Mesa Medical School Has A Unique Approach To Residency Program

August 02, 2013

A Valley-based medical school is trying to help reduce the shortage of primary care physicians. The new program is taking a unique approach to medical residencies.

Rio El Rio Community Health Center in Tucson is taking part in a new residency program. (Photo by Mark Brodie-KJZZ)

There is a doctor shortage in this country, and many observers say it is worse in Arizona, but a new program is hoping to fill some of that gap.

The El Pueblo Health Center in Tucson is one of several sites run by El Rio Community Health Center. El Rio is among the community health centers in six states taking part in a new residency program run through Mesa-based A.T. Still University’s School of Osteopathic Medicine. Organizers say their program is unique because residents are training around the country.

"If we’re concentrating on what we think is necessary for training future docs, this is it," said Dr, Arthur Martinez, chief clinical officer for the El Rio Health System.

He said more than half of the 80,000 patients the centers treat each year are uninsured. Martinez hopes that by helping train primary care physicians, it will help reduce the shortage, especially in community health centers. There are currently four residents training with El Rio and 18 others at sites in Oregon, Washington, Ohio, Washington, D.C. and New York.

"I think this sort of program is essential to the survival of medicine in the future," said Dr. Tuan Vo.

Vo is one of the new residents, and he may be exactly what Martinez and other proponents are hoping for. The Tucson native was a patient at El Rio when he was younger. He now works in family medicine and said he is interested in staying at El Rio after his residency.

"I don’t know how many providers have that personal experience to be a patient at an establishment and then become a physician there. You bring a different perspective, and you really feel for the patients and kind of where they’re coming from," Vo said.

That’s music to the ears of Dr. Thomas McWilliams. He is the associate dean for graduate medical education at A.T. Still. The school has always sent its med students to community health centers for their second, third and fourth years, and McWilliams said the residency program was the logical extension of that. But, it might not be for everyone.

"We can provide great medical education for virtually anyone, but we can’t give individuals the heart to serve," McWilliams said. "And so we specifically, throughout the admissions process, try to identify those that are a good match for our mission."

McWilliams said that sometimes means turning down someone who looks great on paper, in favor of someone the school thinks will return to a disadvantaged community, and that is important, because residents often end up practicing where they train.

According to a 2012 report by St. Luke’s Health Initiatives, the country will face a doctor shortage of almost 63,000 by 2015. That same report found in 2010, Arizona ranked in the bottom half nationally for the number of residents, between four and 14 fewer residents per 100,000 people than the national average. But, Arizona also added more residents between 2000 and 2010 than all but three states.

"The idea of physicians training in that environment should lead to them practicing in that environment. They put down roots, they create relationships, they gain an affinity for that type of work, and that continues into their professional careers. So, it’s important," said St. Luke's Jon Ford.

The residency program is an outgrowth of the Affordable Care Act. It is funded through a $4 million federal grant awarded to the Pennsylvania-based Wright Center for Graduate Medical Education. In fact, Ford said his organization predicted this kind of training.

"This is certainly part of the effect of the Affordable Care Act that funding opportunities have shifted, and the shift is towards creating better primary care opportunities, and in order to do that you have to change where you place those physicians," Ford said.

That’s exactly the sentiment of A.T. Still’s McWilliams. He said officials there knew what was not working, since not enough new docs were going into primary care.

'There’s that definition of insanity, if you continue to do the same thing over and over again and expect a different outcome. So we decided that we would have to design an educational curriculum that was very different if we wanted to get a different outcome," McWilliams said.

But, McWilliams said his program cannot change that outcome by itself.

"The true measure of our success will be to demonstrate a model that improves the outcome and reduces the cost for medical education, and in this case, residency education, and have that adopted by other institutions across the nation," McWilliams said.

Some people are optimistic that will happen. Arthur Martinez with El Rio Health Center said his plan is to take on four new residents a year. That would mean 12 residents at any given time at his facilities, but he said there are limitations.

"Our desire and intent however will be to continue to not only make this program survive but truly to have it spread," Martinez said.

Martinez said that could mean within his system or around the state. Vo thinks there will be plenty of eyes watching the program.

"Right now, there’s so much going on in health care, so much changing and so much that needs to change," Martinez said. "And so being a part of something like this, of course you have hesitations, a lot of my classmates said ‘You’re crazy.’ But, I think there’s some excitement in that too."

Vo and Martinez both acknowledge there have been some bumps in the road as the program rolls out, but they also say those problems have been more in logistics, not patient care.

Editor's Note: The headline has been changed to reflect the medical school's location in Mesa, not Tucson.

Updated 8/2/2013 4:14 p.m.

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