New Medical School with unique focus

[thyme4change]

news.nau.edu/college-of-medicine/

Northern Arizona University (NAU) today announced the creation of NAU Health, a forward-thinking initiative aimed at improving health outcomes for all Arizonans, particularly those in rural, Indigenous, and underserved communities.

At the center of this initiative is the creation of a distinctive new College of Medicine that will focus on educating primary healthcare providers who reflect the residents of Arizona and who will remain in the state to serve Arizona’s increasingly diverse population.

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In stead of focusing on a traditional specialized, research-oriented physician education model, NAU’s College of Medicine will be focused on educating resilient, Arizona-serving primary care practitioners who are committed to serving diverse communities and eradicating health disparities throughout the state.

There are a lot of code words in this press release - but basically, NAU will be training doctors to serve on the reservations and other indigenous people. This is important in and of itself, but I hope it is part of a trend that focuses medical education on groups of people that traditionally have not had great experiences with the medical establishment. Studies show that people of color and women are consistently under diagnosed, under treated and their concerns dismissed. NAU will have a strong focus on indigenous, because they are ‘the city’ that many people on reservations count on, so they have a relationship there they will honor. But, there is no reason the model can’t be used to focus on educating doctors to be specifically aware of other communities of need - even in areas where there are providers and facilities. I am proud of NAU for taking this on, and I wish them all the success in the world!

[pulmonarymd]

Great idea. The challenge will be on admitting the right class. They will need to identify applicants who really agree with the focus. With the recent affirmative action ruling, it may be difficult to use race as a way to make this happen. In addition, given the competitive nature of admission to medical school, students may apply, hoping to get in, and then pursue the specialty training that they were planning to do.

Plenty of studies show that students from disadvantaged communities are more likely to practice in those environments, and students from rural communities are more likely to practice in those areas. Encouraging and identifying those with talent is paramount. But we seem to be getting away from that. Maybe this will be the start of turning that around

[TheOtherMe]

When my friend's husband was in med school way back in the 1970's, he did a summer internship at a reservation in Arizona.  It's been too long and I no longer remember which reservation.  

My friends were very poor when he was in med school and lived in a small efficiency apartment.  She could get a month's worth of meals from a turkey.  She said she had never seen such poverty as on the reservation.

[thyme4change]

Sept 30, 2023 15:49:02 GMT -5 pulmonarymd said:

Great idea. The challenge will be on admitting the right class. They will need to identify applicants who really agree with the focus. With the recent affirmative action ruling, it may be difficult to use race as a way to make this happen. In addition, given the competitive nature of admission to medical school, students may apply, hoping to get in, and then pursue the specialty training that they were planning to do.

Plenty of studies show that students from disadvantaged communities are more likely to practice in those environments, and students from rural communities are more likely to practice in those areas. Encouraging and identifying those with talent is paramount. But we seem to be getting away from that. Maybe this will be the start of turning that around

There are two parts to this. One is the part where graduates actually serve. This is kind of a ROTC situation. They will be contractually obligated, or they will pay back their grants. The goal is to make the education free for those that follow this mission for some length of time. The second part is the actual teaching. If they focus on what to look for in a certain genetic population and a certain economic level, they will take that with them wherever they practice. Even if they go to the richest suburb and open a practice, their medical training will always be rooted in listening and serving people who haven’t traditionally had that experience. It will seep out.

[thyme4change]

Sept 30, 2023 17:58:32 GMT -5 TheOtherMe said:

When my friend's husband was in med school way back in the 1970's, he did a summer internship at a reservation in Arizona.  It's been too long and I no longer remember which reservation.  

My friends were very poor when he was in med school and lived in a small efficiency apartment.  She could get a month's worth of meals from a turkey.  She said she had never seen such poverty as on the reservation.

No joke. Some of the reservations are a little better now because of casino money - but there is still extreme poverty. Some of the hogans still have dirt floors. Some areas don’t have water. I think just about everyone has electricity now - but it is a different world.

[TheOtherMe]

What you described is what they talked about after they returned.  They were living the same way.  

Neither one had ever lived with an outhouse but they did that summer.

[The Walk of the Penguin Mich]

Sept 30, 2023 15:49:02 GMT -5 pulmonarymd said:

Great idea. The challenge will be on admitting the right class. They will need to identify applicants who really agree with the focus. With the recent affirmative action ruling, it may be difficult to use race as a way to make this happen. In addition, given the competitive nature of admission to medical school, students may apply, hoping to get in, and then pursue the specialty training that they were planning to do.

Plenty of studies show that students from disadvantaged communities are more likely to practice in those environments, and students from rural communities are more likely to practice in those areas. Encouraging and identifying those with talent is paramount. But we seem to be getting away from that. Maybe this will be the start of turning that around

Studies are one thing, reality another.

When I was working on my PhD in public health, I had a physician classmate who had been in a similar program.  She grew up in the area, and chose to practice in a severely underserved area where she grew up in an attempt to get rid of her medical school loans.  

What she found out was that her engineer husband did not like being a house husband and watch his career languish while she worked.  Her kids were falling further and further behind in school as th3 schools were not good.  Those problems she dealt with.  The problems she couldn’t deal with was the isolation, the fact she had no peers to bounce off problems with.  She had a miserable problem getting CE credits done because she couldn’t get anyone out to spell her for a few days, getting a vacation was impossible as she was on call 24/7/365 and no one would go there to help her out in the community, so she felt like sh3 couldn5 leave.  As a result, she burnt out.  She moved to the city, was quickly able to pay off her student loans and had no intentions of ever going back.  

So while the premise is good in practice, they really need a support system in play too.  Education isn’t everything, a lot of this is how it impacts the rest of the family, and the sacrifices that they will have to make too.  

It’s unclear how NAU plans on dealing with this, but IMO unless they do…..this program is going to be no better than an6 of the others.

[pulmonarymd]

Oct 1, 2023 14:41:37 GMT -5 The Walk of the Penguin Mich said:

Sept 30, 2023 15:49:02 GMT -5 pulmonarymd said:

Great idea. The challenge will be on admitting the right class. They will need to identify applicants who really agree with the focus. With the recent affirmative action ruling, it may be difficult to use race as a way to make this happen. In addition, given the competitive nature of admission to medical school, students may apply, hoping to get in, and then pursue the specialty training that they were planning to do.

Plenty of studies show that students from disadvantaged communities are more likely to practice in those environments, and students from rural communities are more likely to practice in those areas. Encouraging and identifying those with talent is paramount. But we seem to be getting away from that. Maybe this will be the start of turning that around

Studies are one thing, reality another.

When I was working on my PhD in public health, I had a physician classmate who had been in a similar program.  She grew up in the area, and chose to practice in a severely underserved area where she grew up in an attempt to get rid of her medical school loans.  

What she found out was that her engineer husband did not like being a house husband and watch his career languish while she worked.  Her kids were falling further and further behind in school as th3 schools were not good.  Those problems she dealt with.  The problems she couldn’t deal with was the isolation, the fact she had no peers to bounce off problems with.  She had a miserable problem getting CE credits done because she couldn’t get anyone out to spell her for a few days, getting a vacation was impossible as she was on call 24/7/365 and no one would go there to help her out in the community, so she felt like sh3 couldn5 leave.  As a result, she burnt out.  She moved to the city, was quickly able to pay off her student loans and had no intentions of ever going back.  

So while the premise is good in practice, they really need a support system in play too.  Education isn’t everything, a lot of this is how it impacts the rest of the family, and the sacrifices that they will have to make too.  

It’s unclear how NAU plans on dealing with this, but IMO unless they do…..this program is going to be no better than an6 of the others.

This is an excellent point. It is increasingly common for physicians to marry each other. That will play into this more and more. It is going to be interesting to see how that works in this school. Finding one person who wants to do it is bad enough. Can you find 2.

It becomes even more difficult in 2 career couples. Is there even a job for the second person in the rural area. This is a challenge in recruitment right now

[thyme4change]

Oct 1, 2023 14:41:37 GMT -5 The Walk of the Penguin Mich said:

Sept 30, 2023 15:49:02 GMT -5 pulmonarymd said:

Great idea. The challenge will be on admitting the right class. They will need to identify applicants who really agree with the focus. With the recent affirmative action ruling, it may be difficult to use race as a way to make this happen. In addition, given the competitive nature of admission to medical school, students may apply, hoping to get in, and then pursue the specialty training that they were planning to do.

Plenty of studies show that students from disadvantaged communities are more likely to practice in those environments, and students from rural communities are more likely to practice in those areas. Encouraging and identifying those with talent is paramount. But we seem to be getting away from that. Maybe this will be the start of turning that around

Studies are one thing, reality another.

When I was working on my PhD in public health, I had a physician classmate who had been in a similar program.  She grew up in the area, and chose to practice in a severely underserved area where she grew up in an attempt to get rid of her medical school loans.  

What she found out was that her engineer husband did not like being a house husband and watch his career languish while she worked.  Her kids were falling further and further behind in school as th3 schools were not good.  Those problems she dealt with.  The problems she couldn’t deal with was the isolation, the fact she had no peers to bounce off problems with.  She had a miserable problem getting CE credits done because she couldn’t get anyone out to spell her for a few days, getting a vacation was impossible as she was on call 24/7/365 and no one would go there to help her out in the community, so she felt like sh3 couldn5 leave.  As a result, she burnt out.  She moved to the city, was quickly able to pay off her student loans and had no intentions of ever going back.  

So while the premise is good in practice, they really need a support system in play too.  Education isn’t everything, a lot of this is how it impacts the rest of the family, and the sacrifices that they will have to make too.  

It’s unclear how NAU plans on dealing with this, but IMO unless they do…..this program is going to be no better than an6 of the others.

I agree that it is hard to really know what you are getting yourself into. I was wondering if there would be a rotation program where maybe doctors traveled to the rez, but lived in a more populated place - like Flagstaff. They could do rotations spending some time in Flag, and some time in various towns that are 3 ish hours away. Even a place like Chinle getting two different doctors a couple of days each month would be a huge improvement.

NAU is not known as an educational power house. They have a decent reputation, but they won’t be fighting John Hopkins for students.

[jerseygirl]

Plus after medical school is residency. How many of these students will choose primary care over specialty like ortho?

[thyme4change]

Oct 1, 2023 17:09:16 GMT -5 jerseygirl said:

Plus after medical school is residency. How many of these students will choose primary care over specialty like ortho?

The stated mission of the medical school is to turn out primary care physicians. I am sure there will be a number of people who lie or change their minds and decide primary care is not for them. But most of them will likely have a goal of primary care, or else they would choose a different school with a more helpful mission to their goal. As md said - recruiting and selection will be a task, and I am sure they have someone who is thinking through the complications.

I guess in 20 years we can circle back and see how the school has evolved and if they are achieving their original purpose, or if they have changed their mission. I commend them for trying.

[finnime]

This is an important mission for the school. There is a real dearth of PCPs. I started calling a year ago to find primary care and finally got appointments for September, which were cancelled because the provider called in sick.We are going to keep appointments I also made with another provider in November. No problem getting appointments with specialists, however. And we are well insured. Apparently many people go to urgent care for what would ordinarily be primary care.

[pulmonarymd]

There is no interest in fixing the problem with primary care. Medical school costs are absurd. Specialists make significantly more than primary care physicians. Medical students are smart, they understand the economic realities and they vote with their feet.

I also think that insurance companies like the way things are going. Replace primary care physicians with NPs and PAs. Pay them less. Pocket the profits. Let specialists care for those who are sick. Cheaper for them than to raise reimbursements to primary care physicians. Not like state governments are going to give medical schools more money to keep tuition down.

I hope this works for Arizona. I am just skeptical that it will work. People who want to be doctors will go to any medical school they can get into. I do not see how they are going to prevent these students from specializing when they graduate.

[The Walk of the Penguin Mich]

Oct 3, 2023 13:27:57 GMT -5 pulmonarymd said:

There is no interest in fixing the problem with primary care. Medical school costs are absurd. Specialists make significantly more than primary care physicians. Medical students are smart, they understand the economic realities and they vote with their feet.

I also think that insurance companies like the way things are going. Replace primary care physicians with NPs and PAs. Pay them less. Pocket the profits. Let specialists care for those who are sick. Cheaper for them than to raise reimbursements to primary care physicians. Not like state governments are going to give medical schools more money to keep tuition down.

I hope this works for Arizona. I am just skeptical that it will work. People who want to be doctors will go to any medical school they can get into. I do not see how they are going to prevent these students from specializing when they graduate.

I agree.  However, unless they learn from the past programs like this, then the results will be the same.  

What was the definition of insanity?  Doing the same thing over and over, and expecting a different result?  Students have not changed.  

[ners]

A hospital in my area has greatly cut back their family medicine residency program,

[thyme4change]

I was at a party this weekend and was talking to a doctor. Maybe [mention]pulmonarymd [/mention] can explain better. Medicare is changing their entire reimbursement method from fee for service to one that focuses on follow up care and preventative care. I’m not sure how that will work. But it seems like it will be even harder on PCPs.


www.ama-assn.org/practice-management/payment-delivery-models/understanding-medicare-s-merit-based-incentive-payment

[pulmonarymd]

They are trying to pay one fee for an episode of care to include inpatient and outpatient care(think about surgery or a heart attack). Physicians and hospitals will need to figure out how to divvy it up. Seem like that is going to go smoothly? Medicare has a funding and cost issue. They want to pay less. This is one way for them to do so without it appearing to everyone that is what they are going to do. Just another nail in the coffin of private practice.

ETA: They are also experimenting with ACOs-sort of like the payment models of the HMOs in the 90s. People didn't like them then. Not sure they will go over any better now.

[thyme4change]

Oct 4, 2023 11:48:10 GMT -5 pulmonarymd said:

They are trying to pay one fee for an episode of care to include inpatient and outpatient care(think about surgery or a heart attack). Physicians and hospitals will need to figure out how to divvy it up. Seem like that is going to go smoothly? Medicare has a funding and cost issue. They want to pay less. This is one way for them to do so without it appearing to everyone that is what they are going to do. Just another nail in the coffin of private practice.

ETA: They are also experimenting with ACOs-sort of like the payment models of the HMOs in the 90s. People didn't like them then. Not sure they will go over any better now.

I don’t know if there are many private practices left around here. Primary care doctors seem to be employed by one of the integrated systems.