Opening the Door: Necessity Leads to Innovation in the Search for Access to Primary Care

In 2008, the Health Resources and Services Administration (HRSA) predicted an escalating shortage of primary care physicians in the United States. HRSA also predicted that the deficit of physicians would rise to over 20,000 by the year 2020. In 2010, statistics mirrored these predictions with rural and underserved areas having a shortage of over 7,500 physicians.

Attracting and retaining an adequate supply of physicians dedicated to primary care has been challenging. Rising medical education costs, diminishing wages of family practice physicians and the allure of higher-salaried specialty care positions have all contributed heavily to the shortage.

In response to this data and the ever-changing landscape of medicine, a population of medically trained professionals has been growing. The occupations of Nurse Practitioner (NP) and Physician Assistant (PA) have been around for the last 50 years. Previously quiet in the backdrop of medical care, this group of clinicians is now steadily rising to the forefront of primary care. Communities, especially rural or underserved, are finding that NPs and PAs are becoming essential members of family medicine clinician teams.

Recognizing the immense potential of these clinicians and their future impact on access to care, Shasta Community Health Center (SCHC) has spent the last 2 years developing and implementing a post-graduate Fellowship for newly graduated NPs and PAs. Although new graduates have proven themselves by completing rigorous Master’s Degree Programs, they still face a steep learning curve when entering the workforce. SCHC has become aware that these new clinicians need close mentoring during their first year out of school; especially when serving in Federally Qualified and rural health clinics.

SCHC’s NP/PA Post-Graduate Fellowship is focused on the first year of practice in primary care. The Fellowship provides a one-year “on-boarding” process and a slow ramp-up to a fulltime practice. The year consists of regular clinic time within “Fellow Hall”, as the Fellows begin to build their primary care practice. Fellows begin with one patient per hour and present each patient to a preceptor for collaboration. With one hour per patient, the objective is to give the Fellow the time needed to evaluate the patient, develop diagnoses, consult with the preceptor and deliver evidence-based medicine. In addition to their own clinics, the Fellows have rotations in the various specialties at SCHC during the first six months of the program. These rotations include: Urgent Care, Women’s Health, Pediatrics, Psychiatry, Homeless Outreach, Infectious Disease and Hepatitis C clinics. Procedure clinics are also woven into the first few months of the Fellows’ schedules. Given SCHC’s history as a teaching health center, the Fellows can work with and learn from experienced clinicians who are dedicated to teaching and to community medicine.

After six months, the Fellows begin to ramp-up their own practice schedules, seeing additional patients per session. They have other rotations at SCHC which include: home visit care for the developmentally disabled, care for patients in our satellite clinics, and observation in Telemedicine. Telemedicine at SCHC includes: Adult and Pediatric Endocrinology, Dermatology and Psychiatry, and Adult Neurology and Rheumatology.

As our Fellowship takes off, we are also seeing the need to reach out to the upcoming generation of health care providers. While we are seeing interest in our program with applicants from all over the country, we would also like to focus on recruiting local high school and college students to consider careers in health care. The goal is long term, with the hope this new generation would return to their home town to practice medicine. “Growing our own” will take planning and effort and will hopefully open doors for students who may have never even considered a career in healthcare. This is where our local community can be of help. If you have a child, grandchild, family friends, etc., of young people currently training as a Physician Assistant or Nurse Practitioner, or on track to apply/enter those programs, please forward to them this article and have them contact me (info below) or go to our website and follow the NP/PA Fellowship link (https://www.shastahealth.org/nppa-fellowship). We would greatly appreciate making those connections at any stage of their training.

The current landscape of medicine, especially primary care, is changing rapidly. The demand for clinicians who are dedicated to the care of patients and families is growing annually. In response, SCHC is doing what it has always done: anticipating the needs of the community and investing significant time, resources, and talent towards meeting those needs. NPs and PAs will play a crucial role in decreasing the primary health care provider deficit. Shasta Community Health Center is proud that its NP/PA Post-Graduate Fellowship is helping to meet this need.

For more information, please contact Shasta Community Health Center
Dorothy Bratton-Sandoval, MPAS, PA-C
SCHC NP/PA Post-Graduate Fellowship Director

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