 1974, OSCEP has principal responsibility for developing and coordinating collegiate outreach programs for medical education and community service. This continuous eff ort over more than thirty-fi ve years has resulted in a high level of visibility and trust for the offi ce and for the Carver College of Medicine in Iowa communities.

OSCEP is comprised of three divisions:

Community-Based Medical Education Community Services

Information Systems and Research Services

This report summarizes select 2009-10 OSCEP activities.

The Division of Community-Based Medical Education (CBME) is responsible for administration and coordination

of the Statewide Medical Education System (SMES) in partnership with the University of Iowa’s six Regional Medical Education Centers (RMECs). The SMES was established by the Iowa Legislature in 1973, and provides the venue for carrying out the University’s medical education activities that occur outside the academic health center in communities across the state. The map below summarizes that activity for 2009-2010.

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Community-Based Medical Education

Statewide Medical Education SystemLocation of Educational Activities

2009-2010

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Clinton(3)

IOWA FM GRADUATES PRACTICING IN IOWA (801)

Ackley(2)

Shell Rock(2)

Iowa Falls(4)

Akron (2)

Albia(3)Ottumwa

Algona(7)

Altoona(5)Bondurant

Amana(3)

Ames(12)

Huxley(2)Polk City

BellevueAnamosa(7)

Monticello

Ankeny(13)

Atlantic(2)

Bettendorf(16)

BloomfieldKeosauqua

Keokuk

Boone(6)

Carlisle(2)Norwalk(5)

Cedar Falls(12)

Cedar Rapids(52)

Hiawatha(11)

Centerville (4)

Chariton(2)

Charles City

Clarion(3)

Belmond

Clear Lake(5)

Garner

LeClaire

Clive(7)Stuart

ConradVinton

Brooklyn

Council Bluffs(6)

Creston(2)

Dallas Center

Coon Rapids

Davenport(32)

Decorah(8)Cresco(3)

Denison(2)

Jesup

Denver

Des Moines(73)

DeWitt(3)

Wilton(2)

Dubuque(12)

Dyersville

Eldridge(4)

West Union(3)

Estherville(5)

Fairfield(4)

Fort Dodge(3)

Fredericksburg

Hampton(2)

Sumner(2)

Greenfield

Fontanelle

Grimes(2)Grinnell(7)

Guttenberg (3)

Harlan(2)

MissouriValley(3)

Hudson

Grundy Center(4)La Porte City

Humboldt(2)

Independence(4)Evansdale(3)

Parkersburg

Indianola(3)

Clarinda

Iowa City(42)

North English

Jefferson(3)

Johnston(8)

Fort Madison

LeMars(4)

Leon

Colfax

Manchester(3)

Manning (2)

Maquoketa(3)Marion(9)

Marshalltown(9)

Mason City(23)

Mt Pleasant(7)

Mt Vernon(4)

Muscatine(6)

Nevada(3)

New Hampton

Newton(14)

Nora Springs

Lake Mills

Northwood

North Liberty(7)

West Liberty(2)

West BranchCoralville(2)

Oelwein(2)

Orange City(8)

Osage(2)

Osceola(2)

Oskaloosa(6)Knoxville(4)

Panora(2)Adel

Waukee(3)

Pella(9)

Perry(3)Woodward

Pleasant HillPrairie City

Red Oak

Sidney

Rockford(4)

Rockwell City

Ida Grove(2)

Sheffield

Sibley

Hull(2)

Rock Valley(2)

Sioux Center

Sheldon(4)

Sioux City(34)

Kingsley

Sergeant Bluff(2)

Spencer(11)

Emmetsburg (3)

Spirit Lake St Ansgar

Storm Lake(8)

Story City

Tipton

Tama

Toledo

SolonMarengo(2)

Urbandale(14)

Washington(5)

Waterloo(26)

Waukon(3)

Waverly(9)

Webster City (3)

West Burlington(8)

West Des Moines(15)

Winterset(4)

Hawarden

The Iowa Family Medicine Training Network is the “backbone”of the Statewide Medical Education System. It is comprised of seven community-based family medicine residency programs and one at the University of Iowa. OSCEP provides administrative, educational, and technical support to the network of residency programs, all of which are formally affi liated with The University of Iowa. One hundred and fi ft y-two residents were enrolled in Network programs in 2009-10. The total number of patient visits at the family medicine centers was 189,204. Sixty-four percent of the 42 Network graduates in 2010 stayed in Iowa to practice. The map (below) shows the locations of the 801 family medicine Network graduates who are practicing in Iowa as of March 2010.

801 Iowa family medicine graduates practice in 160 Iowa

communities.

As part of the educational support to the Network, CCOM faculty conducted 93 teaching visits in 2009-10 at the

community-based training sites through the College’s Visiting Professor Program, which is administered by OSCEP. Visiting Professor Program outreach supplements instruction by full-time faculty and volunteer community physicians at each site. Sixty-seven CCOM faculty participated in the Visiting Professor Program during the year.

OSCEP staff also administered a two-day Advanced Life Support in Obstetrics (ALSO) course for 66 Iowa family medicine residents and faculty. Eighteen residency faculty taught the course, accredited by the American Academy of Family Physicians. David Bedell, M.D., Clinical Associate Professor in the CCOM Department of Family Medicine, served as Course Director.

Iowa FM Graduates Practicing In Iowa

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The CBME Division collaborates with the CCOM Offi ce of Student Aff airs and Curriculum to administer the Clinical Shadowing Program. Each medical student, in the second semester of their fi rst year, must complete two half-day shadowing experiences with providers within a 40 mile radius of Iowa City. Staff identifi es over 500 potential shadowing experiences each year and makes the student assignments. Seventy preceptors provided 286 shadowing experiences for 143 M1 students in 2009-10.

CBME staff administer the required four weekCommunity-Based Primary Care Clerkship under the direction of Dr. Paul Mulhausen, Clinical Professor inthe CCOM Department of Internal Medicine. The clerkship combines clinical experience in primary care with exposure to the various community health issues and local resources. The community experience is coordinated through the six UI-Affi liated Regional Medical Education Centers. In 2009-10, 136 M3 students completed the clerkship with the support of over 90 preceptors and numerous community agencies and services.

Clinical Shadowing Program*2009-2010

* First-year medical school

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Each year OSCEP collaborates with the CCOM Offi ce of Consultation and Research in Medical Education (OCRME) to

deliver Faculty Development Workshops to the volunteer teachers in the six Regional Medical Education Centers. Topics are selected to enhance teaching skills and content. Nearly 130 community faculty participated in eight workshops held across the state in 2010. The workshop topics in 2010 were Learning Styles: Maximizing Our Eff orts in Medical Education and The Fine Art of Feedback: Eff ectively Using the Process to Exchange Evaluation Information.

“The faculty who lead these sessions are superb...Beyond the personal benefi ts I have enjoyed,

I know all teaching faculty in the Des Moines area have benefi ted from the faculty development

programs since the Community Teaching Scholars Program was initiated.”

Steve Craig, M.D., Executive DirectorDes Moines Area Medicial Education Consortium

and UI Community Teaching Scholar

The CCOM Community Teaching Scholars Program is designed to promote the development of a cadre of community-based faculty members who have advanced skills in educational faculty development and are able to convey this knowledge to their peers. This “train-the-trainer” program is led by Marcy Rosenbaum, Ph.D., Associate Professor in the CCOM Department of Family Medicine and Faculty Development Consultant in OCRME, and is supported administratively by OSCEP. At least two faculty at each RMEC are designated as a Community Teaching Scholar. They att end quarterly sessions on campus, develop their own teaching skills workshops, and co-facilitate regional faculty development workshops at their respective sites. Seventeen Community Teaching Scholars participated in the program in 2009-2010.

Community Services

The Division of Community Services is responsible for developing relations with and providing services for the benefi t of Iowa physicians, practices and health care organizations. The services provided are encompassed by the

Medical Practice Development Program which includes programs and activities in the areas of physician and non-physician provider recruitment; placement and retention; practice management; and practice coverage. These services are not typically isolated and independent of each other. A single interaction with a physician, a medical practice or hospital oft en results in staff providing a series of services.

The schematic below illustrates the organization of the specifi c medical practice development services provided by the Community Services Division of OSCEP.

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OSCEP staff provide Recruitment, Placement and Retention Services in towns across Iowa. They understand the numerous challenges that medical practices, particularly rural communities, face in the recruitment and retention of physicians. Recruiting communities receive assistance in creating practice opportunity descriptions, preparing community profi les, producing targeted mailings to prospective candidates, arranging preceptorships, and coordinating community visits. In 2009-2010, Community Services staff provided recruitment assistance and related services to 120 communities in 85 of Iowa’s 99 counties. The communities of Audubon, Creston, Oskaloosa, Nevada and Storm Lake received extensive services. The map above shows the towns across Iowa receiving some form of OSCEP community services in the past year.

Staff also meets with physicians and non-physician providers to discuss practice preferences, help prepare CVs and provide information about practice opportunities. Staff worked individually with 99 physicians in 2009-2010.

The Community Services Division off ers

Practice Management Services,practice feasibility studies, practice management consultation, and market research. Many medical practices contact OSCEP seeking help with recruitment, but oft en benefi t from the practice analysis that staff conduct while meeting their recruitment needs. Patient population, practice patt erns, and regional employment trends are routinely considered in making recommendations.

Communities Served*2009-2010

* 120 Communities in 85 counties

“OSCEP’s analysis and guidance regarding Mahaska Health Partnership’s relationship

with Oskaloosa physicians has led to collaboration that will positively impact our

community for years to come.”Jay Christensen, Administrator and CEO

Mahaska Health PartnershipOskaloosa, Iowa

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The Rural Physician Support Program (RPSP), is funded by Iowa’s Primary Care Initiative and administered by the Community Services Division. The RPSP provides recruitment and retention services specifi cally aimed at rural communities. Unique to the RPSP is the practice coverage service for Iowa primary care practices in rural towns. In this service, resident physicians currently enrolled in Iowa primary care residency programs provide supervised coverage for rural medical practices that have an absent physician.

RPSP Practice CoverageReasons for Physician Absences

1994-2010 FrequencyVacation 237Health Reasons/Maternity 36CME/Meetings 18Vacation/CME/Meeting 9Recent Practitioner Relocation 20Total Coverage Events: 320

Since July 1994, resident physicians have covered rural practices 320 times allowing physicians to leave for vacation, CME, and health reasons (below). Family Medicine residents provided coverage in 238 cases, internal medicine residents, 38 times, and 44 involved pediatric residents.

In the aggregate, practicing physicians have been absent from their practices for 568 weeks, and participating residents have received a total of 961 weeks of community medicine experience during the lifespan of this program. Coverage has occurred in most regions of the state.

OSCEP also provides a number of Administrative Support Services for UI-Affi liated Residency Programs. Staff administer and facilitate: Statewide Family Medicine Training Network Interest Groups for: Administrators Behavioral Science Faculty Residency Program Coordinators Residency Program Directors UI-Affi liated Medical Liability Insurance Plan Health Benefi ts Plan for UI-Affi liates Iowa Family Medicine Residents Council Long-Term Disability Plan for UI-Affi liated Residents

These services enable the programs to integrate their activities and achieve savings that cannot be realized independently.

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To support recruitment and placement activities, Community Services produces the Iowa Medical Practice Opportunities Directory. The Directory is generated from a comprehensive survey of practice sites off ering opportunities in the specialties of family medicine, emergency medicine, general internal medicine including hospitalists, general surgery, obstetrics and gynecology, pediatrics, psychiatry, and opportunities for physician assistants and advanced nurse practitioners. Of the 110 communities listed in the Directory in 2009-2010, 42 also received direct recruitment assistance in preparing opportunity descriptions, candidate sourcing, arrangement of interviews or contract review. The Directory is post-ed on the OSCEP website. Over 380 printed copies of the opportunities directories were also distributed to Iowa physicians-in-training and students in Iowa physician assistant and advanced nurse practitioner programs. Practicing physicians seeking alternatives to their current practice also routinely request the Directory. The data provided in the Directory also allows OSCEP to track Iowa workforce demand trends over time.

IOWA family medicine &

emergency medicine

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opportunities directory 2009-2010

The Division off ers a Contract Review Service for physicians and non-physician providers who are practicing or completing their training. A typical contract “review” includes (1) independent critiques by at least two staff members; (2) a 2-3 hour feedback session with the provider and the provider’s spouse; and (3) a lett er summarizing the key points of the review. The long-standing contract review service and routine contract discussions with physicians and practice organizations create the knowledge base used to produce this service. In 2009-2010, contract review seminars were also provided to pediatric and general internal medicine physicians-in-training at University of Iowa Hospitals and Clinics, and at UI-Affi liated Family Medicine Residency Training Programs in Cedar Rapids, Waterloo, and Davenport.

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The Iowa Health Professions Tracking Center, operated by OSCEP, maintains continuous inventories of Iowa’s major health professions:

physicians • pharmacists • dentists • physician assistants • advanced practice nurses •

Established in 1977, the Iowa Physician Information System served as the model for the creation of the other health professions tracking systems. In 1994, the Iowa General Assembly approved the Primary Care Initiative, a state supported program designed to augment the state’s eff orts to produce primary care doctors. In FY 1995, the Primary Care Initiative was expanded and part of the funds were designated for the purpose of establishing and operating the Iowa Health Professions Inventory, a database for continuous tracking of Iowa’s health professions workforce.

Information Systems and Research Services

“The Iowa Dentist Tracking System is a unique monitoring technique that is the envy of other dental school deans. It helps planners highlight geographic areas where additional resources are needed both short and long term.”

Dean David JohnsenCollege of Dentistry

The University of Iowa

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The Iowa Health Professions Inventory (IHPI), contains demographic, educational, and professional information for over 11, 000 actively practicing Iowa health care providers.

The inventory characterizes the health care workforce (e.g., age, gender, and worksite), monitors trends, and facilitates research on the state’s health care workforce. Its benchmarking capacity enables users to track changes in supply and geographic distribution over time. The tracking system is monitored and updated on a continuous basis, incorporating changes in the workforce due to deaths, retirements, relocations, and new practitioners entering practice.

IHPI enables users to chart specifi c trends, forecast changes in the state’s health professions workforce, characterize the workforce demographically, and gauge the return on the state’s investments in health professions education.

Advisory committ ees for pharmacists, dentists, advanced practice nurses and physician assistants were established to guide development of their respective health professions tracking system. The advisory committ ees were essential to the initial design and development of the tracking systems. They continue to play an important role in reviewing the data and supporting the user guidlines and policies.

Since 1977, OSCEP has been tracking the supply and distribution of Iowa Physicians. The physician tracking system inventories all active allopathic and osteopathic physicians in all specialties and allprofessional activities. From 1977 to 2009, the supply of Iowa physicians increased by 80%.

2991

3230 3475

35443729

4001 4262

4545 4828

50255183

5382

2500

3000

3500

4000

4500

5000

5500

'77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09

IA vs. U.S. Benchmark 2000-2008* • U.S. supply increased by 13% • IA supply increased by 10%

Supply increased by 80% in 32 yrs. (2.5% per year)

Iowa Physician Supply1977-2009

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The continous inventory of Iowa’s Pharmacists was started in 1996. Iowa had 2,344 pharmacists at that time. By the end of 2009, the supply had icreased to 2,772. Notably, in 2003 the number of female pharmacists (1,273) in Iowa’s workforce edged past the number of males (1,261). Today 57% of Iowa’s pharmacist workforce is female.

Pharmacy Advisory Committ ee Michael Kelly, PharmD Dean for Academic Aff airs, UI College of Pharmacy Barbara Kelley, BBA, BA Associate Director, UI College of Pharmacy Donald E. Letendre, PharmD Dean and Professor, UI College of Pharmacy Raylene Rospond, PharmD Dean, Drake University College of Pharmacy and Health Sciences Tom Temple, RPh Executive Director, Iowa Pharmacy Association

Terry Witkowski Executive Offi cer, Iowa Board of Pharmacy

Iowa PharmacistsGender

1996-2009

In 1997, the Physician Assistants (PAs) tracking began with a benchmark of 265 PAs. Practicing PAs have increased by over 140% in the last ten years to 642. The Iowa Physician Assistant population also maintains a youthful profi le boasting 42% under the age of 40.

Advisory Committ ee for PAs David Asprey, MA, PA-C

Director, UI Physician Assistant Program

Tina Brightwell, PA-C President, Iowa Physician Assistant Society

Theresa Hegman, MPAS, PA-C Board Member, Iowa Board of Physician Assistants

Jolene (Jo) Kelly, MPAS, PA-C

Director, Des Moines University Physician Assistant Program

Active Iowa PAs1999-2009

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Tracking of Advanced Practice Nurses (APNs) began in 1998. The inventory count was 336, which included Certifi ed Registered Nurse Anesthetists, Nurse Midwives, Clinical Nurse Specialists and Advanced Registered Nurse Practitioners. By the end of 2009, APNs in Iowa numbered 1,145. This represents an 80% increase over a 10-year period. Advanced practice nurses were working in 175 Iowa communities and 94 of Iowa’s 99 counties at the close of 2009. The largest category of APNs is family nurse practitioners (452), representing 39% of all APNs. Advisory Committ ee for APNs

Dolores Hilden, PhD, RN Iowa Association of Colleges of Nursing

Diane Huber, PhD, RN, FAAN, NEA-BC Professor, UI College of Nursing

Linda Goeldner, MA, MA, CHE, CAE Executive Director, Iowa Nurses Association

Lorinda Inman, RN, MSN Executive Director, Iowa Board of Nursing

Brenda Hoskins, DNP, MSN, ARNP, GNP-BC Iowa Nurse Practitioner Society

Family Nurse Practitioners (452)

Cedar

Greene

Hancock

Humboldt

Ida

Lyon Osceola

Palo Alto

Sac

Winnebago

Pocahontas

Benton

Butler

Chickasaw

Clayton

Delaware

Franklin

Grundy

Howard

Jones

Mitchell

Tama

Worth Allamakee

Louisa

Adair

Adams Clarke

DavisDecaturFremont

GuthrieHarrison

Keokuk

Lucas

Madison

Mills Monroe

Ringgold

Shelby

Taylor Van BurenWayne

75

Polk

Woodbury

Pottawattamie

VistaBuena

Carroll

3

3

Black Hawk

23

Boone

Bremer

6

Buchanan2

Cass

2

CerroGordo

16

6

Cherokee

2

3Clay

Clinton12

Dallas

22

Des Moines

5

2

Dubuque

20

Emmet

Fayette

Floyd

2

2Hamilton

10

2

Hardin

1

Henry

Jackson

Jasper

8

Jefferson

Lee

2

Linn

21

1

MahaskaMarion

8

Marshall

4

Page

4

4

3

16

Poweshiek

1

2

Scott

2

Sioux

Story

6

Union

1 3

Wapello

10

Warren Washington

1

1

Webster

2Winneshiek

4

15

1

Muscatine

1

2

3

Crawford

Montgomery

Dickinson

Appanoose

Iowa

Wright

Kossuth

Calhoun

O'Brien

Monona

Plymouth

6

Johnson

33

3

4

1

3

1

3

2

2

2

1

2

71

2

1

1

1

4

1

3

2 2

2

1

2

2

3

3

1

1

1

In 1997, the supply of Iowa Dentists was benchmarked at 1,446. Over the next 12 years 669 dentists entered Iowa practices, but 631 left practice during the same period. So, the net gain in 12 years was only 38, increasing the total supply to 1,484. The level supply is an even greater concern considering more than 50% of Iowa’s dentists are past age 50.

60-6915.7%

50-5934.6%

40-4919.8%

30-3920.0%

< 306.5%

703.4%

Age Category No. % Cumulative %> 70 51 3.4% 3.4%60 69 233 15.7 19.150 59 513 34.6 53.740 49 294 19.8 73.530 39 297 20.0 93.5< 30 96 6.5 100.0%

1484 100.0%

Dentistry Advisory Committ ee Jed Hand, DDS Executive Associate Dean, UI College of Dentistry Melanie Johnson, JD Executive Director, Iowa Board of Dental Examiners David Johnsen, DDS Dean, UI College of Dentistry

Perry Grimes, DDS

Member, Iowa Dental Association Raymond Kuthy, DDS, MPH Professor, Preventive and Community Dentistry, UI College of Dentistry

Iowa DentistsAge Distribution

C ntact UsC

Assistant Dean and DirectorRoger Tracy roger-tracy@uiowa.edu

Associate Director andCommunity-Based Medical Education Division DirectorCarol Alexander carol-alexander@uiowa.edu

Community Services Division DirectorLynett e Lancial lynett e-lancial@uiowa.edu

Information Systems Division DirectorTheresa Dunkin theresa-dunkin@uiowa.edu

EditorKristine Dolezal kristine-dolezal@uiowa.edu

DesignKathleen Testin kathleen-testin@uiowa.edu

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The Offi ce of Statewide Clinical Education Programs (OSCEP)Carver College of Medicine2133 MLThe University of IowaIowa City, IA 52242Phone: 319/335-8618Fax: 319/335-8034Web: www.medicine.uiowa.edu/oscep

OSCEP Contributes to Rural Recruitment

Excerpted from: Szabo, J., “The Wichita-to-New Hampton Six.” Hospitals and Health Networks Magazine, Feb. 2011: 38-42.

Mercy Medical Center in New Hampton, Iowa successfully recruited six family physicians to their northeastern Iowa town of 3,750 residents. The lessons Mercy learned from this recruiting experience provide important insights for other health care organizations in need of doctors.

“If you build it, they will come” was more than just a slogan according to Bruce Roesler, the New Hampton hospital’s president and vice president of Mercy Medical Center-North Iowa in Mason City. “The facility was constructed in a large measure as a recruitment initiative, “ said Roesler. To be competitive in today’s market, New Hampton needed a great facility that would help att ract physicians.

Another of the lessons learned, was provided by Roger Tracy, Assistant Dean and Director of the Offi ce of Statewide Clinical Education Programs for the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa. Before Mercy began its recruiting eff ort, Tracy met with the hospital’s board of trustees, community leaders and administrative staff to point out the benefi ts of hiring in multiples. “It oft en makes sense to hire more than one physician at a time,” says Tracy. “ It is easier and more eff ective for everyone if a health care organization can hire in multiples,” he says, noting that it also helps with retention.

Bringing in one physician at a time defi nitely has its downsides. For example, since there aren’t enough doctors in the call schedule, the new physician has to work more nights, weekends and holidays. It is also important not to neglect the employment needs of the doctors’ spouses and their outside interests. “The defi ning lesson for rural communities trying to recruit physicians is that hospitals have to off er lifestyle advantages,” Tracy says.

Tracy goes on to explain that today’s young doctors are looking at how they can mold their professions to their lives, as opposed to being molded by the profession. The six family medicine residents from Wichita were searching for a fl exible atmosphere that accommodated their lifestyle preferences and for a modern clinic where all six of the physicians could practice. Happily for all parties involved, the practice at Mercy Medical Center-New Hampton fi ts their needs perfectly.

Roger TracyAssistant Dean and Director