Kentucky has a severe shortage of health care providers, with at least some portion of 113 of the state’s 120 counties designated as Health Professional Shortage Areas, including parts of Jefferson County. Recent projections rank Kentucky lowest among the states in meeting the need for primary care physicians by 2025.

To attract and train medical students with an interest in practicing primary care in medically underserved communities, the School of Medicine will enhance existing programs that train students in the underserved rural environments, assist individuals from other careers who want to prepare for medical school, create a new program to train medical students in an urban environment and provide scholarships to support students financially in all of these programs.

“The UofL School of Medicine is honored to have been selected as a recipient of the HRSA grant and is committed to creating pathways that support workforce development for primary care careers in medically underserved regions,” said Jeffrey Bumpous, interim dean for the UofL School of Medicine and vice president of medical affairs. “University leaders recognize the projects and programs supported by this funding are critical to the institutional mission of both the university and the School of Medicine and aim to sustain the efforts beyond the four-year term.”

UofL has a long history of preparing physicians for practice in rural and smaller communities through the , started in 1998 with the goal of increasing the number of physicians practicing in rural areas, and in existing UofL family medicine residencies in Glasgow and Owensboro.

“Students tend to practice what they are taught and where they learn it. Our idea is to enhance our training programs with a focus on improving their educational experience in primary care, particularly in underserved communities,” said Kelli Bullard Dunn, vice dean of community engagement and diversity for the UofL School of Medicine, who leads the project. “At the UofL School of Medicine, we are in a unique position in that not only do we serve rural parts of the state, but we have an urban, underserved core right in our backyard. We would like to take what we have learned from the Trover Campus and replicate part or all of that in the urban environment here in West Louisville and other underserved areas.”

Medical students in the complete their final two years of medical school at Trover Campus, located in Madisonville, Kentucky, hosted by Baptist Health Deaconess Madisonville. Of the 170 physicians who have graduated from the Trover Rural Track so far, 75% practice primary care and 43% practice in rural communities.

“The Trover Campus has been successful because we are able to get more rural students into medical school and then into rural practice by supporting them all the way through the process, starting with high school,” said William J. Crump, associate dean of the UofL School of Medicine Trover Campus. “This grant holds the promise of enlarging our campus, but most importantly building an urban underserved counterpart.”

Three programs to achieve the grant goals

The grant project focuses on three programs aimed at increasing the number of physicians who choose primary care specialties of family medicine, general internal medicine, pediatrics and internal medicine-pediatrics and encouraging them to practice in underserved communities.

First, UofL will increase participation opportunities for students in the Trover Rural Track and expand primary care clinical training for students in conjunction with the UofL family medicine residency programs at Glasgow and Owensboro.

Second, a new urban training program will be created, modeled on the Trover program, that provides medical students opportunities to train in medical facilities in West Louisville and other communities that provide care for underserved populations. This project will involve partnerships with community health systems such as UofL Health, Family Health Centers and others.

In addition, the project calls for enhancement of the UofL , which prepares individuals who have a bachelor’s degree in another field to enter medical school. Of the 114 students who have completed the Postbaccalaureate Premedical Program since it began in 2009, 98% have been accepted into a medical school and 36% of those who have completed residency programs now practice in primary care fields.

The new funding will allow this program to recruit more students from medically underserved communities who are interested in practicing in those areas after completing residency training and to improve access to medical school for them with scholarships and additional academic support.

“This new grant allows us to help even more people fulfill their dream of becoming a physician. A lot of the postbaccalaureate premedical students have come from underserved populations or underserved areas, including rural areas. Having more folks from rural areas and underserved communities going into medicine is a great thing for Kentucky,” said V. Faye Jones, UofL Health Sciences Center associate vice president for health affairs and diversity initiatives and co-lead for the grant project.

Students in each of the three programs will receive academic and financial support with coaching and scholarships to help ensure their success in applying to and completing medical school.

“Everyone deserves the best quality health care we can provide, and that means having the best quality of talent in the medical school pipeline,” said Rep. Morgan McGarvey, who supported the grant proposal. “I’m excited for UofL and for the future of Kentucky health care with this HRSA Medical Student łÉČËÖ±˛Ą Program grant to address the primary care provider shortage. We need to be doing everything we can to ensure we are supporting the primary care providers of tomorrow, and I’m proud UofL is leading the way.”

See photos on from the Oct. 9 press conference announcing the new funding. 

The Health Resources and Services Administration has awarded more than $1.2 million over 5 years to the UofL and Norton Children’s project, out of a $48 million award to establish a Regional Pediatric Pandemic Network. The amount awarded to UofL and Norton Children’s is expected to grow throughout the next four years. The project will involve preparing for global health threats, including pandemics, and supporting communities in everyday pediatric readiness.

Charles G. Macias, chief quality officer at University Hospitals  Rainbow Babies & Children’s Hospital in Cleveland, will lead the project. Mary E. Fallat will head the UofL and Norton Children’s effort.

“We began this work before the global pandemic, and 2020 proved how important it is for hospitals, health care infrastructures, government and private entities to work together to create a coordinated emergency response model,” Macias said. “This grant is an amazing opportunity to grow a national model whose impact can inform all aspects of pediatric preparedness, from daily efforts to global health threats.”

The network brings together five children’s health care facilities but also creates a network of networks—including the nation’s only two federally-funded Pediatric Disaster Centers of Excellence, which are funded through the Office of the Assistant Secretary for Preparedness and Response and the work of the Emergency Medical Services for Children Innovation and Improvement Center, funded through HRSA’s EMSC program.

The Regional Pediatric Pandemic Network includes:

• UH Rainbow Babies & Children’s Hospital, affiliated with Case Western Reserve University, Cleveland, Ohio  
• University of Louisville School of Medicine Department of Surgery and Norton Children’s Hospital
• University of California San Francisco and its Benioff Children’s Hospital, Oakland, California  
• University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
• Saint Louis University and Cardinal Glennon Children’s Hospital, St. Louis, Missouri

This network of children’s hospitals represents a broad geographic diversity and will serve as a hub-and-spoke model of expertise to support efforts for pediatric readiness and disaster/pandemic preparedness by incorporating specific focus areas, called “domains,” such as trauma, equity, analytics and others, to define best practices as supported by the ASPR, HRSA, EMSC, and other existing workgroups.

Norton Children’s Hospital will be the hub for integration of trauma and burns into the network, and Fallat is the principal investigator for the site. The hospital is well positioned for this effort as it has been a leader in pediatric trauma care for the region since the late 1980s, when the hospital administration supported Fallat’s efforts to build a trauma program at the hospital. Norton Children’s Hospital is a Level I American College of Surgeons verified trauma center led by David Foley.

Thanks to support from the community through the Norton Children’s Hospital Foundation, the trauma program remains a regional center for the highest level of emergency care for children. The foundation plans to raise an additional $5 million to further advance the care available to children from throughout Kentucky, Southern Indiana and beyond. 

”This is extremely important work from a number of perspectives,” Fallat said. “The first is that current efforts for national and state preparedness often forget about children. The second is that trauma still claims the lives of more children in this country annually than any other cause. The third is that efforts to prepare for mass casualty events in different domains such as infectious diseases, trauma, natural disasters and others – often operate in silos, and this grant will unite them. Lastly, there is a need in all hospitals to build ’pediatric preparedness’ into the emergency department structure and function, and adult providers need to be a part of this.

“We need to build confidence in community surgeons/emergency providers/trauma teams. Many rural medical providers are used to caring for adults and experience added stress when they are called on to care for children. They want to provide the care but realize and are distressed by a sense of higher stakes,” she said.  “A goal should be to build a team that can, together with the surgeon, support each other to provide their best care to kids. Extrapolating to the grant at large, this seems a reasonable goal for all aspects of emergency planning.”

The UofL portion of the project also will involve Kristina K. Bryant, professor of pediatrics, system pediatric epidemiologist and infection control, UofL Division of Pediatric Infectious Diseases; Beth Spurlin, assistant professor of pediatrics at UofL and director of EMS and mass casualty at Norton Children’s Hospital, and Gena Cooper, assistant professor of pediatrics and emergency medicine at the University of Kentucky and Kentucky Children’s Hospital.  

“The pandemic’s impact on children and the health care systems that care for children extend beyond the diagnosis and management of infectious diseases to challenges with access to care and a behavioral health crisis,” said Daniel Simon, president, academic and external affairs and chief scientific officer, UH. “This new network will help to accelerate research-informed pediatric care transformation for sick and injured children across national organizations and infrastructures and we are proud to be leading efforts here in Cleveland and the nation.”

“We are making great strides to transform health care, and this is another example of our innovation,” said Greg Postel, UofL’s interim president.

“UofL is among just a handful of higher education institutions in the United States implementing a dental-nursing collaborative care model clinic, we are proud to be among them,” said T. Gerard Bradley, dean of the UofL School of Dentistry.

UofL Care Partners will help create a continuity of care for patients, adds School of Nursing dean Marcia J. Hern.

“The solid future of effective health care will rely on inter-professional teams that best serve the public,” she said.

The objective of UofL Care Partners is to serve as an urgent care-style clinic for patients who need help with issues such as blood pressure or diabetes management.

“Without management of these type of health issues, patients run the risk of delaying or foregoing their dental treatment,” said Tim Daugherty, interim associate dean of clinical affairs, UofL School of Dentistry. “If a person went under local anesthetic for a dental procedure and had uncontrolled diabetes, their insulin levels could drop leading to life-threatening problems.”

In 2016, the School of Dentistry wrote nearly 900 medical consults for patients who needed to follow-up with a provider before progressing through their dental treatment. Almost 40 percent of these patients failed to complete the follow-up required for their oral health treatment.

Renovation, expected to be completed in early 2018, will convert an area in the School of Dentistry into a patient room. Dental patients, along with others including faculty and staff, can make an appointment with UofL Care Partners’ part-time nurse practitioner. In addition to offering chronic disease management, patients can have basic lab work completed or be seen for an acute illness. A nurse practitioner also will work with patients to connect them with a primary care provided or specialist, if needed.

UofL Care Partners is an outgrowth of an existing relationship between the Schools of Dentistry and Nursing, which jointly received a $1.1 million grant from the U.S. Department of Health & Human Services Health Resources and Services Administration in 2012. The grant supported an educational initiative for nursing and dental students to enhance communication between the professions and develop best practices in patient assessment, consultation and management to improve overall health of patients.

Additionally, DMD students learn from a nurse practitioner who instructs them on completing medical history forms required for all new dental patients as part of the admission process. Dental students also learn how to evaluate whether a patient is healthy enough to complete an exam and subsequent treatment.

“This initiative is a creative demonstration of how nurse practitioners are meeting the needs of patients where they are, and builds on best practices and success at the School of Nursing’s other clinical operation, the Kentucky Racing Health Service Center,” said Whitney Nash, associate dean of practice and service, UofL School of Nursing.

Kentucky AHEC has been awarded $4.12 million in continued funding from the federal Health Resources and Services Administration to continue that mission through August 2022.

Administered by the University of Louisville School of Medicine in collaboration with the University of Kentucky College of Medicine, Kentucky AHEC has worked to improve Kentuckians’ access to health care since 1985. Kentucky AHEC is composed of eight centers that promote healthy communities and health care delivery in the state’s regional service areas by increasing the number of health care workers of all disciplines, particularly in underserved areas.

“The AHEC centers contribute to the education of health professionals at UofL and at other institutions throughout Kentucky. Having an adequate number of well-trained, dedicated health professionals is a vital component to reducing health disparities, increasing access to health care and improving the health of all Kentuckians,” said Gregory Postel, MD, interim president of the University of Louisville. “This renewed funding is assurance that these programs will continue to support health education in the Commonwealth.”

Since its inception, Kentucky AHECs have facilitated the training of medical students in primary care, in many cases, introducing the students to issues faced by patients in underserved communities. All third-year students in the UofL School of Medicine complete a four-week clinical rotation in family medicine in rural or urban underserved communities throughout the state. The Kentucky AHEC program also provides education and rotations for nursing and dental students.

“Students gain a deeper understanding of the needs of the patients by working in these communities. It encourages them to consider practicing primary care in rural or urban underserved communities,” said Kelli Bullard Dunn, MD, vice dean for community engagement and diversity at UofL, Kentucky AHEC program director and the principal investigator of this HRSA award.

To facilitate training, AHEC staff work with the Schools of Medicine, Dentistry and Nursing to identify physicians and other professionals to coordinate students’ rotations in their communities. This provides a framework for the students to complete rotations in clinics, medical offices and community hospitals across the Commonwealth.

“This is a way for health professions students to come out and serve in rural and underserved communities where they are exposed to different cultures and the practice of medicine without the innovative technologies available at the health sciences campuses. They get to see real medicine, real people,” said Brenda Fitzpatrick, director of the Northwest AHEC, based at the Family Health Center in Louisville’s Portland neighborhood.

In addition to educating health professional students, AHECs in each region develop programs that further their mission in ways best suited to their communities.

For Fitzpatrick, that is developing a true pipeline of health care professionals, from physicians and dentists to nurse practitioners, physician assistants, nurses, nurse’s aides, bioengineers and computer technology professionals.

“While HRSA encourages AHECs to promote careers in the health professions to high school students, we take that a step further and work with middle school students,” she said. “By the time they reach eighth grade, it may be too late.”

Fitzpatrick adds that the Northwest AHEC collaborates with several medical magnet schools in Jefferson County to help students obtain certifications during high school.

“This will get them in the workforce sooner and allow them to then continue their education and move on up the chain.”

In the latest round of program funding, HRSA has instructed AHEC programs to encourage patient-centered medical homes, which coordinate patients’ care in a single office, improving overall health care delivery and reducing costs.

AHEC Scholars program

Another new directive from HRSA is the development of the AHEC Scholars program. Each center will instruct 15 to 25 health profession students from a variety of disciplines in interprofessional education, behavioral health integration, social determinants of health, cultural competency, practice transformation and current and emerging health issues. Interprofessional education fosters collaboration among physicians, nurses, social workers, allied health and other providers.

“In a time of significant federal cutbacks, we were pleased to receive funding under HRSA’s extensively revised criteria,” Bullard Dunn said.

In addition to the federal funding, Kentucky AHEC is supported by Kentucky General Assembly appropriations, UofL and UK. AHEC is part of UofL’s Signature Partnership, a university effort to enhance the quality of life and economic opportunity for residents of West Louisville.