February 20, 2013

Kaiser Permanente Southern California steps up physician training

The Free Clinic of Simi Valley, which marked its 40th anniversary in 2011, is one of the locations where KP Southern California Community Medicine residents provide free care. Pictured here, at center, is clinic executive director Fred Bauermeister and, at far right, Adriana Trujillo, a former KP resident. Also pictured, from left, are Citlali Maldonado, Olga Lafflitto and Lupita Gonzalez of the clinic staff. Photo by Bill Sparkes/Acorn Newspapers

Contributed by Lincoln Cushing, Archivist and Historian

The Southern California Permanente Medical Group has taken giant steps in recent years to enhance our physician training curriculum so we can better meet the needs of our communities. Since 2007, we have instituted new programs to address a looming nationwide shortage of physicians, and we’ve launched two new programs to broaden the scope of our charity care.

Started in 1955, the SCPMG graduate medical education program has grown to include eight different specialties and 27 independent residency programs at 6 Kaiser Permanente medical centers in Southern California. With this flourishing GME program serving as a springboard, we have added community medicine fellowships and a KP-UCLA internal medicine/master of public health degree program.

These enhancements are designed to prepare new physicians to practice in today’s ever-changing and progressively challenging world of medicine.

Community medicine fellowship

The community medicine fellows practice in safety-net clinics in the greater Los Angeles area and study topics essential to the understanding of community health needs and the allocation of resources. The fellows learn how to approach the care of people of different cultures and to identify special needs in the community.

2012-2013 fellows of the Kaiser Permanente of Southern California Community Medicine program
Pictured here from left to right are the 2012-2013 fellows of the Kaiser Permanente of Southern California Community Medicine program: Maegan Dupper, MD, Nzinga Graham-Hines, MD, Janani Krishnaswami, MD, Kiran Mitha, MD, Diana Hoffman, MD, and Long Nguyen, DO.

They also learn to develop and foster partnerships with safety-net providers and to find ways to share KP’s evidence-based practice with clinic staff.  One goal of the program is to inspire new physicians, residents and students to take part in community care opportunities and to share their new knowledge through teaching.

The community medicine fellowship, begun as a pilot with one resident at the Kaiser Permanente Woodland Hills Medical Center, has grown to 6 positions shared among Woodland Hills, Los Angeles, Fontana and Orange County medical centers.

The fellows, new graduates of residency programs, spend half of their time in community settings, providing care and supervising residents and medical students. They collaborate with site leaders to identify needs and plan development of new systems or programs.

Marc Klau, MD, physician director of education for the Southern California Permanente Medical Group.
Marc Klau, MD, is the physician director of education for the Southern California Permanente Medical Group.

The other half of their time is at their home medical centers, providing care to Kaiser Permanente members or mentoring/teaching residents and medical students.

In recent years, the fellows have accomplished much: putting Kaiser Permanente’s pediatric weight management program into practice at Saban Clinic at Hollywood High School; and charting improvements in blood pressure measures and screening assessments of diabetics at the Inland Family Community Clinic.

Kaiser Permanente community medicine fellows have also taken medical care to a number of non-traditional sites, including a mobile clinic set up outside of court for homeless people in trouble with the law, as well as a diabetes clinic on an Indian reservation near Indian Wells. They’ve also offered care at the Motor Inn in Costa Mesa and in Duroville, the largest mobile home park in the Riverside County desert.

Connecting internal medicine with public health

John Su, MD, MPH, director,
Kaiser Permanente of Southern California Community Medicine Fellowship Progam.
John Su, MD, MPH, director,
Kaiser Permanente of Southern California Community Medicine Fellowship Progam.

The person who participates in the SCPMG internal medicine-public health program has the opportunity to train with Kaiser Permanente and then directly enter the UCLA School of Public Health to complete the coursework and earn a master of public health degree.

The goal of this program is to enhance the training of future Permanente physicians and leaders by developing a broader knowledge base in the public health arena, including biostatistics, epidemiology, chronic disease management, injury prevention, health promotion, health policy and management, and disaster preparedness.

We also hope to gain an in-depth understanding of the interaction of biological, psychological, economic, cultural, and political factors that contribute to health outcomes and to share this knowledge with community clinics.

Addressing a nationwide shortage of physicians

Statistics from many sources predict in the near future a severe shortage of primary care physicians, general surgeons, emergency room specialists and psychiatrists. The American Association of Medical Colleges estimates a shortfall of 150,000 physicians by 2025.

To attack this shortage, medical schools and hospitals need to step up efforts to produce new physicians. To properly meet demand, 45,000 of the new physicians should be trained in primary care.

Other sources predict shortages of emergency room doctors and psychiatrists, particularly physicians trained to care for children with mental health problems. In the San Diego area, the supply of psychiatrists dropped by 27 percent between 1990 and 2002 while the demand for these services increased by about 16 percent.

Also in San Diego, where there is no county hospital to care for disadvantaged patients, primary care clinics and emergency rooms are seeing a rising number of patients. In 2009, 32.7% more patients were seen in San Diego community clinics than in 2005.

Adding specialties to the curriculum

To address these trends, SCPMG is adding new residency programs in disciplines where the need for more well-trained physicians is greatest, and enlarging the enrollment in many of its existing residency programs.

In San Diego, Kaiser Permanente is launching new pipeline programs in family medicine, emergency medicine and internal medicine. Family medicine is starting with 6 residents and increasing to 18 by 2014. Emergency medicine will have 6 residents when it opens in 2014 and is expected to increase to 18 by 2016. Internal medicine will open in 2015 with 6 residents with plans to increase to 18 by 2017.

In Fontana, we are opening a new internal medicine program, to begin with 6 residents in 2013 and increase to 18 by 2015. A psychiatry residency program will launch in 2014 with 6 residents and increase to 18 by 2016.

Existing programs to grow

Also, our Orange County family medicine program will increase its number of residents from 18 to 24 this year. Los Angeles Medical Center has added one resident in general surgery, bringing its total to 29; in neurology, the number of residents will increase to 12 by 2014; and in diagnostic radiology, the number will increase from 10 to 15 by 2016.

We continue to discuss plans to open a general surgery program at Riverside with a complement of 10 residents by 2015 and an internal medicine program at Antelope Valley with 5 residents from Olive View–UCLA Medical Center.

In the past, between 30 and 40% of Kaiser Permanente residency graduates have chosen to continue their professional careers with us. By the expansion outlined above, we are ensuring a supply of well-trained young physicians both for Kaiser Permanente and the general community.

Through its graduate medical education programs, Kaiser Permanente Southern California has responded to community needs for better care for the uninsured, as well as planning ahead to ensure we have enough qualified physicians to care for our patients now and in the future.

Marc Klau, MD, is chief of head and neck surgery and former director of medical education at KP’s Orange County Medical Center. He is also chair of the Institutional Graduate Medical Education Committee, Physician Director of Medical Education and Designated Institutional Official providing administrative oversight for all GME and continuing medical education programs for the Southern California Permanente Medical Group.