BY: COREY SURBER, M.H.S.
In 1894, the Sisters of the Holy Cross established Saint Alphonsus Hospital, the first hospital in Boise, Idaho. This Western health care milestone launched an unwavering commitment to developing the medical workforce to meet community needs. Health care in the rural state of Idaho has come a long way since then. We have the latest technologies, nationally renowned specialists and highly ranked hospitals. Still, compared to other states and the District of Columbia, the Gem State ranks at the bottom in terms of physicians and registered nurses per 1,000 in population, according to the Henry J. Kaiser Family Foundation's website, statehealthfacts.org. Yet U.S. Census Bureau data show Idaho's population is growing rapidly, with an almost 20 percent increase between April 2000 and July 2009, compared to a 9.1 percent increase for the nation as a whole during that time. What's more, the state's physician workforce is an aging population, and health care reform will bring extensive coverage expansion and demand for primary care services in 2014.
Add to that picture the results of community needs assessments by Saint Alphonsus Regional Medical Center in Boise (a member of Trinity Health) that underline Idaho's acute shortage of mental health services, psychiatrists and primary care physicians.
In response to these critical needs, Saint Alphonsus has partnered with other private and public entities to support a number of health care workforce development programs. Since Idaho does not have an in-state medical school, we leverage the power of residency education to attract newly trained family physicians, psychiatrists and dentists into our state. This has been referred to as our "train to remain" philosophy.
Examples include:
- Financial and In-kind Support of Family Medicine Residency of Idaho (FMRI)
This is a program for primary care medical residency education in affiliation with a partnership between the University of Washington School of Medicine and the states of Wyoming, Alaska, Montana and Idaho. The Family Medicine Residency of Idaho provides a pipeline of new primary care physicians into the state of Idaho and operates a large safety-net clinic providing low-cost health services to uninsured and underinsured local residents. The residency has served the citizens of Idaho and the surrounding Intermountain West region since 1974 and has graduated approximately 230 new family physicians, 56 percent of whom have stayed to practice in Idaho. Of those, approximately 46 percent are practicing in rural or underserved areas.
The Family Medicine Residency's mission is to train medical school graduates to become outstanding family physicians; prepare broadly trained family physicians to practice all across Idaho, especially in rural and underserved parts of the state; and serve the underserved in a high quality "patient-centered medical home" model of practice.
In fiscal year 2009, Saint Alphonsus gave $1.27 million to the Family Medicine Residency and clinic, in addition to donating the building space that houses the program.
- Financial and In-kind Support of Psychiatry Residency
Saint Alphonsus' 2005 community needs assessment led to collaboration with the Boise VA Medical Center, St. Luke's Regional Medical Center and the State of Idaho to develop a psychiatry residency program in Boise. Affiliated with the University of Washington School of Medicine, the Boise psychiatry residency track hosts three new psychiatry residents per year who complete their first two years of training in Seattle and complete their third and fourth years in Boise. Goals of the program include training excellent general psychiatrists to practice in smaller communities, with a particular emphasis on teaching residents skills in outpatient and inpatient psychiatry and working effectively with primary care providers. Saint Alphonsus provided $166,595 in funding and served as a key clinical training site for the psychiatry residency program in fiscal year 2009.
- Financial Support of Idaho State, University Dental Residency
Oral health needs have surfaced as a priority in our 2005 and 2008 community needs assessments, highlighted by a study several years ago that revealed dental problems as the top reason for "non-emergent" visits to local emergency rooms. To ensure an adequate supply of new dentists, Saint Alphonsus provides funding support for Idaho State University's dental residency program ($273,698 in fiscal year 2009). In addition to training new dentists, this program also operates a safety-net dental clinic for low- income and uninsured populations. Of those dental residents who have completed training through the Idaho State dental residency, 41 percent have remained in Idaho to practice.
- Nursing and Allied Health Occupations Training
From 1906 to 1969, Saint Alphonsus operated its own school of nursing, graduating a total of 800 nurses. By the late '60s, nursing education nationwide shifted toward university-based programs, and, following this trend, nursing education locally shifted from Saint Alphonsus to what is now Boise State University School of Nursing. Today, Saint Alphonsus continues to strongly support local nursing education and is donating $1 million over 10 years to help fund new and expanded facilities for the university's nursing program. Saint Alphonsus also serves as an important clinical training site for nurses and other allied health professions. In fiscal year 2009, more than 1,300 students in nursing and other health occupations programs received clinical training in the hospital and outpatient settings.
SUGGESTIONS FOR THE FUTURE
Over the next few years, the new health reform law aims to extend coverage to 32 million uninsured Americans and shift the delivery system from a "sick care" focus to proactive health management in patient-centered medical homes. According to a Commonwealth Fund/Modern Healthcare survey in April 2010, the top health reform concern among health care opinion leaders is the inadequate supply of primary care providers to meet these new demands, with 88 percent of respondents being either "concerned" or "very concerned."
To respond to this pressing societal need, Saint Alphonsus believes hospitals should actively partner with other public and private entities to:
- Expand the pipeline of new primary care providers, midlevels, nurses and other needed health occupations, through helping fund medical education and residency programs and providing clinical training opportunities
- Ensure appropriate geographical distribution of providers through use of incentives such as tuition reimbursement or student loan forgiveness. Saint Alphonsus has advocated in support of such programs with the Idaho legislature.
COREY SURBER is advocacy and community health coordinator at Saint Alphonsus Health System, Boise, Idaho.