Does the Apple Fall Far from the Tree?

November 18, 2019
Lee Francis, MD, MPH, President and CEO, Erie Family Health Centers, presented the November 14, 2019 ACGME Baldwin Seminar
Lee Francis, MD, MPH, President and CEO, Erie Family Health Centers, presented the November 14, 2019 ACGME Baldwin Seminar

Educating residents in community health settings offers learners an exceptional opportunity to gain a deeper understanding of social determinants of health and how to interact with the various services that address them, said Dr. Lee Francis at the November 14 Baldwin Seminar presentation, Training the Next Generation at Community Health Centers: Does the Apple Fall Far from the Tree?

Dr. Francis is President and CEO of Erie Family Health Centers, a Chicago community-based health center with 13 locations serving 75,000 medical patients and 12,500 dental patients in primarily low-income households. Dr. Francis explored the history of community-oriented primary care (COPC), and the opportunities and challenges presented to providing GME in community health settings, using his own organization as a model.

COPC is rooted in the Civil Rights Movement, and developed from the belief that health care is a human right, a concept close to the heart of DeWitt C. “Bud” Baldwin, MD, for whom the ACGME’s seminar series is named. Dr. Baldwin was one of the pioneers of the early development of this model of health care.

“They (community health centers) are well positioned to play a larger role in solving the primary care provider shortage, whether through formal or informal training models,” Dr. Baldwin noted.

Dr. Francis’ own medical career was rooted in community-based care, when he spent a summer living in a trailer in the hot, rural agricultural region of southern California, talking to churches and other religious institutions about getting involved in the health care of the congregation.

Because community health centers usually have in-house medical, dental, mental, and social services, residents get a wider breadth of experience than they do in more traditional residency programs, Dr. Francis said. This includes learning to screen patients for service needs related to the social determinants of health, as well as learning how to initiate “warm hand-offs” in the examination room to dental, mental, or social professionals, which have been leading to better patient outcomes. Residents also have opportunities to participate in a range of activities that traditional residency programs do not include, from participating in a community parade or teaching in a local elementary school classroom.

“Community-based training programs are best suited to meet the growing demand for primary care physicians, I believe that at my core,” he said.

These types of residency programs, however, face unique challenges, Dr. Francis said. While Federally Qualified Health Centers are the largest patient care system in America, serving more than 28 million people, only 27 states have COPC training health centers, and Erie is the only one in Illinois. Additionally, community health centers work on a different and less stable funding model than traditional residency programs, leading to struggles to maintain government backing for the duration of a resident’s education. Additionally, community health center boards of directors are made up of community members who may not be familiar with the value residents and academic medicine can bring to a health center.

Despite these challenges, Erie Family Health Centers draw 800-1,000 applicants for eight residency slots annually. The selected residents typically have a desire for community change as “a part of their personal social fabric.” They participate in advocacy and initiate innovative community projects, like one former Erie resident’s project to start a community garden, which is active a decade after her completion of the program. Residents trained in these environments continue to be engaged in this kind of work post-residency, Dr. Francis said.

The ACGME’s Baldwin Seminar Series is offered free of charge, and continuing professional development (CME) is available. A recording of Dr. Francis’s presentation can be viewed through December 13. Click the link to register, or visit the Baldwin Seminar Series web page. Physicians can earn 1.5 AMA PRA Category 1 creditsTM.

The next Baldwin Seminar on January 22, 2020, from 9:30-11:00 a.m. Central at the ACGME office, will feature guest speaker Joan M. Anzia, MD, vice chair for Education, Department of Psychiatry and Behavioral Sciences at the Northwestern University Feinberg School of Medicine. Email to join the invitation mailing list.