Med Journal October 2020 - Page 18

EDITORIAL PANEL : Chad T . Rodgers , MD , FAAP | Elena M . Davis , MD , MPH | Shannon Edwards , MD | William L . Mason , MD | J . Gary Wheeler , MD , MPS | Beth Milligan , MD , FAAFP , CHCQM , CPE

Primary Care Fellowship Training : Addressing barriers and finding new solutions to addressing difficult healthcare issues ( Part one )


We were all well trained

through medical school and residency of taking care and managing sick patients but also improving health for our patients through prevention , education , and coaching . Our best training most likely occurred during the first 3-5 years of practice . The experience of caring for patients in your practice setting ( academic vs . private , rural vs . urban , large vs small practice ) teaches us a lot and refines our skill of the “ art of medicine ”. Continuing medical education through self-study , conferences , learning modules , and other modalities is the cornerstone of remaining well trained as doctors . Our career is one of lifelong learning and constantly adapting to new knowledge and ways of practice .
Many physicians experience frustration within a few years of practice not just with the healthcare system , but despite their best efforts and training , their patients don ’ t seem to be getting better . We work on communication styles , motivational interviewing , care plans , close follow up , calls from our nursing staff , but still our patients struggle .
Arkansas has many challenges as a rural state . Economic hardship , poor access to primary and specialty care , low educational attainment and poor health literacy , multigenerational poverty , systemic racism , and many other social determinants of health . Good evidence continues to show that your zip code is a greater predictor of your health outcomes than your genetic code . Eighty percent of what occurs outside our clinic exam room or hospital doors impacts our patient ’ s health .
Childhood trauma , referred to as Adverse Childhood Experiences ( ACEs ), impacts not only our children ’ s current mental and physical health , but many adults ’ past experiences contribute to their current health and their ability to improve their health . The more ACEs you have experienced , the more likely you are to struggle with chronic physical health problems as well as mental health . Factors that foster resilience in children , homes , and communities are protective of the impact of ACEs . It ’ s not what is “ wrong ” with our patient , but perhaps “ what happened ” to our patient . ( For more info about ACEs visit afmc . org / aces
Arkansas also ranks highly in the areas of obesity , opioid and other drug use , as well as poor behavioral and mental health . These are all very complex issues which makes them very difficult to manage . The fact is these healthcare issues can not be solved by the Primary Care Physician alone within the clinic or hospital . It is more than a medication , a procedure , or a therapy .
Within a few years of practice , many physicians identify health issues they would like to confront and adopt new practices or new ways of addressing long-held troublesome diagnoses . But practice is challenging with limits of time , energy , knowledge , and especially the administrative burdens related to managing our patients . Many times , we find ourselves looking to the West or East coast or even urban centers for solutions . But the rural setting is different . Not that there are not solutions , but there are unique , potentially innovative strategies , to improve health care .
In 2018 , AFMC sought and was awarded a Primary Care Training Enhancement ( PCTE ) grant which created a fellowship program
90 • The Journal of the Arkansas Medical Society www . ArkMed . org