A Scholarly Concentration in Health Disparities:
Impact on the Primary Care Physician Workforce
Cynthia Selleck, ARNP, DSN
Program Director, University of South Florida AHEC
Laurie Woodard, MD
Associate Professor, Dept of Family Medicine
Stephanie Peters, MA
Associate in Education, Dept of Family Medicine
University of South Florida College of Medicine
Tampa, FL
National AHEC
Organization
June 2010
History of Scholarly Concentrations
at USF
 A “concept” of the Education Strategic Work
Group, 2005
 SCs are topic areas that medical students can
select to study in greater detail – a “minor” of
sorts
 Voluntary rather than mandatory
 Components include course work, practical
application and scholarly presentation
 The equivalent of 12 semester hours (180 contact
hours)
History of Scholarly Concentrations
at USF
 In 2006, interested faculty volunteered their time
to design and organize SCs
 SCs began accepting students in fall 2007
 Currently completing our 3rd year of SCs
 Interested students complete an application to
join the Scholarly Concentration Program plus an
application for the specific SC they wish to join
Current SCs Offered at USF
–
–
–
–
–
–
Business & Entrepreneurship
Medical Education & Leadership
Health Disparities
Research
Law & Medicine
Public Health/Global Approaches to Clinics &
Communities
– Health Systems Engineering*
– Humanities*
* New for 2009-2010
Why an SC in Health Disparities?
 Some students were already doing significant
volunteer work in this area (ex: BRIDGE
Healthcare Clinic)
 We wanted interest in the topics of health
disparities, care of underserved populations and
healthcare justice to be valued as much as areas
such as Business, Research, Education, Law,
etc.
 We also wanted to mentor those students who
came to medical school seriously interested in
the topic.
Recruitment of Students into SCs
 Promotion occurs during the secondary
application and interview process
 Overview of SCs provided during orientation
(within 1st week of school)
 SC Informational Round Robin evening during
Sept-Oct (“speed dating”)
 Applications due late October
 Selections made by December (but students can
join later as well)
The Health Disparities SC is for
students who want to:
 Exercise your altruism!
 Provide care for those who
have limited access.
 Discover why health
disparities exist.
 Design an intervention to
eliminate health disparities.
 Learn how to improve the
system for all.
Some Background:
 Current Status of the Primary Care Physician
Workforce
– In 2008: 240,416 PCPs (1 for every 1,281 persons)
– Currently a problem of distribution
• Still concentrated in desirable areas
• Relative shortage in underserved and rural areas
• True for physicians, NPs and PAs
Horizon Problem
 Research indicates that access to primary care
is associated with better health outcomes and
lower healthcare costs; however:
– Decline in U.S. student interest (though increased
slightly in 2010)
– Increased reliance on IMGs
– Increased interest in specialization (ROAD)
– Contraction of training programs
– Current physician expansion effort not promoting
primary care
“Flipping the Pyramid”
Growing recognition that any health reform initiative should build upon a
foundation of affordable, accessible primary and preventive care.
Tertiary Care
Secondary
Care
Primary
Care
Tertiary
Care
Secondary
Care
Primary
Care
Today’s health professional workforce is heavily focused on specialty care,
with a shrinking number of U.S. trained physicians entering primary care.
How to Flip the Pyramid
 In order to build a base of primary care providers,
we must reverse the decline in the number of
U.S. healthcare professionals entering primary
care and create incentives for a strong primary
care workforce that can meet the health
challenges of the 21st century.
What Influences Medical Student &
Resident Choices?
 Debt – plays an important role for some but not
most students
 NHSC – growing interest among students
 Title VII programs – important role in facilitating
the choice of primary care, practice in
underserved areas and service to medically
needy
 Physician income gap/Return on Investment
From: Robert Graham Center, March 2009
What Influences Medical Student &
Resident Choices?
 Training in rural locations – important to choosing
practice in rural locations
 Attending a public medical school
 Student interest in caring for underserved
populations (increased likelihood of practice in an
FQHC and serving in NHSC):
– Schools should give weight to this in acceptance
– Target these students for mentoring and training
experiences
From: Robert Graham Center, March 2009
Mission of the Health Disparities
Scholarly Concentration

Our mission is to provide USF medical students
interested in the topics of health disparities, healthcare
justice and care of medically underserved populations an
opportunity to enrich their educational experience by
focusing volunteer and supervised clinical experience
and group and independent learning in these areas.
Objectives of the Health Disparities SC
Upon completion of this Scholarly Concentration, students
should be competent to:
1. Describe barriers that exist for the nation’s medically underserved,
against the complex dynamics of the U.S. health care system.
2. Investigate cross-cultural issues in health care and demonstrate how
sensitivity to those issues (and others) improves health care for all.
3. Identify and evaluate sources of disparities in health care at the
individual (patient and provider), institutional, and health systems
levels.
Objectives (con’t)
4. Identify and describe the unique opportunities and challenges that
medically needy populations present to medical practice.
5. Act as an advocate and design interventions to eliminate health
disparities at the individual (patient and provider), institutional, and
health systems levels.
6. Engage and reflect upon relevant clinical experiences throughout
four years of medical school.
Student Participants

Students who not only want to understand health care
inequities and costs in our society, but who want to be
part of the solutions, are attracted to this scholarly
concentration. Their concerns about health disparities
are nurtured and supported through participation.
Faculty Mentors
 Each student works with a faculty mentor from a
group of approximately 20 interesting and
interested people drawn from USF Health, USF
main campus and the community.
 Mentors help students to develop and tailor an
annual scholarly plan, meeting with them
regularly to assess completion of agreed upon
experiences.
Program Activities & Requirements
Journal Clubs - monthly over the course of 3 years on





5 themes:
Overview of Health Disparities
Health Economics & Policy Issues
Social Determinants of Health
Race, Ethnicity and Culture
Disabilities & Special Populations
Program Activities & Requirements
 Clinical Experiences – through the Longitudinal
Clinical Experience (LCE) course, clerkships,
and electives
 Optional Summer Experience – individually
negotiated clinical, community advocacy or
research experience conducted during the
summer between years 1 and 2
Program Activities & Requirements
 Volunteer Community Service – with medically
needy populations through the USF Health Service
Corps, BRIDGE Healthcare Clinic, Judeo Christian
Clinic, Project World Health, International Health
Service Collaborative, and through HDSC
community service projects.
Program Activities & Requirements
 Scholarly Leadership Project – individually
negotiated leadership project the goal of which is
to design interventions to eliminate health
disparities at the individual (patient or provider),
institutional and/or health systems levels.
April 7,
2010
Dr Lois Nixon served as Nicole
and Navid’s Faculty Mentor
Scholarly
Concentration
Nicole Russell , MSIV Navid
Eghbalieh, MSIV
Health
Disparities
Faces of the Homeless: a
Scholarly Leadership Project
Program Activities & Requirements
 Optional Advocacy Activities – students with
an interest in advocacy can travel to Tallahassee
or Washington DC to meet with legislators to
discuss the needs of the medically underserved
and advocate for change on their behalf.
 And more! - participation in national conferences such
as
– National Summit of Clinicians for Healthcare Justice
– Physicians for Human Rights
– Migrant Stream Forums
Timeline for Completion
 Years 1, 2, 3: clinical and volunteer experiences and
monthly journal club attendance.
 Year 4: Leadership project, mentor junior students,
legislative advocacy.
Evaluation
 Students-Participation
– Attendance, Logs, Project
 Faculty mentors – Feedback
– Informal
 HDSC Co-directors – Feedback
– Informal
 Overall HDSC – Attendance/ Attrition/ SC
Leadership
Research: A Longitudinal Observation of the
Impact of a Specialized Curriculum on
Empathy in USF Medical Students
 Background: research data indicate that empathy
of medical students decreases throughout the
process of medical education
 Hypotheses:
1. New students accepted into the HDSC have higher
vicarious empathy scores than the remaining
students in their medical school class.
2. Students admitted to the HDSC are more diverse
(URM and/or disadvantaged) than the remaining
students in their medical school class.
 Hypotheses:
3. Students in the HDSC will show less decrease
in overall empathy scores through their 4
years of medical school than the remaining
students in their medical school class.
4. Students in the HDSC are more likely to
pursue primary care (core) residency training
than the remaining students in their medical
school class.
Research Protocol
 IRB approval Sept 2009
 Studying class of 2013
 Using a brief demographic questionnaire
and the 30-item Balanced Emotional
Empathy Scale (BEES)
 Instrument administered 5 times (beginning
of years 1, 2, 3, 4 and end of year 4)
Challenges Faced to Date
 Totally volunteer on behalf of faculty; no
funding to support – and lots of work!
 Students have full plates and tend to be “no
shows” in their 3rd year
 No grades given – therefore no grade
incentive
 Lots of student interest – how best to
maintain and mentor “true” student interest
over time
Questions?