• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Billings, Mont., Unites Medical Residency Program With Community Health Centers

Posted on: Wednesday, 15 March 2006, 18:00 CST

By Diane Cochran, Billings Gazette, Mont.

Mar. 16--When researchers studying physician vacancies in community health centers across the country called Deering Community Health Center recently, they found an aberration.

All seven of the Billings health center's medical positions were filled, and officials reported that a full staff was the status quo.

"We probably will never have vacancies here," said Roxanne Fahrenwald, director of the Montana Family Practice Residency Program, a partner to the Deering clinic.

Nationwide, 13 percent of full-time physician positions at community health centers are vacant, according to a study published last month in the Journal of the American Medical Association.

In rural America, more than 30 percent of community health centers with vacancies had been recruiting unsuccessfully for at least seven months, the study reported.

"It would require more than 400 (full-time) family physicians to fill all of the vacancies for this discipline," the authors wrote.

But there aren't enough family doctors out there, and the number is steadily dropping.

In the last seven years, new doctors who opted to practice family medicine -- the kind of doctors most often hired by community health centers -- decreased by almost 52 percent, according to the JAMA study.

New medical school graduates are more likely to specialize than to choose a general practice such as family medicine.

Together, the decline in family practice physicians and the increase in physician vacancies at community health centers have some experts sounding a panic alarm.

Fahrenwald thinks the solution to both problems is right here in Billings.

"We've already started to solve the problem," she said.

Deering Community Health Center and the Montana Family Practice Residency Program are part of the same agency -- the Yellowstone City-County Health Department.

If the 450 other family medicine residency programs around the nation joined forces with community health centers in their neighborhoods, a dent could be made in both shortages, Fahrenwald said.

"It's a great idea," said Lil Anderson, chief executive officer for the health department. "We will take our model forward and try to get other community health centers and residency programs to join." Combining programs helps both types of agencies.

Community health centers benefit because the partnership provides them with medical providers. A steady stream of resident doctors cycle through to treat patients, and it is easier to recruit permanent physicians because of the teaching component of the positions.

Likewise, the arrangement is attractive to residency programs because it guarantees patients for the new doctors to treat, and they are typically patients in dire need of care.

"Some residency programs don't have enough patients," Fahrenwald said.

Fahrenwald sees another benefit, as well. Doctors who train through community health centers take away a community service mindset, she said.

Treating patients at places such as Deering is often more rewarding than other medical work because the patients need so much care and are so grateful for the attention they receive.

"Even if they (doctors) go into private practice, they're still going to have that in their hearts," Fahrenwald said.

The nation needs more community-oriented doctors, she said.

"I see it (medicine) as a service position, and it's gotten away from its roots in the last 50 or 100 years," she said.

Fahrenwald has been giving presentations about the Billings setup to national organizations for years, and she has two such talks scheduled next month.

"It's something people are really interested in," she said. "I've been doing my best to not keep it a secret." Agencies that choose to follow the Billings model will face challenges, including learning how to work together and figuring out how to pay for everything.

In Billings, the concept is successful in large part due to financial support from the local hospitals, Anderson said.

St. Vincent Healthcare and Billings Clinic give the program money they receive from the government for training new doctors, she said.

"Community health centers and residency programs can't make enough money on their own," Anderson said.

It can also be a lot of work for separate entities to mesh into one another. The move was successful in Billings because leaders of both programs were motivated to make it work, Fahrenwald said.

"You can make anything work if you really want to," she said.

BY THE NUMBERS

--3,500 American cities and towns have community health centers.

--14 million people access health care at those health centers each year.

--17,000 people got care last year at Deering Community Health Center in Billings.

--20 percent of the U.S. population lives in rural areas.

--9 percent of U.S. physicians practice in rural areas.

--37 percent of the nation's community health centers are in rural areas.

--42 percent of rural community health centers report that recruiting family physicians is very difficult.

--21 percent of urban health centers report high difficulty in recruiting family physicians.

(Source: Journal of the American Medical Association)

-----

To see more of the Billings Gazette, or to subscribe to the newspaper, go to http://www.billingsgazette.com.

Copyright (c) 2006, Billings Gazette, Mont.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: Billings Gazette, Billings, Montana

More News in this Category