Community Medical School October 26, 2010

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1 Community Medical School October 26, 2010

2 Who is Taking Care of You? Paul A. Taheri MD, MBA President / CEO University of Vermont Medical Group Sr. Associate Dean for Clinical Affairs

3 Health Care is Complex Clinically, patients are sicker than ever We can treat more disorders than ever before Living longer with diseases Technology is more complex Training is more detailed and focused Administration/regulation is more complicated Reform adds more uncertainty This all adds up to increasing complexity which requires more human capital

4 The Human Side MD s Increasing demands on MD s time/effort Increasing sub-specialization Oncologists just treat certain cancers Surgeons treat narrow range of disorders joint doctor liver surgeon pediatric subspecialists abound Cultural changes related to our new generation of physicians Shortages of physicians

5 Human Side - Nursing RN Registered nurse (2,3, & 4 year programs) APN - Advance Practice Nursing (masters trained) NP Nurse Practitioner Clinical Nurse Specialist CRNA Certified Registered Nurse Anesthetist (RN + CRNA school) LPN Licensed Practical Nurse 1 year program LNA Licensed Nurse Assistant licensed by state, approximately a 6 week curriculum (vitals, activities of daily living)

6 Human Side Allied Health Providers Medical laboratory scientists, speechlanguage pathologists, physical therapists, respiratory, dietary, clinical pharmacist, audiologists, nuclear medicine technologists, radiation therapists, others

7 This All Needs to Fit at the Bedside Who is caring for you? What are their credentials? How do we know if they are good?

8 How to Train a Physician 4 years of college 4 years of medical school 3-7 years of residency training Some go onto fellowships after this training Start practice at age ~ 32 Average debt load of graduating medical student is approximately $150,000 It is very costly to train physicians both in terms of time and money

9 What Is a Medical Student? Students that have completed undergraduate studies in college and are now studying medicine at a medical school They are not doctors - yet Take classes in their first two years of school studying the basic sciences - anatomy, physiology, biochemistry, then progress to clinical classes such as pathology, immunology, other more applied areas of study

10 Medical Students 4 years of learning Split between didactic training and clinical ward / clinical work Always assigned to a patient care team with oversight from attending faculty and residents Cannot write orders for care, must be cosigned by a physician A key member of the health care team, but they are students

11 Medical Students In their 4 th year, they enter the match program and rank their residency training program. Both the program and student rank one another and on Match day the student / program find out who is going where to train. This is a big day for the students and programs.

12 What Is a Resident? Residents are licensed physicians in the state They have completed medical school Can write prescriptions and deliver direct care Often called resident or house staff Training is based upon graded responsibility Provide bedside care with supervision Fletcher Allen has about 277 residents The government financially supports approximately 250 training slots

13 Residency Programs Anesthesiology Dental Dermatology Family Medicine Internal Medicine Neurology OB/GYN Orthopaedics Pathology Pediatrics Psychiatry Radiology Surgery Neurosurgery Otolaryngology Urology (recently approved)

14 Impact of Residency Program Many residents choose to stay in VT 322 program graduates in went into practice in Vermont, many in primary care or under-served specialties, including 10 in Family Medicine 13 in Internal Medicine 4 in Pediatrics 2 in Women s Health 4 in Psychiatry

15 Attending Physicians Fully credentialed physicians in practice. To most, these folks are your doctor They treat and bill for services Accountable for your care Often in different business arrangements across the continuum of delivery

16 Alphabet Soup of Regulation, Oversight, and Credentialing Agencies LCME Liaison Committee on Medical Education medical school accreditation ACGME Accreditation Council for Graduate Medical Education ABMS American Board of Medical Specialties oversees 24 specialty boards Medicine, Surgery, others This group provides the board certification

17 Monitoring of Your Physician State Licensing Board Hospital reappointment process CME requirements, chair sign-off Ongoing Professional Practice Evaluation (OPPE) Joint Commission ongoing performance evaluation data driven, can be both general and practice specific (OR returns, complaints, infection rates ). Maintenance of Certification (MOC) ABMS - Continuous professional development, life long learning, specialty specific focus on 6 core competencies: Patient care, communication, medical knowledge, practice based learning, professionalism, systems based practice.

18 Status of Our Physician Workforce ~ 20% shortage of MDs by 2020 Demand growing aging population New technologies create more treatment opportunities. More complex care can be delivered Better survival rates U.S. medical schools graduate approximately 15,500 24,000 residents trained in USA USA imports approximately 7,000-8,000 residents/year (IMG international medical graduates)

19 United States physician population Reproduced from AAMC

20 Response of Medical Schools and Teaching Hospitals U.S. medical schools expanding class size by approximately 10% UVM has increased from 93 to 114 since 2008 Graduate Medical Education (GME) funding from government fixed since Balanced Budget Act of 1987 GME is the bottleneck

21 New Issues Generational differences - Gen Y Instant gratification Team players Multi-taskers Techno-savvy Outspoken Value diversity Social awareness

22 Gen Y All of the aforementioned attributes are great, but they are often perceived differently: Instant gratification Team players Multi-taskers Outspoken Impatient Not accountable Not paying attention Disrespectful

23 Regional Physician Demand Physicians tend to practice where they train Residents have approximately a 30% chance of practicing in the state in which they went to medical school, and where they did their residency This effect is cumulative Overall VT ranks 6 th in the USA for per capita physicians Vermont s issue is the distribution of physicians, both specialty and primary care

24 What are We Doing About the Shortage? Assessing Fletcher Allen s and the region s needs for future MDs Focusing on our pipeline of new physicians Engaging residents early in their training to consider working here Focusing on areas of known clinical need Expanding clinical programs in Dermatology and initiating a Urology residency

25 University of Vermont Medical Group (UVMMG) Evolved from affiliation agreement between UVM and FAHC Subsidiary of FAHC Have our own Board of Directors and governance structure Budget and compensation plan Allocate revenue and expenses Hiring of physicians and other staff

26 UVM Medical Group Approximately 500 MD s 1,100 staff members Full range of specialty services $250M in annual professional revenue FAHC has about 750 MD s on the medical staff ~ 250 are in community practice, not in our medical group.

27 Summary The individuals caring for you are well trained and monitored Committed to doing the right thing We have challenges in maintaining our bedside excellence We will need more people Cultural challenges

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