Hill-Choctaw Teaching Health Center

Graduate Medical Education in a
Rural Tribal Health System
Choctaw Nation Family Medicine Residency
Jason Hill, D.O.
Chief Medical Officer
Director of Medical Education
Program Director
Choctaw Nation Health Services Authority
Halito
Howdy
Choctaw Nation Health Services Authority
Excellence in Rural Health Care
Overview
• Tribal Health System vs Indian Health
Service
• Choctaw Nation Health
• Concept of being Academically Friendly
• Funding - HRSA THC Grant
• Key Elements for Starting a Residency
Program
• Benefits of Having a Residency Program
• CNFMR
Choctaw Nation Health Services
Authority
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Tribal Health System
SE Oklahoma
About 900 Primary Care visits per day
Hospital – Talihina Oklahoma
9 Satellite Clinics
1200 FTE
500-600 newborn deliveries per year
Clinic
Locations
Atoka
Broken Bow
Hugo
Idabel
McAlester
Poteau
Stigler
Talihina
Specialties
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
Discussion Topics
• Funding our Residency
• Concept of being Academically Friendly
• Key Elements for Starting a Residency
Program
• Benefits of Having a Residency Program
• CNFMR
Definitions
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Graduate Medical Education (GME)
Residents
Faculty
Teaching Health Center (THC)
HRSA THC GME Program
• Health Resources and Services
Administration
– Under the U.S. Department of Health and Human
Services
• 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 communitybased 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
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”
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.
– $90K per resident per year
– Congress must vote every two years to fund
program (Affordable Care Act)
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
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
Academically Friendly
• Medical Students
– Policies in place that allow for Preceptorships
– Partnerships with Medical Schools for “Rural
Hospital” rotations
– Provide Student Housing
• This is your chance to shine
– Cover typical costs – Meals, PPD’s,
Background checks, UDS, Temporary ID
Badges
– “Grand Rounds”
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
CNFMR Residents
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
Basic Requirements for Starting a
Residency Program
• Program Director in the same specialty with
AOA / AMBS Board Certification
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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
Basic Requirements for Starting a
Residency Program (cont’d)
• Accreditation by ACGME / AOA or both
– Lengthy process, heavy on paperwork
– Will Designate program size
– Usually takes about one year
– A relationship with a medical school
Benefits of Having a Residency
• For the Health System
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Physician Recruiting
A Marker of Quality
In House Physician Coverage
Community Service
“Grow Your Own Medical Staff”
Community Retention of Residency
Graduates
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”
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
Choctaw Nation Family Medicine
Residency (CNFMR)
• Accredited by the American Osteopathic
Association and the American College
of Osteopathic Family Practice
• Accredited for 9 total residents
• 3 years (3+3+3)
• All residency spots are filled (100%)
– National average for FP Residencies is
53% filled
– Recruiting, recruiting, recruiting
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
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Resident lectures, Attending Physician lectures
Journal Article Review
Case Reviews
Board Study Review
Encourage Medical Staff Participation when possible
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
Choctaw Nation Family Medicine
Residency
• Resident Benefits
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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)
Review
• Funding
• Concept of being Academically Friendly
• Key Elements for Starting a Residency
Program
• Benefits of Having a Residency Program
• CNFMR
• Question???
Contact Information
• Website:
http://cnhsa.com/fmr.aspx
– Contact Information for Dr. Hill
Jason Hill, D.O.
Chief Medical Officer
Choctaw Nation Health Services Authority
One Choctaw Way, Talihina, OK 74571
Telephone (918) 567-7140 FAX (918) 5567-7113
JLHill@cnhsa.com
Choctaw Nation Health Services Authority
Excellence in Rural Health Care