Aiming for Universal Care
Finding a doctor isn’t as easy as it used to be. In fact, the shortage of primary-care physicians has reached crisis proportions across the nation, including in Massachusetts. A 2012 workforce study by the Massachusetts Medical Society found a “severe” and “critical” shortage of doctors specializing in family and internal medicine.
The shortage adds yet another barrier to care for such medically underserved and vulnerable populations as the elderly, the disabled, immigrants and minorities. People in these communities often suffer from more health problems than average, but they have a harder time accessing good medical care because of steep rates of poverty, homelessness and substance abuse, as well as language and cultural barriers. Despite this enduring need, most medical training doesn’t pay much attention to serving these disadvantaged groups.
Randy Wertheimer, the Jaharis Family Chair in Family Medicine at Tufts, is addressing the need directly by developing the Service Scholars Program. The new program will create a pipeline of committed and qualified medical students devoted to gaining the knowledge and skills necessary to care for underserved communities.
“Students come in [to medical school] very idealistic—they want to change the world,” says Wertheimer. But because their training doesn’t focus on providing care to the underserved, students don’t gain the hands-on experiences or skills needed to handle those challenges. They also don’t have the opportunity to develop a community of peers who share their commitment.
The Service Scholars Program will supplement the existing medical school curriculum with added training, skills development and faculty mentoring from physicians working in community health centers in the greater Boston area. Over the course of the four-year program, students will develop the community, the knowledge and the confidence they need to make a difference.
Private support has been critical to the Service Scholars program. Earlier this year, a donor who wants to remain anonymous gave the medical school a $300,000 grant for curriculum development for the program. In addition, the Bingham Trust has pledged $600,000 over three years to support Service Scholars in financial need. “We are fully funded at this point and ready to go,” Wertheimer says. “We’re planning to start this summer with our first class.” With an initial goal to add 10 students a year, Wertheimer expects the program to draw wide interest.
An ancillary goal of the Service Scholars Program is to enhance diversity at the medical school. Studies show that students from typically underserved communities, and women in general, are more likely to choose a career caring for vulnerable populations. The program will work with local, regional and national partners, such as UMass-Boston (see “A Roadmap to Medicine”), to identify and recruit students from diverse backgrounds.
Enrolled students will receive special training on health disparities, health literacy, disabilities and special needs, patient registries, health systems and health financing. Some training will be classroom-based; other aspects will occur in the wider world. Students will gain experience at public hospitals, community health centers, homeless shelters, free clinics and nursing homes, where they will be mentored by doctors who have earned their stripes working among populations in need.
The program will also touch on the essentials of self-care and mindfulness for doctors. “I think for anyone, medical training is arduous. But when you’re taking care of communities in stress, then it feels really, really hard. So they need to understand how to recognize signs of burnout and care for themselves,” Wertheimer says.
Interdisciplinary, team-based care that relies not only on doctors and nurses, but also on community health workers, social workers and other providers, is another critical element in the Service Scholars training.
“And then we’re going to talk about social justice,” Wertheimer says. Physicians will learn what role they can and should play in pushing broader policy changes to support vulnerable people at the local level and beyond.
Wertheimer believes the program will produce doctors who are highly motivated and expertly trained in caring for underserved communities. “It will give students the tools and the ability to go out and make a difference by helping those most in need,” she says.
This article first appeared in the Summer 2013 issue of Tufts Medicine magazine.
Brenda Conaway is a freelance writer in Arlington, Mass.