February 24, 2011
By Lenny Feldman, MD
With the passage of healthcare reform, the need for primary care physicians and leaders has never been more acute. Baltimore, MD faces a primary care workforce crisis as it contends with problems prevalent in the inner-city: poverty, chronic disease, substance abuse, psychiatric illness, urban violence, literacy issues, and health care disparities.
A few years ago, as my colleagues at Johns Hopkins and I reevaluated our institution’s role in the community, we realized that we were not addressing one of its most glaring problems: a lack of primary care access.
In response, Dr. Rosalyn Stewart and I advocated for creating a residency program which would train residents to care for the entire family. We wanted to give trainees the chance to acquire the medical and non-medical skills to care for patients in an underserved, urban community. Through those discussions, the outline of a combined Internal Medicine and Pediatric residency program took shape. We conducted a national and local needs assessment and began to develop the urban health (UH) rotations. We presented these plans to the Josiah Macy, Jr. Foundation, whose subsequent grant made it possible to start the residency.
We started recruiting our first class in August of 2009. We received 162 applications for our four intern spots. After interviewing 43 applicants, we were very fortunate to match a terrific group of residents who helped us launch the program in July of 2010. They were recently featured in The Baltimore Sun.
When the Health Resources and Services Administration announced primary care residency expansion grants last year, we could not pass up the opportunity to grow our urban health offerings. We created a sister internal medicine urban health program (funding was confirmed in October of 2010) called the Osler Medical Residency Urban Health Track.
Our goal for both programs is to produce primary care physician leaders who provide effective, longitudinal, comprehensive, coordinated, patient-centered care for underserved inner-city patients. We want to create systems-level change agents and primary care advocates in local, state, and national forums.
We designed the UH curriculum to couple traditional residency requirements with expanded training in the health issues that burden urban settings. For example, one of the urban health rotations, on substance abuse, will include two weeks in a primary care practice that specializes in buprenorphine induction and maintenance therapy and one week in a residential and outpatient substance abuse treatment center for adolescents. Weekly urban health didactic conferences will provide training in cost-effective care, quality improvement, patient safety, evidence-based practice, medical informatics, health care financing, ethics, end-of-life care, and practice management. To improve their effectiveness as urban primary care physicians, resident doctors will receive essential training in cultural competence, including communication skills that will be interwoven throughout the residency experience.
Johns Hopkins Community Physicians has graciously agreed to host our UH clinics at East Baltimore Medical Center in Greenmount East neighborhood. Due to the shortage of health professionals in the area, providers are eligible for federal loan repayment. EBMC has recently been named a Patient-Centered Medical Home, as defined by Maryland’s Patient Centered Medical Home Program, and encourages residents and nurse practitioner students to care for patients together. We hope that by using innovative care delivery models, like community health workers, our residents will be inspired to explore novel ways to provide better care.
After three or four years of training, graduates of the programs can solidify their position as a leader in medicine by pursuing a two-year, tuition-free master’s degree in public health, health science, education, or business with an emphasis on urban health issues, while working concurrently in a primary care clinic.
To accomplish these ambitious goals, we are utilizing all of Johns Hopkins’ resources, including the School of Public Health, School of Nursing, and the Urban Health Institute, and the resources of Baltimore City, including the Baltimore City Health Department, to create a training program that will prepare our residents for the medical and social problems encountered by patients of all ages in an urban setting. In the process, we hope to produce first-class primary care clinicians who are ready to lead primary care through the 21st century.
Lenny Feldman is the program director for the Hopkins Internal Medicine-Pediatrics Urban Health Residency and the track director for the Osler Medical Residency Urban Health Track.