Collaboration Enhances Primary Care Training

Designed to encourage future primary care providers to address health issues in underserved areas, the funding through the Doctors Across New York (DANY) program amounts to $600,000 over 3.5 years.

The Jacobs School will use the funding to enhance the following primary care training programs:

• family medicine
• general internal medicine
• general pediatrics
• combined internal medicine and pediatrics

Andrew B. Symons, MD, clinical associate professor of family medicine and vice chair for medical student education in the Department of Family Medicine, is principal investigator on the grant for the DANY Ambulatory Care Training Program.

“Through support of the collaboration in this grant, we are increasing resident and student placements in the primary care disciplines,” he says.

Symons notes one area of expansion is the Urban/Buffalo General — Jericho Road residency track within the Department of Family Medicine, which is a clinical setting that focuses on a refugee population and immigration health issues.

“The Ambulatory Care Training Program is focused on developing relationships with practices in rural, underserved areas that are willing to begin precepting students and residents,” Symons says.

Tri-County Family Medicine, with five health centers in Livingston and Steuben counties, is one example of a rural practice in WNY.

Representatives from Tri-County recently gave a presentation on the practice during a residents’ grand rounds session, according to Bridget Forshee, senior program developer at the New York State Area Health Education Center (AHEC) System, who is the DANY project coordinator.

“They are looking to find residents interested in coming to their sites in areas such as Geneseo and Dansville with the hope of eventually employing them,” she says.

The Jacobs School is working with two AHEC centers that have created a database identifying existing ambulatory primary care practices in Western New York that could be potential partners in the new training program.

Information sessions have already been scheduled with the Community Health Center of Niagara Falls, Community Health Center of Buffalo, several locations of the Greater Buffalo United Accountable Healthcare Network (GBUAHN) and Oak Orchard Health, which has locations throughout Orleans and Wyoming counties.

Forshee notes that residents are also provided information about available loan forgiveness and repayment programs that incentivize practice in health professional shortage areas and medically underserved communities.

“There are five or six different opportunities for residents and primary care practice individuals who work in medically underserved areas to get their loans repaid during a period of time while they are working,” Forshee says.

The Department of Family Medicine, in conjunction with the Erie County chapter of the New York State Academy of Family Physicians, also hosted a meet-and-greet in late September to acquaint residents with more than a dozen local practices.

Physicians and health systems representatives who are interested in recruiting primary care physicians met with family medicine residents who are interested in practicing in WNY, Symons says.

“Residents briefly introduced themselves to the group, and each practice was given an opportunity to introduce the practice and talk about what they are looking for in new colleagues and highlight why a resident might want to come practice in their community,” he adds.

“It was basically primary care physicians welcoming residents to the physician community of WNY, so there was a very warm feel to the event — a much warmer atmosphere as opposed to just submitting a resume somewhere,” Symons says.

Along with Symons, the DANY project leadership team consists of:

• Michael J. Aronica, MD, clinical associate professor of medicine and chief of the combined internal medicine and pediatrics division
• Roberto O. Diaz Del Carpio, MD, clinical assistant professor of medicine and director of the combined internal medicine-preventative medicine residency program
• Dennis Z. Kuo, MD, associate professor of pediatrics and chief of general pediatrics
• Ranjit Singh, MB Bchir, MBA, associate professor of family medicine and vice chair for research and director of UB’s Primary Care Research Institute
• Scott H. Stewart, MD, associate professor of medicine in the Division of General Internal Medicine
• Laurene M. Tumiel-Berhalter, PhD, associate professor of family medicine and director of community translational research
• Diana G. Wilkins, MD, clinical assistant professor of family medicine and assistant dean for graduate medical education

In addition to overseeing the enhanced training programs, the core leadership team also is developing a common core curriculum focused on population health to address competencies needed for the advanced primary care model of practice transformation.

One of the first initiatives in curriculum development is the training of internal medicine and family medicine residents on SBIRT (Screening, Brief Intervention, and Referral to Treatment), as well as training on prescribing buprenorphine, a form of medication-assisted treatment (MAT) used to help people with opioid abuse disorder.

Diaz Del Carpio and Stewart are teaching residents in collaboration with Arthur F. Weissman, MD, clinical assistant professor of family medicine and director of MAT.

“Some of the training activities we do, they exist within each department,” Symons says. “What we are trying to do now is identify best practices for providing quality primary care and sharing that with the other primary care residents.”

“MAT and SBIRT training is so far the biggest example of departments coming together and cross-pollinating best practices,” he adds.

Other new curriculum initiatives include:

• Diaz Del Carpio is providing didactic training sessions and mentoring on quality improvement issues that drive the pursuit of the Triple Aim model of better care, better value and better health
  
  “Residents are being encouraged to create their own quality improvement plans and implement them at their training sites,” Forshee says.
• Symons is partnering with faculty from UB’s School of Pharmacy and Pharmaceutical Sciences to incorporate pharmacy students and preceptors at UBMD Family Medicine practice sites.
  
  Working alongside medical students, nurses and physicians, pharmacy students provide assistance with medication reconciliation and education, he says.
• Tumiel-Berhalter is leading seminars for first-year medical students that address elements in a patient’s environment that are often considered “outside” the realm of traditional health care — known as social determinants of health.
  
  Residents are using standardized patient reviews of patients with chronic disease to identify potential health barriers and determine how modifying these factors may improve care to their patients.

 Symons says the enhanced training program boils down to three main objectives:

• expanding training opportunities in high-need communities
• expanding scope of training with a core curriculum focused on population health
• expanding primary care workforce in shortage areas

“All of the focus is really concentrating on promoting primary care in underserved areas,” Symons says.