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Are Teaching Health Centers the Cure to the Valley's Doctor Shortage?

Feb 22, 2013

Dr. Peter Broderick examines a patient's X-ray as three future doctors look on.
Credit Rebecca Plevin / Valley Public Radio

A new type of residency program may provide some relief to the Central Valley’s physician shortage, and change the way we grow and retain primary care doctors in the Valley.

The model is called a “teaching health center,” and it’s funded by the Affordable Care Act.

The idea behind this new approach to graduate medical education is to train medical residents in community health centers, and encourage them to pursue careers in primary care in underserved areas, like the Valley.

“By training and paying for training in these settings, the hope is that more of the graduates from these programs will stay in these underserved settings, will work in these community health clinics, and hopefully address some of the shortages that we have with that population,” said Dr. Peter Broderick, the CEO of the Valley Consortium of Medical Education in Modesto.

Broderick works with medical students and residents through the consortium’s Valley Family Medical Residency Program. It became the first teaching health center in the state when it launched in 2010, and has trained 12 doctors a year since then.

The model is gaining traction. This summer, another teaching health center, the Sierra Vista Family Medicine Residency Program, will welcome its first four residents to Fresno. The state’s third teaching health center will be located in Redding.

This new concept contrasts with traditional medical residency programs, which are often based at teaching hospitals in large cities, and encourage specialty training.

But traditional programs still play a huge role in training our future doctors. UCSF-Fresno remains the largest provider of graduate medical education in the Valley. It also accepts 12 family medicine residents each year.

Gene Kallsen, the assistant dean of UCSF-Fresno, says the university and the teaching health centers share the goal of increasing the number of primary care doctors in the Valley.

But, Kallsen explains, there are several roadblocks that prevent UCSF-Fresno from growing its residency programs to meet the region’s needs for primary care doctors. A major one, he says, is a convoluted system that ties the number of residents to the number of Medicare patients at a hospital. Once the cap is set, it can’t be changed.

“One of the barriers is that programs like ours can’t grow unless we identify new sites,” Kallen said. “We have what’s called a cap that says that based on some historical number, we can only get funding for so many residents. We can only get federal funding for so many residents, and we live up against that cap.”

That’s where new programs, like the teaching health centers, come in.

“We’re not trying to compete with UCSF at all, and we don’t want to have that perception,” said Norma Forbes, the executive director of Fresno Healthy Community Access Partners. Her organization partnered with Clinica Sierra Vista to launch the Sierra Vista Family Medicine Residency Program.

“We want to understand that this is a different model that we hope will grow the number of family medicine doctors, and that there is room for both types of training residents here in the Valley and across the country,” she said.

Forbes said the program follows a curriculum similar to more traditional family medicine residency programs. But residents at the teaching health center will gain experience with a variety of patients and procedures, instead of specializing in one specific type of medicine.

“But what we feel that the difference will be, is the teaching health center’s primary clinics are considerably different in exposure to ambulatory clinic that’s tied to a hospital,” Forbes said. “Those primary clinics are free-standing and they are really focused on prevention and wellness, and working with patients from birth to death. And when you get into ambulatory clinics associated with more urban environment hospitals, you run into the specialization.”

She is confident that the teaching health center model will help train more doctors who are dedicated to serving Valley communities, and slowly remedy the region’s primary care doctor shortage.  In fact, she’s hopeful that all of the program’s residents will practice in clinics in rural areas of the Valley after they finish their residency. There’s a high correlation between where doctors do their residency, and where they practice afterward, she said.

“Our goal is to get a 100 percent of them – all four of them – staying right here, so we can truly increase the number of doctors through this residency program,” Forbes said.

The program currently has a three-year grant from the federal government.

Back at the teaching health center in Modesto, Dr. Broderick congratulated medical student Dr. Gewel de los Santos for helping a patient reach a healthy weight. She responded with outright enthusiasm.

Valley residents can only hope that more family medicine residents are as excited about practicing in the region.