Rick Flinders, MD

The non-profit sector enjoys exemption from income and many other taxes, in exchange for providing public benefits. Most non-profit hospitals are involved in their communities in various ways. Some become extensively involved in providing services to their community’s safety net by increasing primary health care access for indigent and low income persons.

In a period in which the state and county governmental resources are stretched thin, the role of the non-profit sector in meeting a community’s needs become ever more important. A roundtable discussing the role of two health systems in addressing community problems is scheduled. (See: 21st National Conference on Primary Health Care Access April 12-15, 2010 in Kaua’i.)

Doctor Rick Flinders of the Santa Rosa family medicine residency program will speak to the community network created in Sonoma County, California involving the Sutter Hospital system, the Kaiser Permanente foundations and several federally qualified health centers that are providing both service and education to the community.

Doctor Flinders will be joined by two colleagues. Doctor Jimmy Hara of the Kaiser Permanente Los Angeles Department of Family Medicine and Delight Erickson of the Sutter/Memorial Hospital rural health clinic in Los Banos, California.

Doctor Hara represents a not-for-profit hospital and health plan with a community medicine fellowship and residency rotations at the Venice Family Clinic, the Saban Free Clinic, the Asian Pacific Healthcare Venture, the UCLA Mobile Clinic, and the Salvation Army Homeless Shelter.

Jimmy H. Hara, MD

California Kaiser-Permanente has a partnership with the California Primary Care Association, and Dr Hara assisted Dr Flinders with the a new community partnership to govern the Santa Rosa residency.

He also chairs the California Health Professions Policy Commission (that administers the Song-Brown Family Physician Training Act) and participated in the affiliated Health Professions Education Commission. Dr Hara is prominent in the Physicians for Social Responsibility, and is chair of the Board of Directors of the Venice Family Clinic, that is affiliated with the Kaiser Permanente Los Angeles Department of Family MEdicine.

Dr Hara was recongnized by the California Medical Board as the Physician Humanitarian of the Year.

Delight Erickson, FNP

Also participating will be Delight Erickson, a Family Nurse Practitioner, who staffs a Rural Health Clinic in the Central Valley of Los Banos. The clinic is associated with Sutter Health’s Memorial Hospital in Los Banos.

The community of Los Banos, on the Western side of the great Central Valley of California, historically a community that has supported the region’s agricultural economy, has, in recent years, become a center for relatively low cost housing for persons employed in the Bay Area.

The Rural Health Center serves a diverse, multicultural population of low income and “no income” patients. It provides full range of primary care, including women’s health, pre-natal care, and children’s health services.

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The woes of the most populous state will be the focus of several case studies, some suggesting harrowing consequences of systemic failures, others suggesting important results from ongoing and newly developed strategic initiatives.

Stanford University’s Virginia Fowkes will lead off the session on the Golden State, with a discussion of how AHECs (Area Health Education Centers) – partnerships that link health professions schools to areas of workforce need. In her presentation  ”AHECs:  a solution for consequences?” she will argue that AHECs engage in numerous partnerships through their host organizations and their advisory boards.  These partnerships include educational, clinical institutions, and other organizations interested in the health professions work force needs in their respective regions.  Through these partnerships, they conduct their training and advocacy.

A look at the types of partnerships they create provides perspective on how AHECs are positioning themselves regionally and nationally to be players in current and future health initiatives, such as, teaching health centers, the primary care extension model, and other ideas proposed in health care reform.

Other Californians who will contribute to this series of plenary panels and presentations will include Doctors Hector Flores of the White Memorial Medical Center, Jamie Osborn of Loma Linda University, Rick Flinders of the Santa Rosa Family Medicine Residency, Charles Vega of the University of California, Irvine, Ana Bejinez-Eastman of Presbyterian Intercommunity Hospital, Whittier and Jimmy Hara of the Kaiser Permanente Los Angeles Health System, as well as Delight Erickson, FNP, of the Sutter Health/Memorial Hospital Rural Health Clinic in Los Banos.

The leadoff roundtable is entitled 21st National Conference Roundtables: Mission-Oriented Innovations in Teaching Physicians – The Residency-Based Patient Centered Medical Home, Medicaid HMO and Federally Qualified Health Center, and will consist of Doctors Bejinez-Eastman, Osborn and Vega.

The second roundtable is entitled 21st National Conference Roundtables: Strategic Non-profit Sector Initiatives Promoting Primary Health Care Access in California and consists of Ms Erickson and Doctors Flinders and Hara.

Doctor Flores will be a reactor to subject matter covered by Ms Fowkes’ introduction and the two roundtables. Another Californian, Warwick Troy, Ph.D. of Shueman Troy Consultants in Pasadena,  will act as a “thought provocateur” during the Golden State session.

Jamie Osborn, MD

The Twenty-first National Conference on Primary Health Care Access will feature initiatives in several states, including a series of roundtables relating to the State of California. (See: 21st National Conference on Primary Health Care Access April 12-15, 2010 in Kaua’i.) One of these will explore “mission-oriented” residency linkages with innovative models of “health care delivery”.

Over the years, the National Conferences have highlighted various innovations in physician residency training in settings that both promote primary health care access for underserved populations and teach them how to provide care to such populations in ways that are culturally sensitive and cost-effective.

Yet, even though such strategic initiatives can be demonstrated as successful, they tend to be financed by disparate revenue streams and may be simultaneously subject to conflicting regulations. Even if one imagines that the follow-up to any federal health care legislation that should pass might prove to be a positive factor for such initiatives, nothing is presently certain.

This roundtable will discuss several innovations that held great promise, some of which are unambiguously successful and some of which are less so.

Doctor Jamie Osborn, director of the Loma Linda University family medicine residency program, will update the successful rural-based residency program in the Central Valley town of Hanford. She will relate her residency program’s transformative experiences with the Patient Centered Medical Home, which she believes has demonstrated its capacity to provide “whole person care”.

Charles Vega, MD

Doctor Osborn will begin a discussion of the positive and negative issues relating to the Community Health Center and Medicaid Health Maintenance Organization models of primary health care delivery. She will be joined by Doctors Charles Vega and Ana Bejinez-Eastman.

Doctor Vega’s residency program at UC Irvine has one of the longest track records of any physician training program located in a federally qualified health center, this one located in the center of Santa Ana, one of California’s largest Latino communities. An extensive discussion of Dr Vega’s outreach program may be accessed at: University of California Irvine’s Family Medicine Residency Program: Outreach to Orange County’s Latino Community.

Joshua Freeman, MD

The Twenty-first National Conference’s “consequences” theme is especially relevant to the current debates surrounding proposed federal  health care insurance reform. Despite the political rhetoric heard during the past year, the  existing American health care system is the product of myriad federal, state and local subsidies and mandates. It seems certain that much of the existing system will be impacted in consequential ways, certainly by any legislative changes at the federal level and perhaps even if efforts fail to bring about the comprehensive health insurance reform that the president proposed.

The political debate obscures the reality of how the current system actually works. The first two panels of Day One will be asked the question, “What are the likely consequences of the success or failure of current efforts to change the health care system?”

[Note: hear the podcast of a presentation made by Doctor Philip Lee, President Lyndon Johnson's highest rank health official on the development of Medicare and Medicaid at Podcast: Doctor Philip Lee discussing the unintended consequences of the creation of Medicare and Medicaid]

Panel One: the Consequences of the Federal Health Care Reform Legislation – Overview

Perry Pugno MD MPH

The first panel will address the elements contained in the final form of any legislation which is likely to be enacted, and the possible consequences should the efforts fail. (For a discussion of the roundtable, see the article, at: Josh Freeman, Hector Flores, Perry Pugno to Lead Off 21st National Conference on Primary Health Care Access With “What Just Happened?” Roundtable.)

Panel Two: the Consequences of the Federal Health Care Reform Legislation – Impact on the Primary Health Care Workforce

Hector Flores, MD

The second panel will address the issues of our “physician workforce” in light of proposed legislative changes.

Doctor Donald Frey of the Creighton University School of Medicine will moderate the second panel, which will include Doctor James Herman of Penn State Hershey Medical Center and Doctor Thomas Hines from Boston University. Doctor Hines will discuss the impact of the recent Massachusetts experience with health care reform mandated at a state level.

For a description of the second plenary session, see: 21st National Conference Plenary: Health Reform Legislation Consequences for the Nation’s Primary Care Physicians

[Below: a view of the grounds of the Grand Hyatt Kaua'i.]

The third major plenary will address the nation’s public health needs (see 21st National Conference Focus on Nation’s Public Health System: What Happens Now?) Dean Richard Clover of the University of Louisville School of Public Health will be joined by Doctors Marc Babitz of the Utah Department of Health and Charles Q. North of the University of New Mexico.

James Herman, MD, MSPH

Meanwhile, the Coastal Research Group website will reprise many of the past presentations at its National Conferences Each day of the National Conference will be devoted to looking at the consequences of the quest for health care reform on the American commonwealth.

Monday, April 12, 2010: The 21st National Conference will be convened by Doctor James C. Herman of Penn State University’s Milton S. Hershey Medical Center. After his introductions the three plenary panels described above will take place.

A Lesson in History: the Consequences of the Flexner Report of 1910

Observing the 100th anniversary of the Flexner Report that had a transformative effect on American medical education, the National Conference will analyze how changes in national policy can have unexpected consequences whose impact can be seen a century later.

Tuesday, April 13, 2010: The Consequences of Strategic Interventions for Rural, Low Income and Vulnerable Populations and for Community-Based Medical Education (Part One).

Donald Frey, MD

The second day will begin highlighting local and regional strategic initiatives to promote primary health care access. The first panel is entitled The Consequences of Strategic Intervention: Providing Health Care for Rural America and includes Doctors Baretta Casey of the University of Kentucky, Robert Maudlin of the University of Washington’s Spokane Family Medicine residency program, and Robert Ross of the OHSU rural residency program in Klamath Falls, Oregon. (For a more detailed description of that panel, access that webpage through the hyperlink.)

Over the several days of the National Conference, initiatives for decentralizing medical education in the states of Hawai’i, Michigan, Minnesota, New Mexico, Kentucky and Louisiana will be analyzed. These will begin with a presentation by Dean Daniel Webster of Michigan State University’s Traverse City campus, described at: The 21st National Conference’s “Consequences” Theme: Strategic Interventions in the State of Michigan.

In addition, we will discuss initiatives to create Educational Health Centers within community health centers and other federally qualified health centers (see the accompanying forum by Doctor Kevin Murray of Tacoma General Hospital on this website’s frontpage and the description of cross-cultural, linguistic curriculum at University of California Irvine).

Wednesday, April 14, 2010: The Consequences of Strategic Interventions for Rural, Low Income and Vulnerable Populations and for Community-Based Medical Education (Part Two).

The third day of the National Conference will continue the discussions of these initiatives, and, in addition, will have the first presentation on impact of Caribbean medical schools on the nation’s supply of primary care physicians, entitled “From Whence the Workforce: the Contribution of Ross University to the Nation’s Primary Care System”, that discusses the multiple campuses and educational activities of that institution.

Thursday, April 15, 2010: The Consequences of the Quest for Health Care Reform on the Nation’s Physician and Health Care Workforces.

The fourth day (April 15) will include a celebration of the four decades since its founding of the American Board of Family Medicine, which pioneered and implemented the concept of ongoing certification of primary care physicians.

The fourth day will also observe the 20 G. Gayle Stephens Lectures, with a panel including previous presenter of the National Conference’s Stephens, Odegaard and Rodos Lectures.

In recognition of the lively Armageddon metaphor that Doctor Stephens has used to describe the battle of Medicare and Medicaid and of Doctor Patrick Dowling’s Fifteenth Stephens Lecture  (see The Fifteenth G. Gayle Stephens Lecture – Patrick Dowling, MD) which updated the Armageddon theme to comprise the fight for universal health care in the United States, a panel, entitled “Skirmishes at the Armageddon Battlefield: Correspondent Reports on Health Care Reform Initiatives” will take place in the final hours of the National Conference.

This webpage, to be continuously updated, will be the source of the latest information on the 21st National Conference

Conference invitees will be able to secure up to four additional days before and/or after at the Grand Hyatt Kaua’i at the advantageous National Conference rate. Registration will INCLUDE four nights accommodations at the Grand Hyatt, and will be based on the category of room each registrant selects. Although registration fees and payments for extra nights are non-refundable, full credit towards future National Conferences will be given if circumstances require withdrawal from the National Conference and the Coastal Research Group is notified by April 7, 2010.

[Below: a view of the one of the Grand Hyatt pools.]

21st National Conference Faculty (confirmed as of January 28, 2010)

Marc E. Babitz, MD, Utah State Department of Health, Salt Lake City

Macaran Baird, MD, University of Minnesota, Minneapolis

Lee A. Burnett, DO, www.studentdoctor.net, Southern Pines, North Carolina

William H. Burnett, MD, Coastal Research Group, Granite Bay, California

Baretta Casey, MD, University of Kentucky, Lexington

Richard Clover, MD, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky

Mary Coleman, MD, Ross University, Dominica, West Indies

Ana Eastman, MD, Presbyterian Intercommunity Hospital, Whittier, California

Delight Erickson, FNP, MPH, Memorial Hospital, Los Banos, California

Enrique Fernandez, MD, Ross University, Miami, Florida

Richard Flinders, MD, Santa Rosa Family Medicine, Santa Rosa, California

Hector Flores, MD, White Memorial Medical Center, Los Angeles, California

Virginia Fowkes, MHS, Stanford University, Stanford, California

Joshua Freeman, MD, Kansas University Medical Center, Kansas City, Kansas

Donald Frey, MD, Creighton University, Omaha, Nebraska

Jimmy Hara, MD, Kaiser Permanente, Los Angeles, California

James C. Herman, MD, Pennsylvania State University, Hershey, Pennsylvania

Thomas Hines, MD, Boston University Medical Center, Boston, Massachusetts

Allen Hixon, MD, University of Hawai’i, Mililani

Charles Q. North, MD, University of New Mexico, Albuquerque

Jamie Osborn, MD, Loma Linda University, Loma Linda, California

Neal Palafox, MD, University of Hawai’i, Mililani

James C. Puffer, MD, American Board of Family Medicine, Lexington, Kentucky

Perry A. Pugno, MD, MPH, American Academy of Family Physicians, Leawood, Kansas

J. Jerry Rodos, DO, Midwestern University, Western Springs, Illinois

Robert Ross, MD, Cascades East Family Medicine, Klamath Falls, Oregon

Warwick Troy, Ph.D., Shueman-Troy Associates, Pasadena, California

Charles Vega, MD, University of California, Irvine

Daniel Webster, MD, Michigan State University/Munson Healthcare ,  Traverse City, Michigan

Allan Wilke, MD, Ross University, Freeport, Grand Bahama, The Bahamas

Daniel M. Webster, MD

The National Conference’s extended sessions on the primary care workforce will include case studies of several states. Two states hard hit by the current recession are Michigan and California. A presentation led by Doctor Daniel Webster will detail Michigan State University’s interventions in Michigan’s geographical areas of high need to improve the primary care physician workforce and primary health care systems.

Doctor Webster, Community Assistant Dean for the Traverse City campus of Michigan State University/College of Human Medicine (MSU/CHM), will address the supply and demand for Michigan physicians through the year 2020 as presented in the 2005 Blue ribbon physician workforce study and subsequent update of 2008.

Dean Webster will describe the medical school enrollment expansion for all of Michigan’s medical schools and specifically the MSU/CHM response and growth over the last several yours with the further development of regional medical campuses covering the state of Michigan.

He will discuss the pros and cons of increased medical school enrollment, as well as how this initiative does or does not address the need of primary care access in the future. As a previous family medicine residency director, he will discuss the graduate medical education response in the state of Michigan to this physician workforce need, and how recent hospital system affiliations impact Michigan health care.

Dr Webster will consider the impact of health care reform (or lack of it) and the implications of the economic downturn in Michigan on the original goals of the 2005 strategy to increase the workforce of physicians in Michigan.

Baretta Casey, MD

Even if NO health care reform proposal passes in the near future, it is still a public policy issue that has to be addressed. If one looks at the entire history of federal policy development in the area of “primary care” (a term the “feds” promoted), going back to the beginning of World War II, there have been key decisions as well as “non-decisions” that in historical perspective can be considered as importantly consequential.

Whatever was to happen to the health care system was to be (1) something or (2) nothing. Either “change” or “no change” would have consequences for physician supply, the underserved and uninsured (which should be considered different concepts), rural health care access, care of the healthy, sick and frail elderly, care of children, and public health issues.

If health care reform should end up a compromise that takes in features that neither the reform advocates nor status quo advocates had considered (e.g., non-profit cooperatives, or triggers that base more extensive government intervention on the number of health care plans available in an area), there will need to be more work done (clean-up legislation, regulation promulgation, and, of course, implementation of the reforms by all the entities concerned).

Preceding a series of presentations on regional issues, a roundtable panel will discuss the issue. Participants will include Doctor Baretta Casey of the University of Kentucky and Robert Maudlin of the Spokane Family Medicine Residency.

Dr Casey is associated with the University of Kentucky’s rural center located in the Appalachian town of Hazard.

Robert Maudlin, Pharm. D.

Dr Maudlin has been a pioneer in establishing physician residency programs in private practices in very small communities in Eastern Washington and elsewhere in the University of Washington’s WWAMI program, an initiative that links medical school admissions and physician residency programs to underserved communities in the States of Washington, Wyoming, Alaska, Montana and Idaho.

Additionally, he has consulted throughout the United States on programs that create strategic linkages between educational institutions with rural communities.

Dr Troy’s presentation will introduce and analyze two recent  proposals for improving health workforce competencies: (1) for geriatrics and (2) for accountable services development in long term care. These approaches use community-based imperatives to plan and deliver accountable professional competencies and services critical to the spirit and substance of primary care.

Warwick Troy, Ph.D.

These proposals address the needs of a diverse, vulnerable and resource-poor community whose needs have been shamefully neglected for decades; and in so doing they are uniquely responsive to the core theme of this 21st National Conference – “Consequences” – in this case, the consequences of neglect.  Specific legislation is proposed: at very least a possible harbinger of  “services on the ground.”

A caveat: although this presentation is made in the context of health “reform,” it must be noted that one of its foci – long term care – has not been taken up, operationally at least, by health reform submissions.  This is hardly unexpected and, as the presentation will suggest, will someday reap its own dire “Consequences.”

Again, unlike long term care, its bedfellow and our other focus – expanded training in geriatrics – which derives from a medical and not a social services context, would seem to have some realistic hope of implementation within medical schools in the nearer future.

The presentation will invoke a number of seminal issues that have figured prominently previous National Conferences, including community-based medicine, the “Future of Family Medicine” reports, and integrated care (multi/interdisciplinary service delivery).

Without the workforce and practice changes that could be realized, there will be perils indeed for the needy and vulnerable and for the utility and future viability of community based primary care itself as a lever to lift communities.

In taking the conference theme, Consequences, seriously, this presentation assumes that health reform at the nexus of service delivery must spring from primary care as its core and the community as its sustaining base, if it is to meet the health needs of patients and other consumers in a timely, effective, efficient and enduring way.

It’s not that way now and, hence, the professional role options listed above.  Things – service planning and delivery and professional education and training – must change and must do so demonstrably.

The presentation intends to invoke the concept of  “regional infrastructures” as a lever for service (and for professional training) improvement by identifying workforce models that place the multiform roles of the health services provider in the context of existing resources, material and human (individual and collective).

The dual themes of the presentation are critical aspects of informed and accountable primary care, although having very different social and professional profiles.  However, the proposals seem to indicate that, for once, it looks as if the right mix of supporters are present: a rare development that must be handled opportunistically to be made to serve America’s diverse and neglected communities using an enhanced armamentarium for the foci within primary care.

To achieve this we identify two recent developments in health services policy that are not generally seen as critical aspects of the primary care armamentarium: long term care and geriatrics  – areas that are loosely allied.  For up to three decades both areas have had to contend with lip service as to their value and their legitimacy, grievous shortfalls in workforce service and training. Now there has been a vociferous call for protagonists to take up their separate and shared causes.  And this time it looks as if the right supporters are lined up to make changes that will transform their respective fields and likely the entire face of primary care.

It’s a perfect storm, but a healing one.  It’s a phenomenon: probably a one-time confluence that actually can be made to serve America’s diverse and neglected communities using a richly enhanced armamentarium for primary care.  Absent the workforce and practice changes that will result, there will be perils indeed for America’s most needy and for primary care itself as a lever to lift communities.

Consequences of Strategic Intervention: Creating a Board for the Periodic Recertification of Family Physicians

James C. Puffer, MD

The Twentieth G. Gayle Stephens Lecture will be presented by Doctor James C. Puffer, the President and Chief Executive Office of the American Board of Family Medicine, that recently celebrated its 40th anniversary. One of the major workforce innovations of the 1960s, a new physician specialty board with requirements for periodic re-certification was created for doctors who wished to practice as comprehensively trained family physicians.

After Dr Puffer’s lecture, a panel will discuss the twenty Stephens lectures. (For additional information, see: 15 Stephens Lectures Celebrated at 16th National Conference.)

Consequences of Strategic Intervention: The Case of the University of Minnesota’s Rural Physician Associate Program

Macaran Baird, MD, MS

Doctor Macaran Baird, Professor and Head of the Department of Family Medicine and Community Health at the University of Minnesota, will present the Seventeenth Charles E. Odegaaard Lecture. The subject of his presentation will be the Rural Physician Associate Program, a clerkship that matches third year medical students with rural doctors.

With nearly four decades of experience with this strategic initiative, it has proven to be an effective means of replenishing the rural physician workforce. Dr Baird will present evaluative and outcomes data for a 38 year period. (For further discussion of the “Rural Strategic Initiatives” theme at the Twenty-first National Conference, see: The Consequences of Strategic Intervention: Providing Health Care for Rural America.)

Dean Richard Clover

Richard Clover, MD, Dean of the University of Louisville’s School of Public Health and Informatics, will provide another insightful discussion of the state of the public health system in the United States at the Twenty-first National Conference on Primary Health Care Access.

Dr Clover, a fellow of the National Conferences, surveys the nation’s principal public health needs, and assesses the extent of progress towards addressing those needs provided by current legislative effots.

Doctor Clover will be joined in an extended discussion with two Senior Fellows of the National Conferences, Doctor Marc Babitz or the Utah Department of Health and Doctor Charles Q. North of the University of New Mexico School of Medicine.

Marc Babitz, MD

Doctor Babitz, taking note of  the Massachusetts experiment with universal requirements for health insurance, will argue that solving the financial barriers for many individuals through the reform proposals will not decrease the demand for traditional public health services such as surveillance, preparedness, care of special populations, and preventive health programs.  In addition, the reforms being discussed appear to do very little to address the major manpower issues in health care, including the public health workforce.

Doctor North will detail new directions in physician training at the University of New Mexico, particularly a newly designed curriculum in public health. The UNM effort will incorporate a BA/MD program to expand the medical school from 75 to 100 students this year.

A feature of the revised medical curriculum will be an integrated Certificate of Public Health curriculum which we will start with the 2010 entering class to provide 17 mandatory hours of public health training for all UNM students.  This is a rare example of integrating traditional medical school with public health training.  The hope is that it will help meet the needs of New Mexico for primary care doctors in rural and underserved areas and address public health needs better.

Training students and residents in classic public health concepts, especially epidemiology and the social determinants of health will be more important to reach equity.  New physicians will need to develop advocacy and policy sophistication to improve population health as well as providing acute and chronic care to individuals.

Charles Q. North, MD, MS

Doctor North argues that training in clinical effectiveness is more important given the steadily increasing cost of care and the overutilization, over-diagnosis and over-treatment that the current fee for service medical industrial complex fosters. Physicians will increasingly need to develop teams in the practice and partners in the community to be effective personal care clinicians and community advocates.  It will be necessary to adopt the principles of the patient centered medical home into chronic care training. Improved data basis using epidemiology and GIS will provide focused community specific data and allow rapid prioritization and measurement of interventions allowing for improved performance in primary care.

Incentives to teach, research and publish in the Community Health Center setting with academic partners will need to be developed.  A major barrier to care in the CHC setting will continue to be the high cost of hospital care and limited access to resources that the CHC cannot cover for the uninsured who will surely continue to use CHC care disproportionately.  Community hospital partnerships and new mechanisms of payment will need to be developed and pursued with cities, counties, states and the federal government at a time of deficit spending and uncertain tax revenue.

Donald Frey, MD

The second plenary session of the Twenty-first National Conference on Primary Health Care Access will be held on the morning of Monday, April 12, 2010. The session will be comprised of a roundtable discussion on what the consequences may be on the nation’s physician workforce, particularly primary care physicians. The roundtable discussants will be Doctor Donald Frey, Creighton University’s Vice President for Health Affairs, Doctor Thomas Hines of Boston University, and Doctor James Herman of the Penn State University Hershey Medical Center.

Over the past 40 years, Family Medicine and Community Health physicians have been engaged in efforts to meet perceived community and regional health care needs with only a limited mandate to do so. Over that period of time, national public policy devoted relatively little attention to the needs for effectively trained primary health care and public health workforces.

Doctor Hines will give an overview of the policy workforce issues that were raised when the State of Massachusetts enacted legislation mandating health insurance.

Thomas Hines, MD

Additionally, the discussion will note federal efforts and professional organization efforts to encourage the development of primary care physician training programs that address the needs of “underserved” rural and urban communities.With relatively little national attention and minimal funding, regional and community infrastructures for training physicians have been created over that 40 year period that will help meet the primary health workforce requirements of the new legislation.

These regional and community infrastructures include:

• training physicians to diagnose and treat a person’s physical and behavioral health care needs.
• training these physicians in the use of available resources – other physician specialties, tertiary care facilities, community resources.
• creating residency programs that teach “systems of care”.
• creating medical school departments that assume community-oriented objectives, designed to improve the health care delivery system in specific underserved communities and to provide a primary health care workforce for them.
• by training physicians to work in community health centers and other “safety net” providers, assisting those providers in meeting their immediate and long term workforce direct patient care  (“linkage” programs that in the current legislation in Congress are called “teaching health centers”).

Subsequent to this plenary session, a series of presentations on regional primary care training activities take place.

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