Kalamazoo, Mich., sports a population of about 250,000 and is home to Western Michigan University Homer Stryker M.D. School of Medicine. The town also boasts attractions such as the Kalamazoo Valley Museum, an art institute and a nature center.
Susan Jevert, D.O., wouldn't have it any other way than to take care of her patient Olga Villarroel during a recent hospitalization. "She's been my patient for a year and a half; we've developed a close relationship," said Jevert.
But for all its positives, the community has, in recent years, become increasingly short on primary care physicians in general and especially needs more family physicians to hold watch over people's health care needs.
And so, when Allan Wilke, M.D., was hired in 2012 to serve dual roles -- as chair of the medical school's Family and Community Medicine Department and director of its family medicine residency program -- he made a bold move.
Wilke orchestrated the transfer of the family medicine program's clinical operations from its home of 40 years on the school's main campus into the newly expanded Kalamazoo Family Health Center, a designated federally qualified health center (FQHC).
Wilke served as a panelist on the fifth and final stop of the 2015 Health is Primary city tour in Detroit(www.healthisprimary.org), where he talked about his work implementing innovative ideas into training. "The first year of this tour has centered on looking at innovations," said Wilke.
- Allan Wilke, M.D., the family medicine residency director at the Western Michigan University Homer Stryker M.D. School of Medicine program in Kalamazoo, is looking to recruit residents who will stay in the community after training.
- Wilke has also started looking at residents with an eye to training some as future faculty members for the residency.
- Early in his tenure, Wilke orchestrated the relocation of the program's clinical operation to a newly renovated federally qualified health center to give the community access to family physicians and to give residents an opportunity to treat a diverse and challenging mix of patients.
Health is Primary is a multiyear communications campaign of Family Medicine for America's Health(fmahealth.org), a partnership of eight family medicine organizations, including the AAFP.
In an interview with AAFP News, Wilke credited a $10 million federal grant -- secured by Family Health Center President and CEO Denise Crawford, M.B.A. -- for the clinic's renovation.
The two clinics are a mere five minutes apart, but the FQHC "is on the other side of the tracks," said Wilke.
"In general, the patients seen at the Family Health Center are poorer, less mobile and challenged in any number of spheres -- medically, socioeconomically, psychiatrically …" said Wilke. And importantly, pregnant patients are much more likely to seek care at the Family Health Center.
"Since delivering babies is part and parcel of family medicine training, being over here (at the FQHC) helps our residents beef up their OB numbers" and take excellent care of a special group of patients, said Wilke.
In short, the Family Health Center provides the kind of tough training ground young family physicians need if they are to excel in a medical specialty that has a broader scope of practice than any other specialty.
Journal Special Issue Highlights Family Medicine for America's Health
Glen Stream, M.D., M.B.I., board chair and president of Family Medicine for America's Health(fmahealth.org ), recently outlined six key goals(fmahealth.org) to transform the nation's primary care system in a statement about a September special edition(www.stfm.org) of Family Medicine that focuses on the initiative.
Family Medicine for America's Health is a partnership of the AAFP and seven other family medicine organizations that officially launched one year ago during the AAFP Assembly in Washington, D.C.
Briefly, those goals are:
- Increase patients' access to their primary care team,
- Encourage every practice to have a patient advisory council or similar mechanism to facilitate patient engagement,
- Increase transparency in pricing of health care services and educate patients to better understand the cost of their care,
- Integrate public and mental health into the patient-centered medical home and incorporate training to practice in a team-based setting into graduate medical education,
- Support policies that drive at least 40 percent of medical students toward primary care specialties, and
- Sunset fee-for-service payment in primary care and encourage the adoption of a uniform and simplified model of comprehensive payment.
According to Stream, the articles in the special edition "provide insight, recommendations and challenges to the work of FMAHealth."
Crawford told AAFP News that through the years, Kalamazoo's physician shortage meant that primary care physicians who came to town "essentially could name their price and pick their location."
And far too often, physicians chose the higher-paying facilities, leaving the underserved neighborhood's FQHC with a cast of mid-level providers and few full-scope physicians.
Then came the 2010 passage of the Patient Protection and Affordable Care Act and the ensuing expansion of Michigan's Medicaid program -- positive developments both, but a one-two punch that resulted in a flood of new patients that continues to this day.
"Some 13,500 patients in Kalamazoo County now are accessing health care," some of whom had not had regular care in 15 to 20 years except sporadically via the emergency room," said Crawford.
Bottom line, moving the residency's clinical site to an area that historically had difficulty attracting physicians was a win-win for the residency program and the community, said Crawford.
Recruit, Retain, Fill Faculty Positions
But relocating the clinical training site was just part of Wilke's residency revitalization plan.
He also had a basic attitude adjustment in mind.
"We started recruiting for residents who wanted to work with an underserved population and who were extra bright and fun to work with," he said. "Our idea and hope at the time was that if we trained them here (at the FQHC) we'd be able to convince a handful of them to stay on after graduation.
"It's that whole notion of 'Train residents where you want them work.'"
But there's been yet another need: Wilke struggles to fill faculty positions at the residency.
"The pool of well-trained family medicine physicians who do full-spectrum family medicine is pretty shallow," he said. "Even in a small town like Kalamazoo, people who were trained to do deliveries, or take care of patients in the hospital, or perform minor surgical procedures in their office have had their practices bought up by hospitals."
He pointed out that hospital administrators want primary care physicians to take care of routine patient complaints in the office and refer patients to subspecialists for anything out of the ordinary.
"In that kind of setting, you lose your clinical skills," said Wilke.
"We decided that in our program, we would to start preparing our graduates to enter faculty positions upon graduation."
It makes perfect sense, said Wilke, to identify residents who are really good physicians, provide them with faculty development and then hire them.
"They'll come on with their skills intact; they've been taking care of patients in the hospital, so they know how to do that. They have to do OB, because that's what the training is all about," said Wilke.
Allan Wilke, M.D., residency program director, shares a light moment at the Family Health Center clinic in Kalamazoo, Mich., with one of his chief residents, Ibad Farooqui, M.D.
And perhaps most importantly, he added, "You know them and they know you … you've had a three-year period of evaluating what kind of faculty member they're going to make."
Wilke's gamble already has paid off. "Two of my graduates from last year's class -- including one of my chiefs -- are staying on here to become physicians for the Family Health Center," he said.
And a current third-year resident, Susan Jevert, D.O., is training to come aboard as a faculty member after graduation. Clearly, Wilke has an eye for talent: Jevert recently was recognized as one of 12 family physician recipients of the 2015 Award for Excellence in Graduate Medical Education.
Jevert noted that the residency program moved to the FQHC site between her first and second years, and despite some initial butterflies about the change, relocating the clinical training to the Family Health Center has proven to be an excellent choice for the community.
"It's improved the quality of care for patients because the Family Health Center is a safety-net facility." So even patients with the lowest economic status receive the kind of health care they need and deserve, she said.
"Coming back to train in my hometown was intentional, and I'm excited and passionate about investing in the future of physicians in Kalamazoo," said Jevert.
Now Wilke is intent on getting Jevert trained up and ready to go. "We've carved time out of her electives for faculty development, and I've got her doing a high-risk OB elective in Grand Rapids because we thought that would help her with her OB skills," he said.
And this savvy residency director intends to keep on pushing for more resident-to-faculty converts like Jevert.
"People come and go out of faculty all the time, so you don't want to turn the spigot off," said Wilke. He added that preparations already were underway for starting a new program in Battle Creek. "I'm going to need faculty for that location, too."
As for Crawford, working closely with Wilke and his faculty members -- plus a crew of young family medicine residents -- has opened her eyes to how important family medicine can be to a community.
Remarkably, despite a health care administrative career that has spanned more than 20 years, Crawford said she saw, for the first time, full-scope family medicine on display at the Family Health Center.
All the family physicians she'd known in the past had exclusively practiced adult medicine, she explained.
"They'd given up pediatric practice, given up OB practice and all of those very key skills that made them so valuable and so unique," said Crawford.
"So part of our focus in education here has been to say to residents, 'You absolutely do not give that up, because no one else from the primary-care sector can do what you do.'"
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