Growing the Health Workforce: Community Based Residency Training Allen L. Hixon, MD Associate Professor and Vice Chair University of Hawaii Department of Family Medicine and Community Health

Social Determinants of Health

Social determinants of health are: the conditions in which people are born, grow, live, work and age, including the health system. these circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. »WHO CSDH

How we receive care N Engl J Med 2001; 344: June 28, 2001June 28, 2001

Neighbor Island Health Poor health outcomes Access to care Drastic shortage of primary care –Current shortage 150 primary care physicians to meet national physician to population ratios –With aging/retirement of workforce demand will increase Withy/Sakamoto

Hawaii Island Rural Residency Program Problem – Physician/provider shortage, limited access to care, rural neighbor island focus Proposed solution – Increase physician/provider pipeline by developing a rural interdisciplinary FM residency program and collaborative training site 12 residents (four per year) based in Hilo Hawaii Collaboration –Hilo community/Hilo Medical Center –UH SONDH –UH College of Pharmacy

Hawaii Island Rural Residency Principles –Meet real needs of community –Interdisciplinary team based –Financially sustainable –High quality teaching and patient outcomes

Collaboration Needs Assessment –SHPDA –Workforce Data –NHHS –FQHC –Alliance –Mayor’s Office –Others Planning –Academic partners JABSOM School of Nursing and Dental Hygiene College of Pharmacy Funding –CMS –HRSA –HMSA –Tri-West –State of Hawaii –HMC Foundation –Shipper’s Wharf –Individuals Implementation –HMC –UCERA –JABSOM –Steering Committee with community partners

Residents Foundation Rural Residency Family Medicine Faculty School of Nursing JABSOM Hilo Medical Center Medical Students/ Learners Medical Staff CMS HMSA TriWest HRSA Hawaii State Legislature Patients/Community College of Pharmacy

Progress to date Collaborative clinical practice site 2 family physicians (one more coming) 1 APRN 1 PharmD 1 RN 1 GYN consultant Telepsychiatry program

Next steps ACGME FM accreditation Build clinical practice and teaching Develop interdisciplinary curriculum Patient Centered Medical Home Quality initiatives

What we did well Solution oriented Messaging re: workforce shortage and critical need Created public-private partnership for funding

Barriers to collaboration Underestimated level of complexity Created expectations –Timeline –Cost Did not fully understand objectives, expertise or limitations of the various partners At times communicated poorly with partners

Engaging the Community Social determinants are the conditions that exist in the community that promote or undermine good health Program success linked to level of community support Be informed Advocate with lawmakers