By Erin Mundy, M.P.A.

Amanda Fischer, a first-year family practice resident in her home state, is a Georgia AHEC success story. Area Health Education Centers (AHECs) were created to respond to the challenges of limited supply and distribution of health professionals in rural and underserved areas of the states in which they are located.    The center’s programs recruit students to health careers, support students during clinical training, and promote retention among practicing health care professionals.  Amanda spent a significant part of her education making her way through the AHEC pipeline.  Growing up in Claxton, a rural southwest Georgia town federally designated as both a medically underserved area and a health professionals shortage area, Amanda graduated as valedictorian from Claxton High School then went on to attend Georgia Southern University in Statesboro. 

At Georgia Southern, Amanda was one of the founding officers of the college’s first student organization for pre-health majors, the Association of Pre-Health Professionals.  At a meeting, a representative from the Southwest Georgia AHEC spoke to the organization about a program called Pathway to Med School. Pathway to Med School targets rural Georgia college students that plan to go to medical school and pursue a career in primary care. These students would be less likely to get into medical school than their metropolitan-area counterparts without the opportunity that Pathway provides, but they are the most likely to practice in rural areas. While helping these students gain acceptance to medical school, the program aims to validate and sustain their interest in primary care and hopefully keep them in the state after medical school. more...

By Beth Nelsen, MD

Do you remember that Staples commercial from a number of years ago? It showed a dad happily skipping through the aisles, placing various school supplies into his cart while his children lingered grumpily behind him. Every February, I become the dad in that commercial. My program director doesn’t understand why I get so excited about putting together the Match List.
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By Andrew Morris-Singer, M.D.

Primary care residency numbers didn’t change much this year. Depending upon your vantage point, that’s either a good or bad thing. For those who were hoping that the numbers would continue that 2-year steady climb out of the dumps, the 1% increase in FM positions seemed to be a disappointment. But for many of us who work day to day to revitalize the primary care pipeline, we breathed a sigh of relief that the numbers managed to hold steady.

Now don’t get me wrong.  There are many pessimists out there who don’t have faith in our primary care health system.  I’m not one of them. I have firsthand experience to know that change is afoot all around us in the primary care landscape.  I spend most of my time meeting people who are on the cutting edge of the revitalization of the primary care pipeline; people like Dr. Mike Magill of the University of Utah, where they have developed the Care by Design™ model of primary care. Not only are these primary care heroes reinventing how primary care is delivered, but they’re excited to share this vision for a new, more patient-centered and innovative primary care future with our trainees- to offer them a glimpse of a multitude of new models of primary care delivery that are better serving both patients and providers alike. And many of these leaders, like Mike, aren’t just getting trainees exposed to these new models; they’re getting them involved as well. By doing so, they’re not just helping them see a future for themselves in primary care within these revitalized models, but they’re starting to get these trainees marinating in a new approach to care delivery, getting them familiar with those skills and competencies of team-based care that are almost completely absent from traditional models of medical education and training. And it’s making a profound difference. more...

The Case of The Missing Lab Results
By Gunsagar Gulati
 
Sitting at the front desk of the internal medicine office, I twirled a pencil in one hand and tapped the mouse with the other as I sifted through patient medical records for data on laboratory results. The medical assistant beside me was glued to the phone.  I knew I shouldn’t bother her, but I had to know why she was getting so many calls. When she enumerated a seemingly endless list of reasons patients called, what struck me most was that patients were calling to get lab test results.
 
The week of August 4^th, four medical assistants at the clinic received a total of 19 calls from patients about lab test results, and the week of September 19^th, they received a total of 43 calls. That may not sound like a lot, but this was only the data for four of the many medical assistants at the clinic.
 
I didn’t think at first that an occasional missing lab result was an issue, but after spending time at the internal medicine office, I was convinced that it was.  These missing lab test results burden patients, clinicians, and other staff.  It was not only an issue of patient satisfaction, but, more importantly, of quality of care and patient safety.
 
So as an innovation project with the Harvard PCP chapter’s Primary Care Innovation Collaborative last year, I had the opportunity to work under the guidance of Dr. Karen Wood and administrator Greg Laronde at the Harvard Vanguard Copley Practice to improve how laboratory test results are handled in the clinic.
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Experiential Learning to Promote Primary Care:
Benefit to Patients, Mentors and Undergraduate Students
By Karen Wood, M.D.

In the Spring of 2011, I was approached by a Harvard University undergraduate, Gunsagar Gulati, about joining the Primary Care Innovation Collaborative and coming to work on an “improvement project” in my office. Generally this opportunity had been offered to medical students, but Gun was enthusiastic and deeply interested in learning about primary care, so my office manager and I decided to proceed.

There were a number of potential “projects,” but we chose to evaluate the way in which lab test results are reviewed and reported across the practice. Timely review and reporting of lab tests is an important aspect of patient safety.  One concern we had received from support staff was that patients may not be obtaining test results expeditiously. As a consequence, they call the office to obtain this information which is onerous for the nurses and secretaries.

Through chart reviews, Gun looked at all the tests ordered during 2 two-week periods. He then devised  a survey to analyze two separate issues. One was the frequency with which lab tests were not reviewed by the clinician. For the majority that were reviewed, he assessed the interval between when test results were reported by the lab and subsequently reviewed by the ordering clinician in our electronic system. Finally, he examined the time it took for patients to receive their results.  In addition to chart reviews, he interviewed clerical and clinical staff, including nurses, physicians, medical assistants and secretaries to determine how they are involved in the communication of results and what concerns they have about office work flow.  
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By Allison Greco

I am a member of my medical school’s Physician Shortage Program. The program, which does not involve any long-term primary care commitment or loan repayment, is made up of a group of students, primarily from rural hometowns, who are interested in pursuing medical careers in undeserved and/or rural communities. We meet as a group and discuss our personal experiences growing up in rural areas, the challenges faced by community physicians, and the proposed and impending legislation that will affect the practice of medicine in these areas. As part of this program, I was able to participate in a community medicine rotation, something few students at my institution get to experience during their third year.
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By Ishani Ganguli, M.D.


This series, by the former editor of Progress Notes, originally appeared on her blog, Short White Coat, for the Boston Globe. Admitting she had little exposure to the other members of the allied health professions in medical school, Ishani explores here the roles of the diverse members of the health care team at the Ambulatory Practice of the Future in order to better understand the team players we will increasingly rely on to deliver primary care.  

See the first piece in the series here on Progress Notes, and find the rest on Short White Coat.


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