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.Ěý

On April 21, UofL Health announced that three primary care providers who are UofL School of Medicine faculty along with eight first-year resident physicians are opening a new office in Medical Plaza 1, Suite 306, 4402 Churchman Ave.

The new office becomes a second location of UofL Physicians – Family Medicine at Cardinal Station on Central Avenue.Ěý

“This is a great opportunity to increase access and health services to an underserved population,” said Jonathan Becker, chair of the Department of Family and Geriatric Medicine at the UofL School of Medicine. “The immediate benefit is to south Louisville, but long term, the impact is much larger as our future physicians share best practices developed here with other communities and the state.”

“Expanding the School of Medicine’s Family Medicine Residency Program is good for UofL and UofL Health and mostly, good for the people served by Mary & Elizabeth Hospital,” said Toni Ganzel, dean of the UofL medical school and vice president for academic medical affairs at UofL. “In 2019, with the help of the Commonwealth of Kentucky, UofL and UofL Health took on a struggling health care system and promised that it would not close but would, in fact, grow.

“This expansion is another example in that continued growth and represents our ongoing commitment to providing high quality care to the people of Louisville today as we educate and train the health care workforce for tomorrow.”

“Mary & Elizabeth Hospital provides services for a population that has tremendous need for accessible primary care,” said Melisa Adkins, chief executive officer at UofL Health – Mary & Elizabeth Hospital. “The community we serve has above-average rates of obesity, high blood pressure, diabetes and heart disease. The opening of this clinic with 11 new family medicine providers will have immediate positive impact on the health care of our south Louisville community.”

Current patients can move their care to the Mary & Elizabeth Hospital location or continue to receive health care services from other providers at the Cardinal Station location, Suite 100, 215 Central Avenue.

“By establishing a family residency program in Owensboro, we hope to improve the health of our region for years to come,” said Greg Strahan, president and CEO of Owensboro Health. “This program gives Owensboro Health a pivotal role in educating the next generation of physicians and will help meet an important need for more primary care in our area.”

The three-year program is expected to open with a class of six resident physicians and admit an additional six physicians each year. Residents will undertake a robust curriculum of classroom studies and clinical rotations, working alongside expert instructors and practicing physicians from a variety of specialties. They also will provide primary care at Owensboro Health’s family medicine location on Parrish Avenue, which means expanded health care access for area patients.

“Part of our vision for this program is that some physicians will want to continue practicing in Western Kentucky after they have completed their residency,” said Steve Johnson, vice president of government and community affairs for Owensboro Health. “For our system to be working toward that vision, with a valuable partner like UofL, is an exciting development for this region.”

The agreement between the two health care systems establishes UofL School of Medicine as the program’s academic sponsor, a key step toward obtaining approval and accreditation by the Accreditation Council for Graduate Medical łÉČËÖ±˛Ą. Under the affiliation agreement, UofL will provide a program director and faculty and also lend its expertise to help the program achieve and maintain accreditation.

“UofL has achieved success with its family medicine residency program in Glasgow, Ky., in terms of building relationships in the community and improving primary care,” said Brent Wright, MD, UofL School of Medicine associate dean for rural health innovation, and vice chair for rural health and professor in the Department of Family and Geriatric Medicine at UofL. “We plan to achieve the same success in Owensboro.”

Rural-based graduate medical education programs are important to physician distribution since physicians tend to practice within a 100-mile radius of where they did their residency training, Wright said.

“Here at UofL we are working to create solutions,” said UofL President Neeli Bendapudi. “In our health care landscape where there are too few primary care providers to meet demand, UofL Care Partners offers our dental patients an in-house clinical service solution.”

“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, BDS, MS, Dr.Med.Dent., dean, UofL School of Dentistry.

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

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

UofL Care Partners hopes 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, D.M.D., associate dean of clinical affairs, 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 2017, the School of Dentistry wrote nearly 940 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.

The clinic is an individual room located on the first floor within the patient waiting area. Dental patients, along with others including faculty and staff or community members 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 who jointly received a $1.1 million grant from the U.S. Department of Health & Human Services Health Resources and Services Administration (HRSA) 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, PhD, APRN, FAANP, associate dean of practice and service, UofL School of Nursing.Ěý

Check out video from today’s ribbon cutting ceremony below. .Ěý

To achieve that end, , a family nurse practitioner at the , has been selected for the Fellows of the American Association of Nurse Practitioners Mentorship Program, in which a fellow of the organization will guide her in developing a primary care clinical workflow that will increase value-based care.

In the value-based health care delivery model, providers are paid based on patient health outcomes, as opposed to fee-for-service, in which payments to providers depend on the amount of services.

“A value-based approach ensures that providers not necessarily see a large quantity of patients, but that they provide the highest quality of care that allows patients to achieve better outcomes,” said Volpert, MSN, APRN. “Value-based reimbursement encourages health care providers to deliver the best care at the lowest cost.”

Volpert’s mentor will be Phyllis Adams, clinical associate professor and director of the Family Nurse Practitioner Program at The University of Texas at Arlington. At the end of the yearlong mentorship, Volpert will present her work at the 2019 AANP National Conference.

“Through this mentor program, Elisabeth will obtain the leadership skills that will facilitate her growth as a nurse leader,” said Whitney Nash, UofL School of Nursing associate dean of practice and service. “She is ambitious and a role model for clinicians at all levels.”

As a primary care provider, Volpert diagnoses and treats patients across the lifespan with acute and chronic illness. Her passion lies in providing care to people of low socioeconomic status.

“Over the past 10 years, I’ve seen patients turned away because of a lack of primary care providers,” Volpert said. “There is a great opportunity for advanced practice nurses – who are highly educated and equipped to provide evidence-based primary care – to fill that gap.”