1. Graduate Medical Education in a Rural Tribal Health System
Choctaw Nation Family Medicine Residency
Todd Hallmark
Executive Officer of Health Services
Choctaw Nation Health Services Authority

2. Halito
(Choctaw for Hello)

3. Choctaw Nation Health Services Authority
Excellence in Rural Health Care

4. Overview Choctaw Nation Family Medicine Residency
Key Elements for Starting a Residency Program
Concept of being Academically Friendly
Funding - HRSA THC Grant
Benefits of Having a Residency Program
CNFMR

5. Choctaw Nation Health Services Authority
Tribal Health System
SE Oklahoma
About 900 Primary Care visits per day
Hospital – Talihina Oklahoma
9 Satellite Clinics
1600 FTE
newborn deliveries per year

7. Clinic Locations Atoka Broken Bow Durant Hugo Idabel McAlester Poteau
Stigler
Talihina

10. Specialties Other Services Cardiology Emergency & Urgent Care
Endocrinology (Adult and Pediatric)
ENT Surgery
Family Practice
Gastroenterology
General Surgery
Geriatrics
Internal Medicine
Neurology
Obstetrics & Gynecology
Ophthalmology
Orthopedics
Osteopathic Manipulative Medicine
Pediatrics
Psychiatry
Pulmonology
Rheumatology
Other Services
Optometry
Podiatry
Dentistry (General and Pediatric)
Radiology (digital)
CT, MRI, US
Bone Densitometry
Diabetes Wellness Center
Audiology
Speech Pathology
Physical Therapy
Pharmacy
Laboratory
Respiratory
Nutrition
Memory Loss Clinic
Large Refill Center
Electronic Medical Records

11. Definitions Graduate Medical Education (GME) Residents Faculty
Teaching Health Center (THC)

12. HRSA THC GME Program Health Resources and Services Administration
THC GME: Teaching Health Center Graduate Medical Education Program, 2010 AFA
Purpose is to increase the number of primary care residents and dentists trained in community-based ambulatory patient care settings
Residents trained in THC’s
about 3X more likely to practice in underserved settings
3.4X more likely to practice in health centers

13. HRSA THC Program (cont’d)
Eligibility
“Federally Qualified Health Centers, Community Mental Health Centers, Rural Health Clinics, Health Centers operated by the Indian Health Service, an Indian Tribe or Tribal Organization, or an Urban Indian Organization”
Primary Care Residencies
“an accredited graduate medical residency training program in: Family Medicine; Internal Medicine; Pediatrics; Internal Medicine-Pediatrics; Obstetrics and Gynecology; Psychiatry; General Dentistry; Pediatric Dentistry; and Geriatrics”

14. HRSA THC Program (cont’d)
Funding
THC GME payments support: Direct expenses associated with sponsoring an approved graduate medical or dental residency training program; and Indirect expenses associated with the additional costs relating to teaching residents in such programs.
$150K per resident per year
Congress must vote every two years to fund program (Affordable Care Act)

15. Academically Friendly
Mindset that views our local students as a precious natural resource for our health system
High School
Lectures on health topics by physicians in local high schools
Health Career day for Juniors and Seniors
Visit and tour hospital in various departments
Department Recruiting Booths
Pharmacy, PT, IT, Med Staff, Radiology, Lab
Quick Fact sheets: Educational requirements, Duties, Starting salaries

16. Sample Fact Sheet

17. Academically Friendly
College – “Pre-Med”
Policies in place that allow for “shadowing”
Shadowing Program
Must be enrolled in a pre-med program, at least 19 years old
Covers cost of PPD, Background check, UDS, Temporary ID Badges, Meals
Requires Department Supervisor and CMO Approval

18. Academically Friendly
Medical Students
Policies in place that allow for Preceptorships
Partnerships with Medical Schools for “Rural Hospital” rotations
Provide Student Housing
Cover typical costs – Meals, PPD’s, Background checks, UDS, Temporary ID Badges
“Grand Rounds”

19. Academically Friendly
Opportunity to showcase your system to your future staff
Take advantage to your most valuable resource
Engages the Medical Staff
Fosters an environment of continuous learning

20. CNFMR Residents

23. Key Elements for Starting a Residency Program
System that is primed for medical training
A Physician Champion
Attending Physicians on the staff are willing to support a residency program
Sufficient number of dedicated faculty within the department who will practice in the residency program
Hospital administration willing to support the program
Adequate volume and acuity of patients to support the training curriculum

24. Basic Requirements for Starting a Residency Program
Program Director in the same specialty with AOA / AMBS Board Certification
Sufficient faculty to implement the program
Outpatient Clinical Faculty
Library Support
On Call Quarters
Didactic Program
Affiliation agreements with other institutions for resident rotations that cannot be provided in the hospital or outpatient area

25. Basic Requirements for Starting a Residency Program (cont’d)
Accreditation by ACGME
Lengthy process, heavy on paperwork
Will Designate program size
Usually takes about one year
A relationship with a medical school

26. Benefits of Having a Residency
For the Health System
Physician Recruiting
A Marker of Quality
In House Physician Coverage
Community Service
“Grow Your Own Medical Staff”
Community Retention of Residency Graduates

27. Benefits of Having a Residency
For the Medical Staff
Life Long Learning
Enhanced CME Opportunities
Encourages Medical Staff to be up on current literature and topics
Engages staff and is seen as a “breath of fresh air”

28. Rural Residency Benefits
100% Board Certification Exam Pass Rate
80% of CNFMR graduates practice in Rural Settings
60% of CNFMR graduates work for CNHSA

30. Benefits of Having a Residency
For the Patients
Presence of Residents 24/7
Increases Patient Contact with Physicians
Provides patients with the latest in medical science

32. Choctaw Nation Family Medicine Residency (CNFMR)
Accredited by the American Osteopathic Association and the American College of Osteopathic Family Practice
Accredited for 12 total residents
3 years (4+4+4)
All residency spots are filled (100%)
National average for FP Residencies is 53% filled
Recruiting, recruiting, recruiting

33. Choctaw Nation Family Medicine Residency
Affiliation Agreements with Regional Hospitals in Muskogee, OK, Tulsa, OK and Fort Smith, Arkansas
Rotations not available within our system
Residents have “Continuity Clinic” where they see their own panel of patients under the supervision of Board Certified Family Physicians
Didactics 5 hours per week
Resident lectures, Attending Physician lectures
Journal Article Review
Case Reviews
Board Study Review
Encourage Medical Staff Participation when possible

34. Choctaw Nation Family Medicine Residency
Academic Research Projects
Must abide by Medicare duty hour rules
Staff Required
Director of Medical Education (Physician Champion)
Program Director (Physician Champion)
Residency Coordinator

35. Choctaw Nation Family Medicine Residency
Resident Benefits
Resident Salary is about $60K/yr
Full Benefits Package
Housing
Call rooms – very specific requirements
Library with access to a certified librarian (may be via telecommunication link)
Pagers, Lab Coats, Scrubs, Meals while on duty, in service testing, board testing
Paid attendance to one National Conference (required)

37. Choctaw Nation Health Services Authority
Excellence in Rural Health Care