Osteopaths want to extend, expand teaching health centers
Carolyn Parks and Rosa Joseph were positively chipper as they walked downtown here Wednesday morning. Clad in white coats and sunglasses, the fourth-year medical students extolled the virtues of training in a teaching health center, while strolling 1.5 miles from the Ronald Reagan Building to the Capitol.
They walked with 1,075 osteopathic physicians and other students working toward a DO degree during the American Osteopathic Association’s (AOA) DO Day — pushing Congress to extend and expand funding for teaching health centers (THC), community facilities in low-income or rural areas that train residents (and some medical students) while caring for underserved populations.
Federal funding for THC graduate medical education expires in September and, without more, advocates say centers will struggle to continue enrollment. “It’s just not sustainable,” said Eleni O’Donovan, MD, who directs the Unity Health Care-Wright Center Parkside site in Washington. “We are in an ongoing conversation about the stability.”
That’s a potential problem for osteopathic medicine because DOs compose the majority of THC trainees; it could be a broader problem because it figures to compound the national physician shortage, especially primary care providers in underserved areas. “Nationwide this is a very serious topic,” said Keisha Robinson, DO, a family medicine physician at Parkside.
Congress first appropriated $230 million for five years of THC education, then funded $60 million more for two years in 2015, transferring funds directly to the centers.
The program has paid off, according to advocates and published reports. “These are settings in which residents can learn to practice efficient and effective primary care for patients in underserved communities both during, and for many years after, their residencies,” according to a 2015 George Washington University School of Public Health report. Because many physicians stay in areas where they train, THCs also leverage the programs as a recruiting tool, said John Sealey, DO, a thoracic and cardiovascular surgeon who directs medical education at an urban Detroit THC.
The 59 Health Resources and Services Administration-supported THC programs are scattered across 27 states and the District of Columbia (some with multiple sites). AOA said these accounted for 700 graduating residents in the 2015-2016 academic year nationally.
They provide services in demand. Their communities are in dire need of medical services and more than 100 students apply for each residency slot nationally, according to the American Association of Teaching Health Centers (AATHC). Nearly three-quarters of Parkside’s patients earn less than the federal poverty level, for example, with 72% using Medicaid at their last visit. More than half of THC programs are in underserved areas (versus one-quarter for all GME) and one-fifth are in rural areas (versus 1/20).
Then there’s the state of California. Four of its six THCs as of 2016 were located in the state’s inland areas, which the California Health Care Foundation reports have a smaller ratio of primary care physicians to residents than the rest of the state. The other two were in Redding (as a regional hub) and in an underserved part of San Diego.
What does a THC program look like? It must meet the same standards as any residency program, but residents and students can:
- Do something unique. Keith Egan, DO, launched a community HIV clinic with Parkside, for example. Residents at Sealey’s Authority Health center can get certified in population health and must complete a month-long rotation outside the center. “We train for our community,” he said.
- Work in integrated systems similar to the Permanente medicine model. Parkside features dentists, podiatrists, and psychiatrists among others, in addition to primary care providers. “To have the experience of providing patients with a lot of services is unique,” said Egan, who has signed on as a primary care doctor with Mid-Atlantic Permenente Medical Group in Washington.
- Focus on a primary care specialty (63% of residents go into family medicine), adopt the osteopathic mind-body-spirit tenet, and treat the underserved. “Their heart aligns with the mission,” Robinson said.
Advocates hope the THC program not only survives, but becomes a fixture and model for addressing localized healthcare needs, said Laura Wooster, AOA’s senior vice president for public policy.
“It is premature to cut off one of the most promising alternatives seen in decades,” the GWU report read, noting another benefit: “if funding is not restored in the immediate future, there will be serious longer-term consequences. Further support and testing of the (THC) model can inform the debate about methods of resident training and facilitate the development of national policies for graduate medical education.”
The THC model is not without flaws. Because federally qualified health centers depend largely on patient load for revenue, residents have reported administrators focusing more on service than training, and clashing with other directors, according to the California report. And of the 81 residents who had graduated from California THC’s through 2015, only 11 were practicing at the same center and 25 the same county.
But Sealey spoke highly of residents in his program: “They love to take care of vulnerable patients.”
Will their proteges get to? Rep. Niki Tsongas (D-Mass.) is circulating a letter to the House Energy & Commerce Committee requesting a minimum three-year reauthorization, a spokesman wrote in an email, and it had 88 bipartisan signatures as of Thursday afternoon.
Perhaps the weather Wednesday was also an omen. Parks and Joseph walked and talked under a clear sky, with temperatures in the mid-60’s. The forecast for Thursday, one DO noted, called for (and later delivered) thunderstorms. But Wednesday it could be said of the two students and THCs, no matter how cliché: Their future’s so bright, they gotta wear shades.
Said Robinson: “We still have hope.”