Care Delivery Issues- Michigan Physician Workforce and the Patient Centered Medical Home Kari Hortos, DO Associate Dean-Macomb Site Michigan State University College Osteopathic Medicine

Patient Centered Medical Home…  …began in 1874  Osteopathic Medicine: AOA 1998 “A complete system of medical care with a philosophy that combines the needs of the patient with the current practice of medicine, surgery and obstetrics; that emphasizes the interrelationship between structure and function; and that has an appreciation of the body’s ability to heal itself” “Order and health are inseparable…the object of the physician is to find health, anyone can find disease.” -A.T. Still, 1899

Osteopathic Principles and PCMH  The body is a unit; the person is a unit of body, mind and spirit.  The body is capable of self- regulation, self-healing and health maintenance.  Structure and function are reciprocally interrelated.  Rational treatment is based upon the understanding of the basic principles of body unity, self-regulation, and interrelationship of structure and function.  Patient centered primary care, holistic and comprehensive  Health management & prevention  Integrated patient management systems  Quality outcomes and patient satisfaction *Foundations for Osteopathic Medicine; Second Edition 2002 Osteopathic Principles*Patient Centered Medical Home

Patient Centered Medical Home Pre-doctoral curriculum  Medical Curriculum centered on primary care from day one.  Primary Care Ambulatory Clerkship –A 24-week block of clinical experiences in ambulatory care settings to prepare the student for current and future health care delivery expectations.  Recognized nationally for our curriculum –Ranked 7 th Medical Schools-Primary Care 2010 US News & World Report

 Over 30 community hospitals with ~ 2030 residency positions  Curriculum and residency experiences are community-based.  Centralized monthly didactic programs for each residency program that includes curriculum, evaluation and faculty development for community-based medicine. Patient Centered Medical Home Post-doctoral curriculum

Michigan’s Physician Workforce 2004 Blue Ribbon Committee Physician Workforce*  Study Findings: –4,400 doctors short by the year 2020  Types of physicians most needed by 2020: –Family physicians –General Surgeons –Cardiologists –Internists *

SEMCOG 2030 Regional Development Forecast Population by Age Group by Community September 2002 Accessed http://library.semcog.org/InmagicGenie/DocumentFolder/RegionalDevelopmentForecast_2030_AgeByCommunity.pdf

Michigan Faces Serious Shortage of Physicians May 4, 2009 …“The number of new primary care physicians has just barely kept pace with the number of primary care physicians leaving the workforce in the past few years. And the percentage of physicians who plan to discontinue practice within the next 10 years is increasing.” Accessed

 92% medical students Michigan residents  67% MSUCOM graduates stay in Michigan  65% MSUCOM graduates are in primary care  In 2009 MSUCOM-SCS –Graduated 130 physicians in primary care specialties of FM, IM and Pediatrics MSUCOM contributions to Michigan’s physician workforce

Michigan Physician Workforce and the Patient Centered Medical Home In 2009 MSUCOM increased class size from ~200 to 315 medical students, including ~50 each at the two new expansion sites in Southeast Michigan.