UC Davis program addresses California's need for diverse physician workforce

doctors with patient
IMPART program second-year resident Angie Yu evaluates a patient at the Sacramento Primary Care Clinic with doctors John Onate (left) and Sergio Aguilar-Gaxiola (right).

Post July 11, 2012

An innovative physician education program that combines psychiatry with either family practice or internal medicine training has received $1.2 million in additional funding from the California Department of Mental Health to extend the program through 2014.

Established in 2009, the Integrated Medicine/Psychiatry Ambulatory Residency Training (IMPART) program is the largest combined program of its kind in the country, and the only one that combines residencies in internal medicine with psychiatry in the western United States. The program currently includes 18 physicians in training but, with the supplemental funds, four new physicians began their five-year program in July to become board certified in two specialties.

"The grant is a clear recognition of the importance of integrated medicine in health care today," said Robert McCarron, an associate professor in the UC Davis Department of Psychiatry and Behavioral Sciences and Division of Pain Medicine. He is also the immediate past president of the Association of Medicine and Psychiatry and the Central California Psychiatric Society.

"We are not only training physicians who mostly come from underrepresented or culturally diverse backgrounds themselves but who will also work in underserved settings and be future residency directors, policy makers and thought leaders in this critical area."
— Robert McCarron

"We are not only training physicians who mostly come from underrepresented or culturally diverse backgrounds themselves but who will also work in underserved settings and be future residency directors, policy makers and thought leaders in this critical area," he said. 

Research shows that underrepresented minority physicians are also more likely to work in health workforce shortage areas and to care for medically underserved populations, patients of their own ethnic group and Medicaid recipients.

Moving toward integrated health care

Integrated health care has emerged as a much needed new movement in the United States to help address mental and physical health needs in primary-care settings. Under health-care reform, the demand for primary-care doctors is expected to increase substantially; in addition, more than half of all mental health care now is delivered in the context of primary care. Personnel trained through the IMPART program will be counted on in the near future to help alleviate a projected severe shortage of physicians in California and throughout the nation.

Individuals with serious mental illness can expect to live 25 fewer years than the general population, and physicians miss nearly half of co-morbid chronic disease conditions in people with serious psychiatric disorders. The combined residency programs not only train primary-care doctors to better recognize and address mental health issues, but they also train psychiatrists to practice better preventive medicine and improve care to improve health outcomes for all patient populations.

Doctors discuss patient load at Sacramento County Primary Care
The Sacramento County Primary Care Center is one of the sites where residents will receive combined training in mental and primary health care.

"A multicultural focus is imperative in California, where minorities are now in the majority," said Sergio Aguilar-Gaxiola, a professor of internal medicine and director of the UC Davis Center for Reducing Health Disparities. "Our charge through the IMPART program is to meet the health needs of the patient population in California, and that population is widely and increasingly diverse. It is anticipated that health-care reform will result in an unprecedented number of newly insured patients, and because these patients will come mostly from poor and underserved communities, these changes will require academic health centers to fundamentally realign their core training and health-care delivery practices. Innovative initiatives such as the IMPART program is strategically contributing to increase the numbers of personnel prepared to work with these currently uninsured and underserved patient communities."

Overcoming language and cultural barriers

Residents receive combined training in the Integrated Behavioral Health Clinic at the Sacramento County Primary Care Center, as well as in special integrated medicine clinics at UC Davis Medical Center.

Second-year resident Angie Yu, who is in the combined internal medicine and psychiatry track, became interested in the program as a medical student when she rotated through the Integrated Behavioral Health Clinic.

Brought up in an immigrant Chinese family in San Francisco, Yu saw first-hand how language and cultural differences act as barriers to obtaining the standard of care others take for granted.

"A multicultural focus is imperative in California, where minorities are now in the majority."
— Sergio Aguilar-Gaxiola

"Psychiatric issues so often confound the health problems faced by immigrant communities," said Yu. "The stigma of mental illness adds yet another obstacle, and when superimposed on already dire socio-economic circumstances, it becomes extremely difficult for these patients to seek the care they need."

Yu recalls one Pakistani man who was seen repeatedly at an outside health clinic for vague physical complaints. When he was finally referred to the Integrated Behavioral Health Clinic, residents took the time to talk to him about his life and social situation, learning that he was completely alone in the United States and severely depressed. A thorough physical examination also revealed that he had an ear infection that was causing his frequent fevers, a finding that was previously overlooked because of the distraction of his myriad complaints.   

"Combined training allowed for an integrated approach that enabled us to address this patient's  underlying physical problems in the context of his mental health needs," said Yu. "We serve many patients with similar stories, and it is very gratifying to be able to care for the whole patient, empowering each to be an active partner in his or her mental and physical well-being."

An excellent collaboration

The IMPART program is an excellent example of teamwork and interdisciplinary collaboration between the UC Davis Center of Reducing Health Disparities and the Departments of Psychiatry and Behavioral Sciences, Internal Medicine, and Family and Community Medicine. The grant is funded through the Mental Health Services Act that passed in 2004 -- also known as Proposition 63 -- which imposes a 1percent tax on personal income of Californians earning $1 million or more. Authored by then California State Assembly member Darrell Steinberg and Rusty Selix, executive director of the Mental Health Association in California, the act is designed to provide better coordinated and more comprehensive care to those with serious mental illness, particularly in unserved and underserved populations. Funding is provided for a variety of mental health-related programs, including workforce education and training.

About the UC Davis Center for Reducing Health Disparities

The UC Davis Center for Reducing Health Disparities, in alliance with the UC Davis Clinical and Translational Science Center, provides leadership and support within and beyond UC Davis Health System to promote the health and well-being of ethnically diverse populations.

The center focuses on raising awareness of the unique cultural and linguistic attributes of minority populations, developing culturally and linguistically sensitive communications for health-care professionals, and working with policymakers, administrators, practitioners, consumers and families to reduce health-care disparities and improve quality of care. The center's ultimate goal is to improve health outcomes for all. For more information, visit www.ucdmc.ucdavis.edu/crhd.