TARGET 2020 The Future of Georgia's Primary Care Medical Workforce 2011 2020 - There is URGENCY to act; - Augusta ...
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TARGET 2020 The Future of Georgia’s Primary Care Medical Workforce 2011 – 2020 Recommendations from the October 2011 Statewide AHEC Network Primary Care Summit There is URGENCY to act; The Time is NOW
TARGET 2020 Raise the primary care physician to population ratio from 2011 level of 82/100,000 to 100/100,000, by 2020 MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / Medical School GME / Residency College Training Years K-12 Years 13-16 Years 17-20 Years 23-28 ROAD MAP TO ACHIEVE GOAL 2012: Provide funding to create 400 new primary care Graduate Medical Education (GME) slots in Georgia; establish a joint Senate-House Graduate Medical Education Study Commission to set targets for primary care GME expansion in Georgia; (Phase 4) Create GME “bridge fund” to support new Primary Care GME expansion programs; (Phase 4) Create incentives for Georgia Medical School Graduates to select Georgia Primary Care Residency Programs for training; (Phases 3-4) Create incentives for community based faculty to provide clinical training for core medical student clerkships, to accommodate medical school class expansions; (Phase 3) Increase housing resources available to support community based training of medical students completing 3rd and 4th year medical school core clerkships and rural/primary care electives; (Phase 3) Initiate mandatory Pre-Med advisor training for all USG institutions, and available to all private education institutions; (Phase 2)
Create uniform messaging and marketing for Primary Care in Georgia; (all Phases) Establish a joint legislative committee to develop and recommend incentives for primary care practice, for rural practice, and to address payment obstacles for primary care; (Phases 3, 4 and post pipeline practice). 2013-2015: Expand primary care GME slots each year, based on recommendations of Joint House-Senate GME Study Commission; (Phase 4) Increase primary care loan forgiveness programs to be competitive with National Health Service Corps and with contiguous states to a minimum of $30,000 per year with a service commitment; (Phase 4 and beyond) Implement $25,000 per year salary supplements for Georgia medical school graduates selecting primary care residency programs in Georgia; (Phase 4) Implement holistic admissions protocols at 3 Georgia medical schools; (Phase 3) Create primary care and/or rural admissions tracks / programs at 3 Georgia medical schools; (Phase 3) Expand and deliver secondary education advisors training in health career opportunities; (Phase 1) Implement regional Pathways to Medicine Programs across the state; (Phases 2-3). 2015-2020: Continue to expand primary care GME slots each year based on Joint Committee recommendations; (Phase 4) Develop incentives for primary care GME residency graduates to remain in Georgia to practice; (Phase 4).
SUMMARY OF THE 2011 STATEWIDE AHEC NETWORK PRIMARY CARE PHYSICIAN SUMMIT WHY HOST A PRIMARY CARE SUMMIT? According to the American College of Physicians, “the nation is facing a severe shortage of primary care physicians for adults…44,000-46,000 by 2025” (ACP position paper, 9/2/11). The Macy Foundation in 2010 found “the shortage will be in excel of 100,000 physicians by 2025…recommend an immediate increase of 3,000 entry level positions in targeted residencies.” The Council of Graduate Medical Education (COGME) in its 20th Report, published in 2010, recommended policies to increase the total of primary care residencies from 32% to 40%. In Senate testimony, the General Accounting Office in February 2008 reported the Health Resource and Service Administration (HRSA) “estimated a need for 65,960 NEW primary care physicians to meet the need for 2020”. The American Association of Medical Colleges in December of 2008 estimated “a shortage of 45,800 primary care physicians by 2020.” Overall, the national primary care physician to population ratio is 100 primary care doctors / 100,000 population. In Georgia, Georgia had 82 primary care doctors / 100,000 population. According to Access Transformed- Building a Primary Care Workforce for the 21st Century, 2010, Georgia will need 676 new primary care physicians to meet the needs of the state’s Community Health Centers. For 2010-2011, according to the Georgia Board of Physicians Workforce, the state produced 96 primary care Georgia medical school graduates. Of these, only 47 chose to complete their training in a Georgia residency program. The data is endless – we are facing an acute and critical shortage of primary care physicians in Georgia. The current medical education pipeline in the state has significant disconnects, and our capacity to provide the final level of training (residency training) is severely limited by the lack of appropriate numbers of training slots. These factors converge to create a looming crisis in the state, and one that will take many partners and many systemic changes to address. In October of 2011, the Statewide AHEC Network invited key stakeholders across Georgia to come together to craft a Primary Care Physician Plan for the state. The Statewide AHEC deliberately chose to limit the focus of the Summit to the production of primary care physicians in the state, while acknowledging the key roles to be played by other health care providers (e.g. nurse practitioners, physician assistants, etc.) The Plan was envisioned to address issues and challenges across all four phases of the Medical Education Pipeline and to provide a comprehensive set of recommendations for each phase. It is clearly understood that intervention in one area is not sufficient to meet Georgia’s short and long term needs. For example, the recent investments in medical school expansions have certainly increased the number of medical students training in Georgia, but we have not addressed the resource needs to support community based training in the third and fourth year, and we have not
expanded our GME slots to provide an in-state opportunity to complete medical training. Thus we have created an imbalance that, if not corrected, may lead Georgia to become the nation’s largest exporter of medical students into residency training programs. A balanced and multi- faceted approach is required if we are to meet the goal of providing Georgia with the appropriate primary care physician workforce for 2020 and beyond. MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / Medical School GME / Residency College Training Years K-12 Years 13-16 Years 17-20 Years 23-28 Summit attendees were divided into workgroups to discuss specific questions relative to each Phase in the medical education pipeline. (Pre-summit materials had been circulated, and short presentations provided to create a framework for these facilitated workgroup discussions; presentations are available at www.georgiahealth.edu/ahec). The following Summit Recommendations and Phase Summaries of the workgroup deliberations are provided as background to support the Target 2020 recommendations. SUMMIT FUNDING ISSUES AND ACTIONS: RECOMMENDATIONS MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / Medical School GME / Residency College Training Years K-12 Years 13-16 Years 17-20 Years 23-28 PHASE 1 1. Design, develop, and launch a statewide coordinated primary care messaging campaign to create a more responsive audience for primary care medicine recruitment and training. 2. Provide funds to develop training and resources for middle and high school guidance counselors for guiding students into primary care medical careers. 3. Increase funding to regional AHEC centers to deliver messaging to school systems through health career recruiters, classroom tools / aids, etc. 4. Provide funds for innovative programming offered by medical schools in partnership with local schools, boards of education, or districts. PHASE 2 1. Fund the Statewide AHEC Network to develop and deploy a standardized pre-medical student advisor training to be offered regionally and on-line. 2. Expand the Pathways to Medicine program from southwest Georgia to four other (largely rural) AHEC regions. 3. Fund the Board of Regents to develop and open three regional Primary Care Post- Baccalaureate programs in the University System.
4. Create an innovation fund to develop new web based resources and tools for advisement and guidance (available to both students and college advisors). PHASE 3 1. Provide start-up funds / technical assistance resources for any Georgia medical school willing to implement Holistic Admissions processes. 2. Provide start-up funds / technical assistance resources for any Georgia medical school willing to implement a primary care and/or rural admissions and training track. 3. Provide innovation funds to any Georgia medical school willing to implement an accelerated primary care track. 4. Create incentives tied to state appropriations for high percentage of graduates selecting primary care specialties. 5. Expand primary care loan forgiveness resources to allow more students to be offered these resources. 6. Create capacity to award provisional loan forgiveness based on completion of primary care specialty selection for residency training. rd th 7. Increase funding to support housing needs of 3 and 4 year medical students on rotations in community based training sites. 8. Increase funding for travel stipends for 3rd and 4th year medical students completing rotations remote from their campus. 9. Provide tax credits for primary care community based faculty precepting 3 rd and 4th year Georgia medical students. PHASE 4 1. Educate policy leaders about the impact of failure to act. 2. Request the Governor and General Assembly to appoint a Joint Legislative Committee on the GME crisis in Georgia. 3. Adopt a Primary Care Physician Plan for Georgia with a timeline of implementation and clear outcome goals articulated. 4. Provide funding for 400 new residency slots in Georgia. 5. Explore legislation encouraging insurance companies to provide some level of support for GME start up and expansions. 6. Create a revolving fund to support new GME Program Start-Up and to support pairing of hospitals / programs to expand or establish primary care residency slots. 7. Create tax incentives for hospitals to partner and collaborate to provide local funds to support GME expansion or creation of new programs. 8. Address the existing and worsening deficit of GME faculty to support expanded residency slots by providing funding for accelerated learning and for recruitment. 9. Increase primary care loan forgiveness programs to a minimum of $30,000 per year with a service commitment, be competitive with National Health Service Corps and with contiguous states. 10. Implement $25,000 per year salary supplements for Georgia medical school graduates selecting primary care residency programs in Georgia. 11. Launch a high tech marketing campaign promoting Georgia Primary Care residency training opportunities, targeting Georgia medical school graduates and Georgia graduates from out of state / off shore medical schools.
12. Provide cash stipends for residents completing rural residency training tracks. SUMMIT WORKGROUP SUMMARIES MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / Medical School GME / Residency College Training Years K-12 Years 13-16 Years 17-20 Years 23-28 PHASE 1: SECONDARY EDUCATION (K-12) CHALLENGE: To graduate Georgia high school students who are academically prepared and appropriately advised to pursue primary care medical careers. SUMMARY OF DELIBERATIONS Are Georgia students adequately prepared to succeed in college and beyond? This key question drives much of the discussion about the first critical component of the medical education pipeline. How can we better prepare Georgia students for college? Appropriate K- 12 education and preparation is essential to insure student success in higher level careers, such as those in medicine. Parents have tremendous influence during the first phase of the medical education pipeline. How do we educate the families/parents about available resources that could support their children financially through medical school? Parents can discourage their children from pursuing a primary care career based on incorrect knowledge about funding and supports available to assist their child. Georgia students have a prodigious gift in the HOPE scholarship that can make undergraduate education more affordable or even free. The AHECs and other organizations have done significant work in educating small populations that they can afford medical school through various loan repayment and scholarship programs. The need is to take this information to larger populations through multi-media assets, classroom tools, and consistent messaging. We have to develop a very concrete strategy that connects these programs and organizations to better educate students and parents. The need for better academic and career advisement continues to emerge as a strong theme, especially with the wide array of choices available for student consideration. The need to excite students about pursuit of a primary care career is even more complex and urgent. The advisement piece needs to be strengthened at all levels within the K-12 years. Programs that focus on early identification of students early in the K-12 years (much like the AHEC Pathway
Program for College students) have proven successful in Chicago and other sites, proving their application in Georgia has great potential. Consistent messaging is an ongoing challenge. A strategy defining how we market existing primary care programs and information must be developed and deployed. The K-12 educators with contact to the students on the front line need to be targets of these marketing efforts, so they can identify, guide, connect, and mentor students along the correct career trajectory from an early age. We need to engage local business organizations and communities in creating a primary care workforce pipeline for their regions. This type of support would reflect the significant economic impact created by recruitment of a primary care physician. Additionally, linking the presence of a developed and well-staffed health care system to medical recruitment in communities conveys a strong message. We need this strong “mission mentality”. There are considerable outside (community) funds invested in high school sports, but not comparable funding provided to enhance academics. Students need emotional, family, and community support to succeed in medical school and training for a primary care career. PHASE 1: PRIORITY ISSUES 1. EARLY INTERVENTION / IDENTIFICATION OF STUDENTS A. Increase the professional development opportunities available to all levels of Math and Science teachers to improve student outcomes in their classes. B. Enhance academic advisement at middle and high school levels through increased training opportunities, development of tools and resources to support counselors, and development of advanced training opportunities for health careers; focus on identification of potential medical students in middle school. C. Develop resources to improve test taking skills such as rigorous online training for key standardized tests (ACT, SAT, Compass, etc.). D. Increase number of magnet schools devoted to health care sciences. 2. MARKETING OF CAREERS A. Create High School Pathways to Medicine programs to support students who indicate potential to successfully complete primary care medical training. B. Create a Georgia Youth Health Service Corps initiative dedicating to exposing high school students to primary care medicine in the field. C. Connect with Georgia Health Occupation Students of America (HOSA) to increase involvement and exposure to Primary Care careers. 3. UNIFORM PRIMARY CARE CAREER MARKETING MESSAGE A. Connect students with collaborative community partners to show them future opportunities.
B. Provide comprehensive communications with parents and students stressing the importance of maths and sciences, and of following the correct primary care pathways through high school to increase their potential odds of acceptance into medical school. C. Develop consistent messaging strategies to be utilized by the AHECs and other community / organizational / academic partners, with support from medical schools. PHASE 1: PROPOSED STRATEGIES 1. Utilize AHECs to promote existing primary care programs to K-12 students in Georgia. 2. Improve quality of K-12 career advisement through advanced training and tools / resource development. 3. Begin concentrated education of students about primary care career options, by entrance to middle school. 4. Support development and implementation of “Mini-Med School”, “Saturday Medical School”, or similar pipeline programs whose goal is exposure of students to primary care careers prior to college matriculation. 5. Utilize medical students as college coaches in middle and high schools in communities where they rotate for clerkships and / or electives. 6. Improve the “Marketing” of primary care medicine as a viable career choice.
MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / Medical School GME / Residency College Training Years K-12 Years 13-16 Years 17-20 Years 23-28 PHASE 2: UNDERGRADUATE / COLLEGE YEARS CHALLENGE: To appropriately prepare for and direct college students towards primary care careers, specifically but not exclusively, primary care medicine. SUMMARY OF DELIBERATIONS There is no standard curriculum for faculty pre-med student advisors at our colleges and universities. Mandatory standard curriculum should be developed and delivered to all USG pre-med advisors; the curriculum and training should be made available to private college and university pre-med advisors at a reasonable cost. Many students who are in the pre-med track do not possess the necessary scores or GPA to matriculate into a medical school. These students should be redirected into other primary care careers rather than left to flounder and seek other employment sectors for pursuit. Increased support in the first two years when students are deciding on their majors should be provided, including tutoring in the sciences and mathematics as needed (organic chemistry, etc.). Many potential primary care medical students would benefit from a one year Post- Baccalaureate program to further hone and refine their scientific and mathematical skills prior to medical school matriculation. This one year Post-Baccalaureate Program should be offered as a Masters level program to qualify with new federal financial aid policies. These programs, specifically designed to academically bolster selected students, should result in increased student performance upon admission into medical school. Need exists for programs available to college students to immerse them in in primary care medicine through mentoring, research, and “exploration”. Rural students could particularly benefit from these programs, as evidenced by the success of the Pathways to Medical School offered through the SOWEGA AHEC. Currently Pathways has a success rate of ___% of graduates matriculating into a Georgia medical school. Students are exposed to a rigorous curriculum featuring in-depth research projects, mentoring, shadowing, and exposure to the wide domain of practice environments for primary care providers. Professional organizations and medical school faculty could unite to support Programs / Clubs at the college level, such as future Doctors of America, Campus Community for Health, etc., to
provide early exposure to primary care, rural health care, and to education, training, and practice opportunities in Georgia. PHASE 2: PRIORITY ISSUES A. Strengthening and standardizing college pre-medical advisory skills and access to appropriate resources for guidance; provide broader advisement within the array of health careers rather than simply medicine. B. Provide Primary Care Post-Baccalaureate Masters level programs to better prepare rural and/ or provisionally accepted students into the medical school education track. C. Provide intensive mentoring, shadowing, and medical research programs for pre- medical students to validate their career choices and prepare for the rigors of medical school. PHASE 2: PROPOSED STRATEGIES A. Develop and deploy a mandatory standardized curriculum and training for college pre-medical advisors in the University System; make curriculum and training available to private college and university advisors for a reasonable fee. B. Create provisional medical school admissions opportunities for rural students while in their 2nd or 3rd year of baccalaureate education as a strategy to retain students in the Georgia medical education pipeline. C. Expand the Pathways to Medicine program from Southwest Georgia to four other AHEC regions who serve largely rural populations. D. Create three regional Primary Care Post-Baccalaureate programs, with financial aid available, to strengthen rural, minority, or provisionally accepted student performance. E. Support the development of web-hosted guidance and advisement resources available for students and college advisors. F. Encourage professional organizations, medical schools, local medical societies to sponsor Primary Care oriented clubs / programs on college and university campuses statewide.
MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / Medical School GME / Residency College Training Years K-12 Years 13-16 Years 17-20 Years 23-28 PHASE 3: MEDICAL SCHOOL CHALLENGE: Admitting students predisposed to primary care practice and/ or rural medicine; supporting community based clinical training needs of the five medical schools; developing rural / primary care training tracks. SUMMARY OF DELIBERATIONS The image of medical schools as elite meccas for high scoring students should be modified. Admissions based heavily on high MCAT scores and GPAs can exclude students who can succeed in medical school and who may have a predisposition to practice in primary care and/or in underserved communities. Recruiting should be broadened to encompass a more Holistic Admissions process that includes value for emotional intelligence, demographic origins, and solid academic performance. The AAMC has begun work in defining Holistic Admissions processes. Several medical schools have already moved to “blind admissions” wherein students who meet the basic qualifications (MCAT scores and GPA) proceed through Admissions interviews without their test scores and GPAs being available to interviewers. Research has shown that a student does not to have a 4.0 GPA or the highest MCAT score to successfully complete medical school and pass national boards. Changes in the admissions process would not necessitate lowering the academic standards for admission, but could broaden the pool of students being admitted. Implementing dedicated primary care and /or rural admissions tracks in medical schools has been proven to yield a high number of successful graduates. Medical Schools in Minnesota, Arizona, and Pennsylvania are but a few examples where these tracks are in place and resulting in increased graduates in primary care and rural medicine. These programs focus on recruiting students from rural and underserved areas in order to return physicians to those areas, as well as identifying students early in the pipeline who have an expressed interest in primary care. Mentoring during the medical school experience is critical. Anecdotal stories indicate preceptors of medical students are teaching students differently, based on their specialty orientation. Many talented students are advised to choose a sub-specialty over primary care, with inferences made that the best and brightest pursue specialties rather than primary care. Much of what influences a student doctor to choose primary care physician has to do with the environment of the medical school. Incentives should be implemented at the highest levels of medical education to encourage faculty to support primary care choices and to be rewarded for
such choices. Tying state support to production of needed primary care providers may be an avenue to explore. With the recent investment in medical school class size expansion, a host of new problems has been created. Specifically, the need to provide clerkship and elective rotations at the community level have increased dramatically, but resources to support (through housing, travel stipends, and community based faculty identification and development) these mandatory clerkships and electives has been decreased. We need to increase support available to support these critical years of medical education which occur in communities across the state. Additionally, the need to find and develop more community based clinical faculty and teaching sites is hampered by the demands already on these practices. To take a student into a practice for training reduces the efficiency of the practitioner, and is done with no remuneration. Out of state medical schools, along with off shore medical schools, have targeted Georgia as a state to place their 3rd and 4th year medical students, and they provide financial payments to sites to take these students. The need to provide some sort of tangible benefit to community based faculty taking Georgia medical students is paramount and must be addressed if the Georgia medical school students are to have access to the community based training they require. Additionally, regulatory issues can create barriers for community based faculty to take their students into local hospitals and nursing homes – significantly impacting the quality potential of the community based teaching site. Efforts need to be undertaken to identify and support more contemporary training sites for primary care rotations. Students in this generation are immersed in technology and need to see firsthand the applications and use of technology in primary care training sites. Finally, the cost of medical education and the need to repay loans is a barrier to selecting a primary care discipline for practice. Payment reform is needed to recognize and appropriately reward primary care medical services, and to lessen the salary gap between primary care and specialty medicine. PHASE 3: PRIORITY ISSUES A. Admissions processes and procedures B. Change culture of Medical Schools C. Medical School Debt and impact on specialty choice D. Support for 3rd and 4th year medical student rotations E. Support for community based faculty who provide free training to 3 rd and 4th year medical students PHASE 3: STRATEGIES A. Admissions processes and procedures 1. Identifying admissions criteria that will meet the needs of the state
a. Develop Rural Admissions Track b. Develop Primary Care Admissions Track c. Increase Diversity 2. Develop accelerated programs to move students through the medical school portion of the pipeline more quickly, e.g. allowing primary care medical students to forgo the 4th year and enter directly into residency programs. 3. Provide training and resources for medical schools willing to move to Holistic Admissions processes 4. Add more community representation on medical school admissions committees B. Change culture of medical schools to embrace primary care choices 1. Create incentives tied to state appropriations for percentage of graduates selecting primary care specialties 2. Create web-based training to teach medical school faculty on how to mentor medical students towards primary care B. Medical School Debt and impact on specialty choice 1. Expand primary care loan forgiveness resources to allow more students to be supported 2. Create capacity to award provisional loan forgiveness based on completion of primary care specialty selection for residency training C. Support for 3rd and 4th year medical student rotations 1. Increase support for housing needs of students on rotation 2. Increase support for travel stipends to students completing rotations remote from their campus. D. Support for community based faculty who provide free training to 3 rd and 4th year medical students 1. Provide Faculty Development and training 2. Provide tax credits for primary care community based faculty precepting 3 rd and 4th year Georgia medical students 3. Establish more contemporary primary care training sites across the state to showcase technology in practice.
MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / Medical School GME / Residency College Training Years K-12 Years 13-16 Years 17-20 Years 23-28 PHASE 4: GME/ RESIDENCY TRAINING SUMMARY OF DELIBERATIONS The complexities of the medical education pipeline are most apparent when the final phase of the medical education pipeline is examined. Many individuals (policy makers, community leaders) do not understand the graduate medical education piece, or its importance for meeting workforce needs. The lack of general awareness of this pipeline component must be overcome and education must replace misinformation. Residents are licensed physicians who provide services to individuals while in training, and comprise a significant workforce when viewed in toto. Many medical students choose to leave the state for their residency training once medical school is complete. Data indicate many factors influence this choice, including but not limited to: desire to have exposure to another health care system different than where they completed medical school; exposure to other geographic locales, family / spouse issues, resident salary, perceived quality of in state residency programs, advice received from medical school faculty or other medical mentors, etc. As a result, Georgia residency training programs are retaining less than 30% of our Georgia medical school graduates. This disconnect has significant impact on the likelihood of these Georgia graduates returning to our state to practice after residency training. Published research on students who go to college, medical school and GME training in the same state indicate that these students will stay where they received their education rather than leave Georgia to practice. Understanding the factors that break this cycle are important and, if understood and addressed, could yield a significant increase in the number of providers remaining to practice in the state. The recent medical school class size expansions were not accompanied by a simultaneous increase in available residency “slots” in Georgia. This has created a funnel that will only worsen. We are producing more medical school graduates than we have capacity to provide residency training for, thus making us an exporter of medical students to other states for residency training.
Creating more residency training slots is the priority issue in the medical education pipeline. The Board of Regents has stated that 400 new slots are needed immediately to begin to address the “funnel”. Existing residency programs, particularly primary care, need to be expanded, and new residency programs established in order to meet this high goal. Models such as the Southwest Georgia GME Consortium are excellent examples of how to jump start GME initiatives in regions across the state. Similar efforts are underway in Northeast Georgia with St. Mary’s and Athens Regional Hospitals in Athens. The fact that we do not currently fill our existing residency slots with Georgia medical school graduates provides another immediate starting point to increase our in state physician supply. While the slots are predominantly filled in existing programs, only a small percentage fills by Georgia graduates. Incentivizing selection of Georgia residency programs in primary care could help strengthen our pipeline and retain these graduates as providers for the state in the future. The provision of residency training in rural areas is also needed to increase the odds of residents practicing in rural communities after graduation. Minnesota has one model of this rural residency training that should be explored in Georgia. Resident salaries provide another avenue to increase retention of Georgia graduates. Providing signing bonuses, salary supplements, enhanced loan forgiveness are all strategies that may be utilized to increase the number of primary care residents choosing to train in Georgia. Federal support for residency training continues to decline and is generally unstable. This will require creative new funding partnerships to be developed if we are to meet Georgia’s needs. Insurance companies are a logical potential funding partner, but creating an environment that supports community, business, philanthropic, and foundations, etc. to come together will be a critical task. Hospitals cannot depend on state and federal support to meet all of the financing needs, and thus other alternatives must be identified and built. An existing state agency should be identified and resources expanded to serve as a clearinghouse for residents / communities to connect for placement. This would allow active facilitation of collaborations with generalized oversight and reporting lines. PHASE 4: PRIORITY ISSUES 1. URGENCY A. Educating policy leaders about the impact of failure to act. B. Publishing inventories of what GME programs we have, how we fill, where graduates practice. C. Executive and legislative branches need to engage actively in resolving this issue. D. Clarification of uniform steps to start and maintain a residency program, including cost projections. E. Articulate economic impact of residency programs and residents on local economies. F. Articulate community level economic impact of successfully retaining a primary care physician resident after graduation.
2. FINANCIAL A. Insurance Companies should be leveraged to provide some level of support for GME. B. New Program Start-Up funds to support pairing of hospitals / programs to expand or establish primary care residency slots; Create an “Innovation Center around GME”. C. Create incentives for hospitals to partner and collaborate to provide local funds to support GME expansion or creation of new programs. D. Address the existing and worsening deficit of GME faculty to support expanded residency slots. 3. RESIDENT RECRUITMENT A. Salary Supplements for primary care residents. B. Loan forgiveness beginning PGY1 for primary care residents. C. Marketing Georgia Primary Care Residency programs more effectively, focusing on quality of education and incentives. D. Define incentives for choosing rural residency training tracks. PHASE 4: STRATEGIES 1. URGENCY A. Educating policy leaders about the impact of failure to act. B. Georgia Trend and Atlanta Business Chronicle exposure – Write up the results from this summit and issues about GME to educate larger audiences about the crisis in primary care medicine. C. Create constant flow of educational information to legislators D. Request the Governor and General Assembly to appoint a Joint Legislative Commitment on the GME crisis in Georgia. E. Publish and promote examples of communities that have already expanded GME programs. F. Publishing inventories of what GME programs we have, how and with whom we fill, where graduates practice. G. Create clarified uniform steps to start and maintain a residency program, including cost projections to assist local hospitals considering start-up of residency programs. H. Articulate economic impact of residency programs and residents on local economies. I. Articulate community level economic impact of successfully retaining a primary care physician resident after graduation. J. Adopt a Primary Care Physician Plan for Georgia with a timeline of implementation and clear outcome goals articulated. 2. FINANCIAL A. Provide funding for 400 new primary care residency slots in Georgia.
B. Explore legislation encouraging insurance companies to provide some level of support for GME start up and expansions. C. Create revolving fund to support New GME Program Start-Up and to support pairing of hospitals / programs to expand or establish primary care residency slots. D. Create a “GME Innovation Center” as a clearinghouse for successful models and for provision of technical assistance. E. Create incentives for hospitals to partner and collaborate to provide local funds to support GME expansion or creation of new programs. F. Address the existing and worsening deficit of GME faculty to support expanded residency slots by providing funding for accelerated learning and for recruitment. 3. RESIDENT RECRUITMENT A. Increase primary care loan forgiveness programs to $30,000 per year with a service commitment to be competitive with National Health Service Corps and with contiguous states. (Phase 4 and beyond) B. Implement $25,000 per year salary supplements for Georgia medical school graduates selecting primary care residency programs in Georgia. (Phase 4) C. Launch a high tech marketing campaign promoting Georgia Primary Care residency training opportunities, targeting Georgia medical school graduates and Georgia graduates from out of state / off shore medical schools. (Phase 4) D. Provide cash stipends for residents completing rural residency training tracks. (Phase 4) PRACTICE ENVIRONMENT In the course of deliberations several issues were identified relating to what happens after the education pipeline is complete. The current practice environment has many challenges that must be addressed to allow the strategies implemented in the medical education pipeline to be successful. Without addressing these challenges, we will NOT realize the full potential of our pipeline initiatives AND we will not meet Georgia’s primary care practice needs for the future. Significant salary differences exist between primary care specialties and other specialties in medicine. Payment reform, particularly for primary care providers, must be addressed. If primary care physicians continue to receive significantly lower reimbursement for comparable procedures, and if their cognitive services continue to be undervalued, it is unlikely that a higher proportion of students will choose careers in primary care disciplines. We recommend that a legislative task force address this issue and be directed to offer recommendations for the 2013 legislative session. Tort Reform is another challenge that has been successfully addressed in other states, specifically in Texas. Georgia needs to grapple with this issue and create realistic tort reform initiatives to address barriers to primary care practice. This too could be addressed via a legislative task force with recommendations for the 2013 legislative session.
Finally, incentives to practice in rural and underserved sites need to be continued and enhanced. For example, extending the Rural physician tax credit to 5 years and expanding the practice sites to include community health centers would provide further incentives for our medical education pipeline graduates to practice in our underserved communities. 2011 Primary Care Summit Attendees List Name Title Organization Andresen, Susan, MD Barnes, Julie, MD Chief Medical Officer Redmond Regional Medical Center Bina, William F., MD Dean Mercer University School of Medicine Blumenthal, Daniel, MD Chairman/ Professor Moreshouse School of Medicine Brown, Detra Director Recruitment and Statewide AHEC Program Office Evaluation Bucholtz, John, DO Director of Medical The Medical Center Columbus Education Family Practice Residency Program Byrd-Verizzani, Daphne Center Director SPCC-Atlanta AHEC Caldwell, Collette Statistical Research Georgia Board for Physicians Analyst Workforce and State Medical Education Board Carter, Ashley Preceptor Coordinator Foothills AHEC Caseman, Matt Executive Director Georgia Rural Health Association Chastain, George, MD Interim Assistant Dean SW Georgia Health Sciences University Clinical Campus Cibirka, Roman, DDS, MS VP & Associate Provost Georgia Health Sciences University Coggins, Margie Senior Budget and Policy House Budget Office Analyst Collins, Sonya Notes Editor for Clinicians, Primary Care Progress Educators & Advocates Craver, William, DO Dean and Chief Academic PCOM Officer Daniels, Mary Executive Director Georgia Chapter of the American College of Physicians Denson, Bobby Preceptor Coordinator SPCC-Atlanta AHEC Dent, M. Marie, PhD, EdS Assistant Dean Mercer School of Medicine, Savannah Campus Don Diego, Frank R., MD Director Floyd Family Practice Residency Program/ Floyd Medical Center Dorage, Steve Region Officer HRSA Regional Office (Georgia)
English, Kathy Center Director Three Rivers AHEC Fincher, Jacqueline, MD Georgia Chapter Governor Georgia Chapter of the American College of Physicians Fleischmann, John, EdD, Campus Executive Officer PCOM MBA, MPA Frederick, George, MD Family Medicine Residency Phoebe Putney Memorial Hospital Program Dir. Fulton-Brown, Fay Executive Director Georgia Academy of Family Physicians Gologan, Trena Admissions PCOM Coordinator/Recruiter Gregory, Paula, DO Coordinator of Clinical PCOM Education Hakman, Jeneva Academic Director Athens Regional Health System Harrison, Sheila, PT, MLIS Center Director Foothills AHEC Hobbs, Joseph, MD Chair, Family Medicine Georgia Health Sciences University Hotz, James, MD Board Member SOWEGA AHEC Jackson, Leslie Assistant Director of Mercer University SOM Communications and Recruitment Keshinro, Carolyn L. HRSA/NHSC Georgia Bureau of Clinician Recruitment Regional Recruitment and Services Representative Kornegay, Denise Executive Director Statewide AHEC Program Office Kundu, Bela Preceptor Coordinator Magnolia Coastlands AHEC Lang, Sarah Board Member Three Rivers AHEC Lockwood, Angie Senior Project Director Tripp-Umbach Consulting Madaio, Michael, MD Chair, Department of Georgia Health Sciences University Medicine Malan, T.Phil., MD Dean Mercer School of Medicine, Savannah Campus Mariani, Lisa Region Officer HRSA Regional Office (Georgia) Martin, Kathryn, PhD Assistant Dean for SE Georgia Health Sciences University Clinical Campus & Interim Dean of Admissions McCrory, Aldous Board Member SPCC-Atlanta AHEC Middendorf, Bruce Chief Medical Officer St. Mary's Health System Miller, Andy Chief Executive Officer Georgia Health News Miracle, Steven, MBA Board Chair Blue Ridge AHEC Moreno, Raymond, MD Vice President Medical Tift Regional Medical Center Affairs
Mundy, Erin Director Community Based Statewide AHEC Program Office Training Programs Newell, Paul, MD Former District Health GA District 8-2/ Southwest Cancer Director/ Retired Board Coalition Member Norman, Sharon Center Director Blue Ridge AHEC Nuss, Shelley, MD Campus Associate Dean GHSU/UGA Medical Partnership for GME Owens, Charles Executive Director Office of Rural Health Pallay, Robert, MD Program Director, Family Mercer University School of Medicine Medicine Savannah Campus Family Medicine Residency Savannah FMRP Memorial Medical Program Dir. Center Palmisano, Donald J., Jr Executive Director Medical Association of Georgia Park, Margaret Board Member Three Rivers AHEC Patten, Doug, MD Chief Medical Officer and Phoebe Putney Memorial Hospital SVP Pung, Mary Kate Center Director Magnolia Coastlands AHEC Reeves, Leonard, MD Board Chair Georgia Academy of Family Physicians (GAFP) Assistant Dean for NW Georgia Health Sciences University Campus (GHSU) Reynolds, Pam Center Director SOWEGA AHEC Risby, Emile Medical Director GA Department of Behavioral Health/ Developmental Disabilities Robinson, Ben Executive Director Center for Health Workforce Planning and Analysis Schuster, Barbara, MD Campus Dean GHSU/UGA Medical Partnership Shepherd, Tom Sr. VP/ Planning & Gwinnett Health System Development Shiver, Jan Preceptor Coordinator SOWEGA AHEC Shurling, Christy Community Educator East Georgia Health Cooperative, Inc. Skelton, W. Douglas, MD Board Member Magnolia Coastlands AHEC Smith, Pamela Administration Manager Georgia Board for Physicians Workforce Spires, Shelley Deputy Director Albany Area Primary Health Care Strothers, Harry, MD President Georgia Academy of Family Physicians Thompson, Melody, VP, Physicians Practices Southeast Georgia Health System FACHE, CMPE
Tucker, Cherri Executive Director Georgia Board for Physicians Workforce Umbach, Paul Partner Tripp-Umbach Consulting Vericella, Sharn Preceptor Coordinator Blue Ridge AHEC Walker, Teresa Program Manager Statewide AHEC Program Office Waters, Karen Georgia Hospital Association Wernick, Joel President/CEO Phoebe Putney Hospital Wilkerson, Jan Quality Manager Georgia Association of Primary Care Williams, Cassandra Board Chair Three Rivers AHEC Williams, Joanne, MD Assistant Professor, Emory University Department of Family Medicine Willocks, Stacey Sr. Research Associate GA Health Policy Center @ Georgia State University Young, Suzanne, CNP Georgia Rural Health Georgia Mountains Health Experience Director
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