MDNews - Central New York

Dr. Gorman explains that the question of why physicians are less likely to practice in one town over another is connected to a spouse's ability to fi nd employment or comfort in sending children to the local schools, among other factors. "So, what you have is not a global shortage of doctors. What you've got is a maldistribution of physicians against the need," says Dr. Gorman. "When you consider these factors, the drivers need to be addressed with a different set of lenses or a different strategy if they are to be mitigated." Health Workforce New Zealand has helped develop extensions of practitioners' roles on the island, such as pharmacists becoming more intimately involved in the management of medication — rather than simply the dispensing — and optometrists providing treatment for glaucoma and macular degeneration. These extensions allow physicians to concentrate solely on the elements of care that only they can provide. Sharing the Care The idea of utilizing medical personnel beyond the M.D. and D.O. is circulating in the American health care industry, as well. Jean Moore, M.S.N., Director of the Center for Health Workforce Studies at the University of Albany — SUNY School of Public Health, reports New York state investigated how small changes could positively impact access to health care and improve quality while also decreasing costs. The study, New York Medicaid Redesign, specifi cally examined the legal rationale for prohibiting medical assistants from administering flu shots and how making a statutory change would address its goals related to access, quality and cost. As Paul Keckley, Ph.D., Executive Director of the Deloitte Center for Health Solutions, and his colleagues discovered in conducting The Physician Workforce study — commissioned by the Bipartisan Policy Center — the health care industry is experiencing growth to the tune of 732,000 new jobs since December 2007. However, the majority represent hourly wage, supporting positions in medical practices, not highly paid specialists in hos- pitals. Dr. Keckley explains that research is simultaneously demonstrating that urban, educated consumers don't perceive a compromise in quality when seeing a nurse practitioner instead of an M.D., and the delivery of care at a retail clinic results in reduced costs and improved patient satisfaction, even for populations in which the majority have a primary care physician. As a result of both a proliferation of provider options and consumer confi dence in choosing a nontraditional health care setting, Dr. Keckley predicts the model of primary care will evolve into teams of nurse practitioners, nutritionists, pharmacists and psychologists helmed by physicians. So, what does that mean for the 100-year- old Flexner model of training? "We're going to turn medical education upside down," says Dr. Keckley. "I suspect we will have team-based care curriculums where students are using problem-based learning models and technology like electronic health records, personal health records and registry functions rather than the doctors completing two years of preclinical education and then two years of clinical rotation." The New Classroom The Northern Ontario School of Medicine is well on its way to coalesc- ing the ideas of team-based care and exploring spare capacity with solutions to maldistribution. The cooperative program of Lakehead University and Laurentian University in the province's two urban centers — Thunder Bay and Sudbury, respectively — originated from a social accountability community movement to upgrade health care in a section of Canada that is comprised of urban, rural, native and Francophone populations spread over a 300,000-square-mile area. Many towns and outposts are manned by first responder providers who com- municate with physicians via the Ontario Telemedicine Network. The curriculum incorporates engaged, team-based learning and an integrated clerkship in which residents handle the full range of family practice. Most critical is the deep appreciation students develop for the various populations and communities, all of which have different needs and systems impacting their health care needs. "There are three factors that help infl uence a practitioner's decision to go into rural practice," says Roger Strasser, A.M., M.D., Dean and Professor of Rural Health at the Northern Ontario School of Medicine. "First is a rural upbringing; second is a positive clinical experience during education; and third is a residency that prepares the graduate to practice in the rural setting. We actually developed programs that were informed by the research." Just as Dr. Keckley cites the infl uence of consumers in reshaping primary care delivery, Dr. Strasser points to community engagement as a central element in engen- dering physicians to the rural setting. Each residency site has a steering committee composed of local leaders who welcome and assist residents and their families. Northern Ontario School of Medicine also strives to refl ect the demographics of the province in its student body: The admission process favors applicants from rural and native communities. While the program is still young, initial fi gures demonstrate its effi cacy. Graduates in the fi rst four classes have consistently placed at the top of Canada's medical students academically and are all matched with residency programs within the first round of registry. In addition, of the students at the Northern Ontario School of Medicine, 4% opt for a career in a subspecialty, 33% go into internal medicine or general surgery, and 63% choose to practice primary care medicine. Download the MD News iPad edition from the iTunes App Store to read an extended version of this article. MDNEWS.COM ■ MD NEWS Central New York | 13

• Cover