Community Organizing For Primary Care Training

Here at PCP, we encourage med students and trainees to use community organizing to gain the training opportunities they need and to create a culture that fosters their choice to pursue primary care. In today's post, PCP Colorado's chapter leader shares how his chapter used those skills to launch a student-run clinic in the medical school's local community.

By Joseph Johnson, M.D.

In 2013 at the Society of General Internal Medicine Conference in Denver, my primary care residency program director, Karen Chacko, arranged a meeting with Primary Care Progress to explore starting a chapter at the University of Colorado. I remember the thrill of reconnecting with an old high school friend, Trishul Siddharthan, now a PCP chapter leader and chief medical resident at Yale. He shared a powerful story of residents, medical students and nurses teaming up to advocate for increased primary care training opportunities made possible through the health system's acquisition of a major community provider network. Inspired by Trishul’s story, four of us – students and residents at the University of Colorado Anschutz Medical Campus – set to work that day to build a similar network that could fulfill our vision of collaboration between our campus and our forward-thinking neighboring community in Original Aurora.

We recognized early on that board-type chapter meetings would never fly if we wanted to achieve our goal of establishing a student-run free clinic at a local Aurora community organization. Our students and residents rotate through four different metro-area hospitals. The clinic at Denver Health where I completed my residency continuity clinic is a half-hour drive from the Anschutz campus. Plus, it seems that every time I finish a hospital rotation and have some time freed up for a chapter meeting, our student leaders have a major test coming up and can’t spare any time.

To overcome this fragmentation, we organized ourselves into small groups with shared responsibilities, each contributing to the larger project. Through an extensive series of community round-table sessions on campus and in the Aurora neighborhood, we developed a blueprint for an interdisciplinary student-run free clinic closely partnered with a local start-up community hub called the Dayton Opportunity Center. The hub aims to create a “one stop shop” for community-based local resources and health care navigation. A weekly clinic for uninsured area residents fit well with this vision and created an opportunity to bridge the gap between Anschutz and our neighbors.

Through the spring our mixed groups of medical, pharmacy, nursing, physical therapy, clinical psychology and dental students communicated via email, Google Docs, Facebook and GoToMeeting to lay the foundation for our clinic. This summer small group leaders convened for three hours every other week to share progress and design an interdisciplinary clinic flow. Groups report on and discuss supply procurement, test negotiation, referral networks, and documentation methods. Each meeting has been preceded by skills workshops around teamwork, innovative primary care models, and coalition building facilitated by Anschutz faculty and experts such as PCP National, Colorado Coalition for the Medically Underserved and HealthTeamWorks, a local primary care consulting firm.

Meanwhile, another of the small groups served as our advocacy team, and they laid the groundwork for our on-campus advocacy campaign to build enthusiasm for the clinic. After months of slowly building our chapter’s core leadership team, our first big call for student clinic volunteers, marketed via student group pages on Facebook and grassroots outreach, drew 75 people. With online mentorship from PCP in Boston, plus connections through college friends in the social media marketing world, we launched an online and paper petition through which we collected more than 750 signatures of students who supported the creation of the clinic. We also edited a video with student testimonials, and PCP’s national media director began filming a documentary of our work. To get our message out, we’ve held mentored field trips to local primary care clinics, spoken at family medicine grand rounds, and live-streamed discussions about the state of health in Aurora to three remote internal medicine noon report locations.

Going forward, we aim to train student volunteers to be care coordinators at the Opportunity Center clinic. Students, paired with trained and paid Fields Foundation community health workers, will learn to use analytic tools to manage their patient panels. Early understanding of this technology empowers students to take an active approach to population health early in their career. The fear of practicing primary care in a reactive fee-for-service rat race is minimized as the next generation of providers taps its inherent tech adaptability to use electronic tools in a truly meaningful way.

As a teacher, I believe these community organizing skills not only activate the next generation of health care leaders, but they also translate into powerful clinical primary care skills later in practice. A deep understanding of a patient's social background within Aurora's dichotomous political economy of health care teaches students to target preventive measures sensibly. These experiences and ideas empower millennial physicians to not take the system for granted and to start by changing their own concept of primary care practice. By creating a new culture of collegial, mutually-reliant, team-based practice in every field of health professional training, Primary Care Progress allows us to redefine and improve primary care delivery in our communities. Not all of our volunteers will choose careers in primary care, but more will than otherwise, and those going into specialty fields will hold a true appreciation for the vital role of primary care in quality health care delivery.

Joseph Johnson, M..D., completed a combined BS/MD program with Villanova University and Drexel University College of Medicine, where he was introduced to Catholic social justice work and the potential of grassroots community organizing. He now serves as chief resident in Quality and Patient Safety at the Denver VA and as PCP Colorado's chapter leader.

Hear from other chapter members who've put their leadership skills to work.
Posted by Sonya Collins on Aug 5, 2014 10:46 AM US/Eastern
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