Preparing a community-oriented primary care workforce
While the U.S. spends twice what other nations spend per capita on health care, we rank near the bottom in key indicators such as infant mortality and life expectancy. The country’s poor performance includes unconscionable health disparities along racial, ethnic, socioeconomic and geographic lines. Sixty-four million Americans live in primary care shortage areas, and only about half of adults under age 65 receive recommended preventive services. These failures reflect the nation’s urgent need for a primary care workforce that is large enough and skilled enough to care for current patients and the 30 million soon-to-be insured under health-care reform.
Medical schools must find solutions to primary care shortages, and institutions committed to research must show students how to leverage community-based participatory research to improve care and outcomes for underserved communities. Medical schools need to seek out applicants who are passionate about primary care and the underserved, implement programs and curricula that will nurture those passions, and graduate students who understand how to partner with communities to achieve better health. I am proud to share model programs and strategies at UC Davis Health System.
Start with admissions
Admissions processes must proactively identify prospective students who are interested in primary care and underserved communities. UC Davis successfully utilizes multiple mini-interviews, which leverage 10-minute interview vignettes to reveal candidates’ special interests, abilities and experiences. We are very pleased with the results — more than half the students accepted to the class of 2016 expressed interest in special programs for primary care and underserved communities.
Create innovative programs
Schools must expose students to innovative education and training that encourages, harnesses and satisfies their interests in primary care and underserved communities. Rural-PRIME and San Joaquin Valley-PRIME are five-year programs at UC Davis that combine an M.D. degree with a master’s degree for those interested in serving rural communities. In these programs, students also learn how to use telehealth technologies so rural patients may receive specialty care without leaving their communities. TEACH-MS (Transforming Education and Community Health for Medical Students) is a four-year M.D. program focused on community-based experiences in underserved urban areas. PRIME clinical rotations take place in rural hospitals and TEACH-MS rotations occur in urban clinics.
These programs use the community as the classroom to provide students with first-hand experience early in their education and training, which helps fill the health professions pipeline with students who have lived the personal fulfillment of primary care and service to the underserved and, therefore, will be more inclined to practice primary care and commit to serving disadvantaged communities.
Provide new venues for learning
To prepare students for the transformation currently underway in the health-care system, learning venues must include the non-traditional environments in which future primary care providers will practice, such as community centers, retail pharmacy clinics, workplaces and schools. In addition to hospitals and clinics, UC Davis students are learning in these new settings. These community-oriented, social-determinants-based venues reflect a paradigm shift in the health-care system from hospital-based, acute intervention and crisis care to a primary care, population-health driven approach; from fragmented health services to a coordinated continuum of care across the life span.
Emphasize interprofessional learning
Students who train in professional silos cannot be expected to work effectively in care teams after they graduate. Innovative models of primary care incorporate interprofessional teamwork. To prepare the next generation of health-care providers for this reality, UC Davis provides students with interprofessional courses and simulation in virtual clinic rooms and operating rooms that facilitates the development of interprofessional communication and collaboration needed for patient-centered primary care. Students have expressed their support for interprofessionalism by forming interprofessional student interest groups that help advance additional interprofessional educational opportunities and provide social experiences that enhance the understanding and respect of other future health professionals enrolled at UC Davis.
Accelerate curriculum reform
Adequately addressing the health needs of our nation requires that medical schools change what, how and where they teach. The UC Davis curriculum includes primary care-oriented courses and training that focus on the social determinants of health, health disparities, cultural competence, and teaching systems-based approaches and their relationship to safe, high-quality and cost-effective patient care. The entire UC Davis Health System comes together during the annual Integrating Quality Symposium to share best practices and innovations that incorporate quality improvement initiatives into undergraduate, graduate and lifelong learning programs. The next generation of primary care providers at UC Davis further benefit from research programs that focus on telehealth, social determinants of health, health disparities and health-care policy.
Preparing primary care leaders
The primary care workforce must change dramatically if our nation is to control health costs and improve outcomes. Practitioners will work in new ways, in new venues and with new expectations. Patients will be empowered, and primary care providers will be the face of most health experiences. Today’s students must prepare to be leaders in this new landscape, which will require advocating for their patients and for public policies that will impact health and health care.
One way UC Davis prepares medical students for this role is through opportunities for them to participate in advocacy programs at the state Capitol, speaking out on behalf of their future patients. Other programs, such as the Community and Health Professions Together program, teach students to partner with community leaders to unlock the understanding of a community’s unique interests, perspectives and barriers to better health, and how to use such information to shape responsive interventions and services.
The nation is facing huge challenges and unprecedented opportunities in health care and health. Ensuring a skilled primary care workforce that is focused on the needs of communities is central to achieving the goal of better health for all. Students deserve to know the excitement, satisfaction and joy of primary care, and the country deserves the health benefits these future practitioners will provide. Now is the time for academic health centers to ensure that they meet the mission of training the very best community-oriented primary care practitioners.