A crisis in physician shortages is on the horizon, and few places will be harder hit than the nation’s urban inner cities. Nationwide, research by the Association of American Medical Colleges indicates that by 2025, we will see a shortfall of 61,700 to 94,700 physicians. In primary care alone, that shortfall could range from 14,900 to 35,600.In urban communities, Dr. Sonja Harris-Haywood says, the shortages are compounded by the intertwining factors that influence health care quality and equity — barriers to access for patients, low cultural competence on the part of providers, lack of health literacy, underexposure to preventative care and the often-inherent stress of life in America’s inner cities.
“Urban health care is complicated. It’s expensive,” says Dr. Harris-Haywood, Senior Associate Dean, COM, at Northeast Ohio Medical University, co-director of the Northeast Ohio Medical University (NEOMED) - Cleveland State University (CSU) Partnership for Urban Health, and a member of the teaching faculty at University Hospitals’ Department of Family Medicine. “If we were able to address health issues two or three years beforehand, we wouldn’t be paying top-dollar for the care. There still is a historical mindset that at the emergency room, you can get your care quicker, you can get more done in one setting, it is covered by insurance and your employer respects it — as opposed to having to tell your employer, ‘I’m leaving at lunch to go to a doctor’s appointment.’”
The program is one of the few in the nation to tackle the problem of primary care in urban communities. The goal is straightforward — recruit students from low-income urban areas, provide mentoring and intrusive support and then help them return to their own communities to provide primary care. The program is not only supported financially by both schools, but also by area hospitals, civic leaders and major foundations — more than $10 million has already been invested. Now in its sixth year, the first two pilot cohorts have graduated, with the first true cohort graduating in 2018.
“We’re focused on workforce development, diversity, and the fit for the urban setting,” she says. “How do we develop a work force for the urban setting in primary care, who is best to be a part of that work force, and how do we retain that work force are our primary objectives.”
Beyond spoke with Dr. Harris-Haywood about the challenges of urban primary care and what the NEOMED-CSU Partnership for Urban Health is doing to address them.
Q: What’s your philosophy toward addressing the shortage problem of urban primary care?
A: To recruit, train and retain individuals to practice primary care in urban settings, is the best thing we can do for the community. No one can take care of their community better than someone who’s from the community. They know where the challenges are, they know the things they faced growing up in trying to access care and they understand the population much better. That’s regardless of what community it is, whether it’s urban or rural or suburban. But in underserved communities, the challenge you face is that the people you’re trying to recruit are just as underexposed to medicine as the individuals you want them to serve. Hence, recruiting residents of underserved communities, having them successfully complete a very rigorous professional program, and bringing them back to serve is a challenge.
Q: How does the NEOMED-CSU Partnership for Urban Health work?
A: We go out and recruit students from the city, surrounding suburbs and from CSU. Some of the students have completed their degrees already and apply to the Partnership to enhance their medical school application. Some are career-changers. Some are two years away from completing their bachelor’s degree at CSU and want to go to medical school. They all want to practice medicine and want to practice in their community.
To apply to the Partnership, applicants should have a “B” average and some exposure to standardized exams. Successful applicants are granted early assurance to NEOMED and spend two years at CSU getting ready for medical school where they are overexposed to the urban communities and medicine while enhancing their GPA and MCAT scores.
Q: What can you say about the results you’ve gotten so far?
A: We are very pleased. About 35 percent of the students in the Partnership are under-represented minority students (African-American and Hispanic), and when you factor in other diversity factors, like low socio-economic status and first-generation college graduates, our diversity is about 80 percent. About 85 percent are from the state of Ohio.
Every year we accept 35 applicants, and this year we had three times the number of applications. You could have all of the criteria that peoplethink about — a high GPA, high MCAT scores, or be the cream of the crop — but that’s not the student we’re looking for. If you can’t share with us why you think you want to be an urban pediatrician, OB/GYN, psychologist or generalist or have some experience in urban medicine, you’re not the right person for the mission and vision of this program. We take that information seriously. If we don’t start with the people who want to practice this type of medicine, the attrition rate grows tremendously, and that’s not good for the city. And the city is watching.
The program is working, and now people have to change. Mindsets have to change. Physicians have to stop telling students, “don’t go into primary care.” Fortunately, these students say, “not only am I going to primary care, but I can give you 20 reasons why it’s the best place for me to be.” Our students are wiser, they’re resilient, they have grit and they know where they’re going because they know what their community needs.
Q: How unique is this program nationally?
A: Three or four years ago we were unique. Now other cities have patterned what we’ve done. But they’re not as successful yet because they don’t have the other part of our program, which is the “community as the classroom.” The only things we teach in the classroom are the basic sciences. If we’re going to teach about homelessness, we’re going to the shelter. If we want our students to learn about the Central neighborhood, we’re going to be at St. Vincent Charity Hospital. If the goal is to understand the Asian population, we’re going to be at the Asia Inc. FQHC (federally qualified health center). I cannot teach what I don’t experience. The community is the best teacher.
Q: What’s in the future for your program?
A: We started off with, how do we impact urban health? We have to get the people here to practice primary care. We can have all the specialists in the community that we want, but I, as a family doctor, still have to make the referral [to a specialist]. If that infrastructure breaks down, then the health equity breaks down because the specialist can’t do it all. We never use the words “non-compliant patient.” Why? Because until you figure out why the patient can’t get to the doctor, why they can’t get their medication, what someone said to them about a particular health problem — until you dig deep, this is not way to describe a patient. Instead we ask the patient the question, tell me what you think needs to happen in order for us to give you the best care.