UC Davis School of Medicine’s unique, community-based residency program fosters careers in primary care

Dr. Harris and residents visit patient © UC Regents
Tracie Harris, shadowed by internal medicine residents, meets with a patient.

Posted June 30, 2010

UC Davis School of Medicine program that immerses new physicians in a community health clinic practice is developing a more diverse workforce, delivering culturally competent care and helping address the need for more practitioners in medically underserved areas of California and beyond.

The model program, known as Transforming Education and Community Health (TEACH), has trained 25 internal medicine residents since 2005, including five who completed their residencies this month. Of the graduates who have been delivering primary care services for more than a year, nearly one-third work in medically underserved areas. The program has been especially successful in recruiting a diverse group of physicians, many of whom grew up in communities historically underrepresented in medicine.

“The TEACH program gives new physicians an incredible opportunity to experience the true rewards of primary care,” said Mark Henderson, professor of internal medicine and director of the residency program that includes TEACH. “They have the opportunity to follow patients over time and across different settings, creating the type of trust and understanding that is so important for effective health care. Our program also enables physicians to become part of a community early in their careers, which is unusual and can be very rewarding for young doctors who seek to actively participate in building healthier communities.”

Dr. Henderson © UC Regents“The TEACH program gives new physicians an incredible opportunity to experience the true rewards of primary care.”
— Mark Henderson

Trying to maintain and increase the numbers of physicians who practice primary care medicine is a national priority. The Association of American Medical Colleges (AAMC) estimates that an additional 45,000 primary care physicians will be needed by 2020 to keep up with rising needs and demands of an aging population. The number of new physicians entering primary care practices — generally defined as family medicine, general internal medicine and general pediatrics — has been on a downward trend for the past 10 years. The American College of Physicians estimates that not more than 20 to 25 percent of internal medicine residents currently choose general internal medicine as a career, compared with more than 50 percent in 1998. Lower compensation, larger administrative workloads and lower prestige than other medical specialties are a few of the leading reasons identified in physician surveys as causes of the decline.

Ranked among the top 20 schools by U.S. News & World Report for its excellence in primary care training, UC Davis has established a robust program in family and community medicine, pediatrics and internal medicine. In 2010, about 40 percent of School of Medicine graduates chose primary care residency programs.

“For me, what was so riveting about the TEACH program was its return to an almost ‘old school’ principle of care,” said Tracie Harris, who co-directs the program. While she started out her residency planning to practice in critical-care medicine, Harris found that it wasn’t as satisfying as she had anticipated. “TEACH enabled me to tell my patients, ‘When you’re sick and in the hospital, I’ll be there. When you’re well and in the clinic, I’ll be there, too, because I’m your doctor.’ It’s truly a rewarding experience.”

Dr. Harris © UC Regents“For me, what was so riveting about the TEACH program was its return to an almost ‘old school’ principle of care.”
— Tracie Harris

TEACH is unique in its focus on delivering care in medically underserved communities. In partnership with the Sacramento County Department of Health and Human Services and funded through the federal Health Resources and Services Administration, TEACH resident physicians each spend 32 weeks in a local clinic over the course of a year, in contrast to residents in most other training programs, who typically spend less than half that amount of time. The program’s innovative design and success has attracted national attention. Last year, in response to a congressional request, a team from the RAND Corporation and the Medicare Payment Advisory Committee visited the School of Medicine to gather information about unique residency training programs that aim to better prepare physicians for the challenges and rewards of caring for patients with chronic illness.

With UC Davis Medical Center just blocks from the county clinic, TEACH residents not only see their patients in clinic, but also in the hospital. With more consistent contact across the full spectrum of care, physicians develop strong bonds and a deep understanding of patient needs.

“When you feel mastery over something, you tend to like it more,” said Harris. “Gaining expertise in an ambulatory environment, in the clinic, can be very difficult. TEACH residents get so much more experience that it gives them more confidence in this skill set. Patients are more satisfied because they are receiving quality care that usually is delivered by a familiar face.”

TEACH enables a type of health care rooted in the effectiveness of long-term patient-physician relationships, something individuals and families with health insurance typically enjoy. Physicians who know a patient’s medical history based on a long-term clinical experience are able to integrate new medical information and make patient-care decisions more efficiently and effectively.

TEACH Program

The Transforming Education and Community Health (TEACH) program is a federally-funded primary care training program for residents interested in caring for the medically underserved and becoming leaders in academic General Internal Medicine (GIM). The long term goal of the TEACH program is to improve access to high quality health services by training GIM physicians who provide well-coordinated, evidence-based, culturally competent care to underserved adults with chronic illness. Click here to learn more.

The intensive nature of the TEACH program and its strong connection to the community makes it an attractive option for medical students who are considering a variety of residency options. The UC Davis Department of Internal Medicine is now focusing on how to enhance the program with plans that call for even more community-oriented curricula, including a youth-mentoring component, as well as a partnership with a Native American health center in Sacramento.

In the meantime, Harris and other members of the TEACH team remain committed to the rewards of primary care.

“Most of us went into medicine because of a desire to give unto others,” said Harris. “Ultimately, practicing physicians are ‘people, people.’ The connections we make, whether it’s in the hospital or clinic office, are what drive us. The TEACH program enables physicians to know their patients and, we hope, continue to establish those types of bonds throughout their careers in primary care.”