Daily Practice of a BHC

Healthcare Practitioners for CHC's: Urban versus rural/frontier in using PCBHI: A question was asked regarding what are the factors to consider when implementing a primary care and behavioral health integrated care progr...

I spend the day with checking my emails and phone messages prior to beginning the day. I typically see 10-12 patients per day. Utilizing an electronic health record enhances communication between the medical practitioner and the behavioral health consultant and the experience to have a major impact on patient's health issue is significantly rewarding to both the patient , PCP , and BHC. The patient's enjoy the " one stop shop" approach and lessening the stigma
of receiving brief behavioral health services within the clinic.
The PCP truly enjoys the support and benefits the BHC brings to patient care and improving the patient's health outcome.

Urban versus rural/frontier in using PCBHI

A question was asked regarding what are the factors to consider when implementing a primary care and behavioral health integrated care program in both a rural and urban area. My experience over the years has told me that placing a major focus on understanding your patient culture (with sensitivity and compassion)to the diverse and unique needs of patient that enters your clinic. The type of PCBHI program should reflect the needs of your patient that is culturally induced in your region. Good question.

Healthcare Practitioners for CHC's: VRHA Panel Discussion

Healthcare Practitioners for CHC's: VRHA Panel Discussion: I would like to share this video with you which truly reflects the experiences that are reported by those who work within primary care...

VRHA Panel Discussion

I would like to share this video with you which truly reflects the experiences that are reported by those who work within primary care and behavioral health settings. This is also what I have experienced in this journey to integrated care in treating the "whole person."

Join the Virginia Rural Health Discussion

Hello , this is Dr. McFeature. Please feel free to ask questions relevant to primary care and behavioral health integration. I will comment soon on the dialogue generated from the Virginia Rural Health Association integrated behavioral health panel discussion.

Integrated Behavioral Health from Coast to Coast

If you don’t know what INTEGRATED BEHAVIORAL HEALTH is, you have not met Dr. Bill McFeature.  Dr. Bill McFeature has  made promoting and educating about this emerging type of behavioral health his mission from coast to coast.  Born in Dublin, GA, Bill left the east coast initially to go to East Tennessee State University on a baseball scholarship. Baseball was fun but when it fizzled as a career, Bill needed to find a “real job.”  He began as a part-time alcohol counselor, completed his Bachelor of Science in Psychology and a Master’s in Counseling from ETSU, moved to California, and ultimately completed a PhD in Clinical Psychology. 

Although Dr. McFeature began as a traditional mental health therapist, in 1997 he entered the emerging area of primary care integration with behavioral health.  After a recruiting phone call in 2004, Dr. McFeature was offered the opportunity to move to Virginia to further develop and implement this new concept.  This continental leap was made possible with a federal grant opportunity as a way to see a patient in a “one-stop shop” environment and simultaneously improve both the overall primary care and the access to behavioral health.

Today in the integrated behavioral health setting there is typically brief therapy and practical health consultations that follow best practice, research-based methodology. This is the vision, mission and daily work that Dr. McFeature advocates as the Director of Integrative Behavioral Health Care Services for Southwest Virginia Community Health Systems, Inc.  He coordinates all aspects of behavioral health including program development and oversight, grant writing as well as direct patient care.

In coordination with a primary care provider, Dr. McFeature sees 12-14 patients per day.  In this context, his are not the traditional 50 minutes pre-scheduled appointments. For his integrated behavioral health sessions, Dr. McFeature sees 85% of patients for 30 minutes in his office and 15% of patients are seen for 15 minutes in the exam room. His patients from Bristol, a border city between southwestern Virginia and Tennessee, are predominately older.

Personally, Dr. McFeature loves the rural areas and feels he has a satisfying work/life balance. Family is very important to Dr. McFeature and his wife.  Together in 2009 they wrote and published the book Heart Path Practitioner (http://heartpathpractitioner.com/).  In addition, Dr. McFeature appreciates the NHSC (http://nhsc.hrsa.gov/ ) loan repayment opportunityand is now in his third year of what he calls “a wonderful program.”  But the greatest part about living in a rural area is the close knit community that has expansive views.

Dr. McFeature sums up his journey to spread Integrative Behavioral Health from coast to coast simply saying he appreciates the opportunity to positively “touch lives”. That seems to say it all. 

Welcome Isabella

At our community health center, each provider has a primary nurse that works with them. There was a time when nurses rotated daily but we found this to be somewhat disruptive. Now, each nurse still has to know how to work with multiple providers and how to manage pediatric and adult patients, but for the most part, a nurse and provider form a team. This works very well for us. The nurse forms a trusting relationship with the patient and parent. There is great continuity if a child is being followed for an illness and also for well care.The provider and nurse over time develop an understanding of how to provide the best patient care. This relationship is such an important one with regard to time and efficiency in the office. In many offices and hospitals, care is very fragmented and one staff member may ask history, another do vitals, another draw labs, another give vaccinations. This may be efficient but I feel something is lost for the patient and the nurse. I love the fact that these are our patients; I love that my nurse takes such pride in taking care of them. The provider/nurse relationship is something to explore when you interview at an office.

The nurse I currently work with is young enough to be my daughter. She had her 21st birthday this fall but has more maturity in 21 years than many get in 40. She chose her career in high school and attended a special program to get her LPN degree during her final years. She did an internship at our health center and because of her clinical skills, her willingness to learn and her genuine warmth, was hired to start as soon as she graduated. We started working together about a year an a half ago.

Sharon has been a pleasure to work with. She is very quick to learn. She will watch me and see all the things I am doing and say " Why don't you let me try and handle that piece, I think I could do that." She is great on vaccines. She knows when I will want a vision screen and when we need a urinalysis. She is the one that is trained on all the new equipment in our office and then she teaches the rest of us.

Sharon also found her soul mate in high school and they married when she was 18. This week, they became proud parents of a beautiful little girl, Isabella. I became just proud, of all of them. Isabella is the third baby born in our health center family this year. We also welcomed Jayson and Victor. They are all healthy. We have so much to be thankful for. Sharon gave me permission to post some pictures.

Catching Up and Keeping Up

November 20, 2011 CATCHING UP AND KEEPING UP Last week, we took a lovely vacation out to the mountains of Giles County where my husband’s family takes a yearly hunting trip. It is great fun hiking and taking time to watch the sunset. Returning to work is never an easy feat after vacation. The electronic bubbles on our computers are always brimming over with double digit numbers of phone calls, results to be checked, refills. The red exclamation point indicates urgency and these are addressed amidst the heavy flow of patients that always characterizes a post- vacation week. And of course, the hospital is
bustling with new babies.
David and I are also completing our NRP recertification. There is a new edition of this education and it is our responsibility to keep our small unit up to date on all of the changes. We have an excellent nurse manager, Ann, in our maternal child health unit, and we handle changes together. For us, updating NRP involves not only our personal recertification, but solving the logistics of how we will get blended oxygen in our nursery, how we will incorporate an oximeter on the warmer in the OR where c-sections are done, and how we will update the nurses who are still certified with the older version. Ann did a great job and by the time I had a sick baby delivered in the wee hours of Saturday morning, we had new laminated algorithms and normal oximetry charts posted in our resuscitation area.
Our other educational event this week was an update on concussions. Thanks to support from Children’s Hospital of the King’s Daughters (CHKD) in Norfolk, Virginia, our community was able to hear two experts discuss Virginia’s law regarding concussions and the management of concussions. David and our director of nursing at ESRH (Eastern Shore Rural Health) worked very hard in the weeks prior to this presentation to invite all members in our community who deal with this problem. On a rainy Wednesday night, coaches from both counties, school nurses, physicians from our local private practice, our local adult neurologist, pediatric providers, school administrators, some parents and some students, gathered to hear Dr. Ralph Northam and Dr. Joel Brenner discuss concussions and return to play. It was a wonderful turnout and showed the power of community. Our local restaurant provided the space; CHKD provided a wonderful meal and speakers. We were able to discuss the barriers that we face in a small area where we do not have certified athletic trainers in our schools. We were able to work together on ideas for solutions to provide the neurocognitive testing that is important in the management of these athletes.
While we know there is never a dull moment around here, and often feel there is never a spare moment, the beauty of this place will often force us to just witness a special moment. I share two sunsets that opened and closed my week. The first is from Wind Rock in western Virginia. The second is from the overlook on the Chesapeake Bay Bridge Tunnel.

Finding Home

Some people find a job and then find a place to live nearby, but husband and wife pediatrician team, Drs. David and Cathy Riopel, had a different approach.  On a very long trip up the eastern coastline – from Florida to Virginia - the Riopels first found the right place.  They both felt life change when they crossed the 17 mile bridge tunnel span connecting their future home to the rest of Virginia.  The ocean pounded Smith Island on one side. Striper fisherman fished around the nets on the bay side. Bald eagles flew overhead.  The bridge joined a highway surrounded by the vast green of winter wheat. The place felt right but would there be a need for pediatricians?  On the way home they called the local hospital.  They were connected with Eastern Shore Rural Health, a local community health center.  They had never heard of a community health center but instantly felt comfortable with the idea.  The mission to provide healthcare to a whole community was right.  Nineteen years later they still enjoy living, working and playing on the Eastern Shore.

Although Cathy was born in Texas and David in Boston, they met in Charlottesville, Virginia where their fathers were professors at the University of Virginia. Both tracked to medical school, but in different ways.  Cathy knew she wanted to work with children in Pediatrics because she had worked at summer camps and a children’s rehabilitation center but David took a bit longer to figure out his direction. David knew he wanted to be physician and help people, but having worked during school with a Family Practitioner, he wasn’t sure if he wanted to work exclusively with children. He completed a combined medicine/pediatrics residency but later decided to practice pediatrics.

The couple trained together at Louisiana State University where one of their work sites was Charity Hospital of New Orleans – the one that you may recall was destroyed by Hurricane Katrina. At the time, the hospital provided healthcare for the underserved.  Cathy chose it because she knew the training would push her. “I was shy and quiet,” she said, “I needed to be in a place where I would be forced to engage. I wanted to train in a place where I would see a high volume and variety of patients.”   David says without hesitation that Charity provided great training for a rural practitioner because there the physician did almost everything.  In addition to the standard resident role, physicians drew blood and labs, performed many procedures, started their own IV’s and learned to “make do” with minimal equipment.  In addition, they were exposed to many different cultural and social backgrounds.

So after residency and a very long trip up the east coast with their 14 month old son in tow, the Riopels landed on the Eastern Shore of Virginia.  After 19 years of both out-patient care at the Community Health Center and inpatient care at the local hospital, they are only surprised that more people don’t want to do this. More than ever, they believe in the community health center mission.  They love life in their rural coastal community surrounded by water and nature and are grateful for the opportunity to work together and to live and work in a close community.   Every day, at school, at the ball field, or at the store, they interact with their patients. Sometimes there is a consult but more often there is a hug and a special feeling of appreciation that keeps them going.

Eastern Shore Rural Health is comprised of five community health centers (CHC’s) from Cheriton’s Bayview CHC to Chincoteague CHC with Franktown, Olney and Atlantic in between.  NINETY PERCENT of children on the Eastern Shore are seen by these five community health centers.  The community consists of professional and agricultural workers with a large number of those who speak either Spanish or Haitian Creole.  There is also a large seasonal migrant population.

 Although their eldest son is now in college and their second son is in high school, the Riopels’ “typical” day once consisted of logistical issues with childcare, sporting events, and with rounds preceding their time in the community health center. They joked that they would often pass on the highway.   Unlike many other CHC”s,  in this community where a close arrangement with the hospital exists,  the CHC pediatricians also consult in the Emergency Room, care for inpatient pediatrics and nursery,  and attend all C-sections. This comprehensive care may be sometimes tiring but the Riopels consider it incredibly rewarding to have attended premature births and then see these at-risk children grow up.

 
David and Cathy are proud that their CHC provides accessible healthcare for ALL without turning people away.  They also enjoy proactive healthcare programs that offer support for teenage moms and breast feeding and allow nursing home visits.  They are thankful to Eastern Shore Rural Health System for the support that has enabled them to maintain an ideal work/life balance.  They consider themselves very fortunate to work in a CHC whose administrators are so dedicated to mission and community.  Their leaders have always been committed to pediatrics even though sometimes this has been financially challenging.

David says, “Being at a place for almost 20 years gets more and more rewarding – especially in a Community Health Center. You have great perspective into the community and really know your patients and families well. Sometimes a well-child visit is like catching up with an old friend.”

 “Like most people,” Cathy states, “I try not to dwell on my age but there is one particular patient that I see every year where I can’t resist a little nostalgia.  She was 1000 grams when she was born and now a healthy teenager and I look at her mother and tell her every year, “ I remember when we first held you and you fit in one hand.”  Surrounded by the water and embraced by the community of the Eastern Shore, the Riopels are home.



My beautiful community!

My beautiful community is a great place to live, work, and play! Come join us!

My history with CHC's

I started my career as a Community Health Center (CHC) nurse about 23 years ago. I had worked at the local health department and loved community health nursing. My job with the health department ended due to funding cuts within the state of Virginia. I was heartbroken when I found out my job with the health department was over. Little did I know my career as a community health nurse was far from over…it was just beginning!

When I started my new job…I really did not have an understanding of what a CHC was and it took several years to fully understand the CHC “world”. Some days, I feel as if I still do not fully understand this “world”. The CHC “world” is unique and CHC employees are some of the best you will find anywhere. They are some of the most dedicated, loyal, and hard working people you will find. Once you work in the CHC “world”, it is very hard to leave.

I have lived in the community where I work my entire life. CHC communities are as special as the CHC’s who serve them. I love going to work each day knowing I am taking care of my family and friends. I just helped celebrate my grandmother's 93rd birthday this past weekend! I like giving back to the community who has given me so much. My husband is also from the same community and we are raising our two sons here, as well. I like raising my sons in a small town and the fact that I know most of their friends as well as their parents. It is a lot harder to get into mischief when everyone knows everyone…

Saltville, Virginia

Southwest Virginia is the place to be!

Hi, my name is Jill Talbert and I am a registered nurse in a Community Health Center (CHC) in southwest Virginia. This month, I have been asked to blog about my experiences as a CHC nurse. I grew up in a very small town in southwest Virginia called Saltville. Our town has a current population of about 2,500 people. I was the first of two daughters for my parents and I had always known since I was about ten that I wanted to be a nurse. This is probably because my mom always wanted to be a nurse, but didn’t have the opportunity. I entered nursing school the summer right after I graduated high school.

A lot of people asked why I chose to stay in my small hometown instead of moving away to a larger town or city. My reply is: I want to raise my sons the way I was raised and I want to give back to the community I was raised in. My Community Health Center, Southwest Virginia Community Health Systems, Inc. is very near and dear to my heart. I began my career as a CHC nurse 23 years ago.

When I was hired, I have to admit, I did not know what a CHC was. I was hired as an office nurse working in two physician office. I learned a lot of new things not taught in nursing school such as how to take x-rays (which nurses aren’t allowed to do now without a license). I loved the people I worked with and the schedule was very convenient for my family, but I especially loved the patients I cared for and I like to think they loved me back.

Hello from Jill Talbert and southwest Virginia

Jill Talbert’s life seems to have come full circle.  Today Jill is the Clinical Director for Southwest Community Health Systems in the same building where she was born and she loves it this way. Jill is very satisfied that she is able to be a RN and Clinical Director in the small town she grew up in – what she enthusiastically describes as a beautiful rural area that is a good place to raise a family.

As a young girl, Jill wanted to be a nurse – maybe because her mother had aspired to be a nurse but never pursued it and this carried over.  Jill completed Appalachian Tri-College Nursing Program and then accepted a temporary position with the Health Department. Apparently, Jill’s mom also instilled the value of giving back to the community, because Jill was attracted to community health nursing and upon the end of her temp position; she immediately started to work for Southwest Virginia Community Health Systems – 23 years ago!  In the beginning, Jill appreciated that her work was close to her home although she confessed that initially she had no concept what a community health center really was.

Today Jill appreciates the balance of her professional life with her family life with her husband, and two energetic sons. Thanks to her boys, her family life is “pretty much sports – whatever is in season,” although she also likes to read and travel.  Jill is happy with personally knowing every principal and teacher that her sons have, living in a safe area, and having the opportunities to go camping, horseback riding, and “all that outdoorsy stuff.” 

But what really completes this satisfaction is the support Jill has been given to balance her family and profession. As a Clinical Director Jill does not spend as much time directly treating patients but she provides the same supportive environment she was given to allow other healthcare practitioners to care for patients. And these aren’t just any patients – these patients are her family and friends in this close knit community.

Jill calculates her success with the stories of patients who were cared for because the Community Health Center is here. She says she could go somewhere else and make more money but it’s about how you live your life and giving to others.

When Jill is interviewing someone for a clinical position in Community Health, she typically expresses her job satisfaction this way – “  At the end of the day when you lay down and put your head on your  pillow, you know you have given back to the community, and rest easier at night, knowing you do a good thing.”

Chronic Disease Management

It is easy for patients to become overwhelmed with management of chronic conditions. The other day I saw a middle aged woman in follow-up. She had initially presented for an acute respiratory illness. She was overweight and blood pressure was elevated. She mentioned that she would like to lose weight, quit smoking, eat better, and become more active. We discovered with routine labs that she was also diabetic! We treated for acute illness and began to help her with lifestyle changes. I quickly referred to to our Patient Educator for free help with tobacco cessation, weight loss, diabetic education and overall wellness. The patient educator helped her to quit smoking via the "Quit Now" program. They met weekly for education and support. She was able to begin losing weight, getting her sugar under control, and begin an exercise program. During follow-up her blood pressure was controlled, her sugar was controlled on diet alone, and she continued to be a non-smoker! "I could not have done it alone!" She told me.

"one-stop-shop"

One of the most rewarding things about practicing at my community health center is the ability to offer comprehensive primary medical and dental care as well as behavioral health services. Last week I saw a young man who had not received medical care for some time due to lack of health insurance. When he learned of our services he scheduled an appointment in hopes of getting a "check-up" and medication refilled. He shared with me that he had recently witnessed the suicide of a family member and was experiencing severe distress related to this trauma. We talked for a while and he was thrilled to hear that we had a psychologist in the center that could help him process what he had endured. He also mentioned that he had some dental issues and needed some work done that he had neglected due to finances. We were able to provide him with a check-up and medication refill, as well as lab work and appointments to return for counseling with the psychologist and dental work with the dentist! Everything we provided was discounted on a sliding scale to a rate that was affordable for him!

Welcome to Dr. David Neff

Welcome to our newest Ambassador - Dr. David Neff, Site Manager and Family Practitioner at Hopewell Prince George (HPG) Community Health Center, a site of Central Virginia Health Services

Somehow it is totally appropriate that Dr. Neff began as a Site Director in Hopewell at Thanksgiving time in 2004 – because he feels he has much to be thankful for. And talking with his co-workers, they feel very much the same way.

Initially Dr. Neff was not planning on being a physician but instead, with his love of science, he went to pharmacy school and practiced two years as a pharmacist. During this time, Dr. Neff made an important discovery – working as a pharmacist at a big retail store did NOT provide the one to one personal interactions that he thrived on. Dr. Neff had been involved in the Co-Step Program Commissioned Officer Student Training and his supervisor went to the National Health Service Corps to recruit Dr. Neff as a way to enter Medical School at Virginia Commonwealth University.

Immediately after medical school, Dr. Neff worked at another Virginia Community Health Center, but moved to be closer to his home and family. Originally from California, Dr. Neff now calls Virginia home for his wife and five children – three foster and two adopted children. Being closer to home means Dr. Neff can participate more actively in his children’s activities and yet pursue the profession he clearly loves. The choice of working in a Community Health Center for Dr. Neff means no rounds and other erosions to his family life.

Dr. Neff describes his interest in public health and his enjoyment in dealing with people as having a ministry aspect – and not just treating illness. He sees his current role as a merger of medicine, social work and mission. His practice of medicine goes beyond the script to include consideration of housing, social and outside medical resources.

The Hopewell-Prince George area is a community of both agricultural and industrial business with most patients native to the area. Dr. Neff’s patient group currently has a high level of unemployment and disabilities are frequently on fixed incomes and often have diabetes, high blood pressure and heart conditions. On a typical day (excluding earthquakes, hurricanes, and power outages) Dr. Neff begins at 9 AM, and with a break for lunch, concludes his day between 4-5 PM.  As a testament to his incredible efficiency and skill, Dr. Neff usually has an initial schedule of 24 patients per day, which with no-shows and work-in translates to about 20 actual patients per day.

In addition to excellent support staff, Dr. Neff also has third year medical students from Virginia Commonwealth University who may assist with patients. Under Dr. Neff’s direction, HPG is a wellness center that provides comprehensive care with dental services, behavioral health services and has a Medical Assistance Program (MAP).  His greatest challenges are patients with significant lack of resources and lack of transportation.  Dr. Neff describes Community Health Centers as a way to have a well balanced life style of family and profession, and “a very rewarding place you can practice medicine the way you were trained without having to run a business.”

Community Health Center Model

I am frequently asked how I ended up practicing for so many years in a community health center. The answer is simple...It "fits" me well. I was first introduced to the Community Health Center (CHC) model by my mentor when I was a pharmacy student because of my interest in working with underserved populations. That introduction led to a scholarship from the National Health Service Corps (NHSC) which offers scholarships and loan repayment for health care workers in underserved areas (nhsc.bhpr.hrsa.gov). After residency, I fulfilled my scholarship obligations in a rural CHC. I loved working in a setting where I could practice medicine and help patients without regard to finances. I loved that the administration took care of all billing and collections and could offer a sliding scale for our services. I loved providing care for folks that could not otherwise afford health care. I loved the comprehensive and holistic nature of our practice. My current practice offers medical care, dental care, behavioral care (psychologist), and a patient educator/nutritionist. My office has a "wellness center" multi-purpose room where we have exercise classes, Yoga, Tai Chi, fitness/wellness groups, diabetic and chronic disease classes. I love that I can refer patients just down the hall for all of these services at little or no cost to them!

PCMH Story Time!

What does the Patient Centered Medical Home feel like for the patient?  The story I'm about to tell you is based on my actual experience with obtaining health care for my daughter when she was a baby. 

My daughter was 5 months old when she got her first ear infection, which was accompanied by flu-like symptoms, high fever, lots of snot, vomiting and pain.  Thus began a cycle that would last until she was almost 2 years old.  We would adhere religiously to our antibiotic regiment and ibuprofen/ acetaminophen routine, and after several weeks of smooth sailing it would start all over again.  Eventually she was diagnosed with childhood asthma and chronic otitis media and she was on a regiment of inhalers, nebulizer treatments, and several allergy medications.  The poor child could practically operate the nebulizer before she could walk.

Little did we know, our pediatric practice had many elements of the Patient Centered Medical Home.  We loved it.  Here is what it felt like to us.

Friends of ours recommended the doctor, who I'll call Dr. V.  The practice was set up so each patient selected their personal doctor.  Whenever we called to make an appointment, they addressed us by name and told us when Dr. V's next appointment was.  It was always the same day (except well-child visits which we scheduled well in advance).  We saw her every time with very few exceptions.  When I would call with the occasional question, I would leave a message with Dr. V's nurse (who also knew us by name) and she would return my call within 2 hours.  After hours, they had an agreement with the closest hospital to answer urgent calls.

For questions about a problem we thought our daughter was having, they encouraged us to first look on their website which had a list of common illnesses, symptoms, and their recommended course of action depending on the severity.  I feel like I looked at their website at least once every few weeks!  It really helped us decide what to do.  I could also email them if I wanted to, but I never needed to use this function because they were so responsive to phone calls.

At the end of every visit (of which there were a lot!), Dr. V would give me a printed summary of what happened during the visit, my child's diagnosis, and our agreed-upon course of action, along with frequency of her medications and what to do in case of a bad reaction.  She would make sure she answered all our questions.

Eventually, we decided to get ear tubes for our daughter.  It was a godsend and changed our worlds.  When the decision was made, Dr. V arranged the appointment with the specialist to have the procedure done, and followed up with us afterwards to see how it went.  Another time, our daughter had a febrile seizure and went to the emergency room in an ambulance (that's another story!).  The next day, Dr. V called us wanting us to come in and see if everything was alright.  I was so impressed that she knew we had been to the ER!  Another time, we called the after-hours line and again, Dr. V followed up with us the next day to see if everything was alright.  What I then thought was just great customer service, I now realize as also great medicine.

During all of this, my husband I both worked full-time.  I exhausted my leave going to all these appointments (and was exhausted in general!).  But the clinic had Saturday hours which was soooo helpful to us on several occasions. 

I really could tell that she cared about my child and our entire family.  She will never know how grateful I am for the breastfeeding encouragement she gave me.  Dr. V was so excited when we appeared for an appointment and told her we were expecting another baby!  And she was so sad when we told her we were moving to another state.  I miss her and that practice; they were kind of like an extension of our family.  And our home. 

Knowing what I know now about Patient Centered Medical Home, they hit many of the high notes.  They would probably easily qualify for Level 2 or 3 NCQA PCMH status.  It is sad that I felt lucky in our practice, compared to stories I heard from friends and others.  I wish everybody were so lucky... and that "lucky" becomes commonplace as this becomes everybody's experience.

Think about your practice.  What would your patients' experience stories sound like?

Patient Centered Medical Home's #1 Fan!

I have a secret to share with you.  When I was hired, I had a tiny fraction of a clue as to what I was supposed to be doing in this job.  I avoid saying “no clue” because I had my job description in hand!  What did "Patient Centered Medical Home" mean and what would my role be in operationalizing it for our member Community Health Centers?

I am a researcher at heart.  During my first months as the new Healthcare Transformation Specialist, I read everything, watched countless Webinars and attended every training I could.  There is a lot of information out there!  In this process I quickly became a huge fan Patient Centered Medical Home - and not just because it's part of my job!
 
In its simplest terms, becoming a PCMH – or “PCMH transformation” - means that a primary care practice aligns itself to reflect seven basic principles which you can learn about here.  National accrediting bodies such as the National Committee for Quality Assurance (NCQA) and the Joint Commission are offering formal recognition programs.  Our organization, the Virginia Community Healthcare Association, has implemented the Home Improvement Project as a coordinated approach to helping 100% of Virginia's CHCs achieve PCMH transformation and formal recognition.
 
Whether its within my job or describing what I do to a friend, when I start talking about Patient Centered Medical Home I start channeling my inner Oprah and start overusing words like "excited," "love," "dream," "journey," "eager" and "great."  I can't control it.  Here let me show you by outlining the three major reasons I am excited about PCMH:

A) As a patient and mother/daughter/wife/sister of current and future patients I would love for the PCMH to be my, their and all patients' experience with the health care system every time;

B)  I am eager to work with practices to help implement this model because once they adopt and begin implementing their PCMH journey (which will not be easy, admittedly) there is evidence that providers will be more satisfied because this is how they dreamt of practicing medicine in the first place and

C) Based on data that demonstrate significant cost savings and increased quality in practices that implement the PCMH model, I believe it will be a great part of the solution to all of the ills (pun intended) in our country’s health care system today.
  
I’m happy to report that I now have a pretty good grasp of my job (at least a whole clue or more!) and we are getting down to the business of helping our CHCs through the Home Improvement Project. My hope and vision is that the primary care community, through channeling its inner Oprah and embracing the PCMH movement, will live its best life now and in turn help patients do the same.

Mary Beth Cox & the Patient Center Medical Home

Mary Beth Cox is on a mission to improve and transform the way that Virginia’s Community Health Centers provide healthcare!  She is the Healthcare Transformation Specialist with the Virginia Community Healthcare Association.  Mary Beth’s primary role is to help all of Virginia’s Community Health Centers (28 organizations with 115 sites) achieve Patient Centered Medical Home (PCMH) transformation and recognition.

The Patient Centered Medical Home – or “PCMH” – is a model of providing primary care that is both old-fashioned and revolutionary.  It is old-fashioned in the sense that the concept of patient-centeredness is fundamental to all medical care; without patients there would be no need for care!  In addition, the medical home term has been used for decades by organizations such as the American Academy of Pediatrics.  It is revolutionary in the sense that the healthcare system has strayed far away from this fundamental principle and it will take some major reconstruction to get it back on track.  Coupled with integration of modern technology and ramping up to serve an expanded population of insured patients by 2014, PCMH is a big job!

Mary Beth has been with the Association since February 2011 and is both excited about PCMH and up to the task!  She is especially passionate about working with Virginia’s Community Health Centers to ensure access to quality, affordable healthcare for all.  Mary Beth holds master’s degrees in Public Health and Social Work from the University of North Carolina at Chapel Hill, and a Bachelor’s degree from the College of William and Mary.  In addition, she brings over ten years’ highly relevant experience coordinating, evaluating and leading community-based health initiatives.  Mary Beth’s keen interest in PCMC dovetails nicely with her interest in maternal and child health issues and systems-level initiatives that can do the most good for the most people.  When she’s not working, Mary Beth also enjoys being involved in the community and keeping joyfully busy with her husband, two young children (ages 3 and 17 months) and three dogs! 

To further explain how Virginia’s Community Healthcare Association is helping all Community Health Centers (CHC’s) in Virginia achieve Patient Center Medical Home (PCMH) transformation and recognition, Mary Beth will be blogging and answering your questions. So please welcome Mary Beth to our Ambassador’s Blog!



How appropriate and timely for my last blog to highlight what I think is one of the most fascinating parts about the acronym CHC. The word “Community” in Community Health Center. Without it, we would be just another Health Center.

Community does not mean that we alone serve the community, that’s a tall order for a Health Center. But Community means that we work within and share our labor with our neighbors. Those neighbors include our local government, community organizations, businesses, civic leaders and the like.

I enjoy working with the community to help give our Daily Planet patients the best care available. Today The Daily Planet partnered with Virginia Commonwealth University School of Nursing, Department of Health Education and the Department of Genetics. I feel it is important to expose young learners of all disciplines to public health. I also believe it is important to stay involved with research and the institutions of medicine, so that our patients are afforded the same level of cutting edge care that is offered to the general public. VCU is our neighbor and we work closely together to take care of our community.

Last week at the Daily Planet we held an orientation for the VCU School of Nursing and Department of Health Education students. These students will be working with us on a HRSA grant that we were awarded to improve how we obtain family histories. We know that if we explore the family history of our patients it will give us useful information to predict their personal health risk and implement a plan for prevention. Not only are we teaching cultural competence, but these students are helping us to take better care of our patients.

We are a “Community” Health Center in the true sense, in that we involve the Community, to take care of the Community, because we are the Community!

I hope that during my month of blogs, you have noted that practicing Community Health has all of the excitement, adventure, and variety of specialty care medicine or third world mission work.

It is truly what you make it, and it is all available to you in many different shapes, sizes, and locations.

Dare to explore and enjoy! Thanks to all for allowing me to share!

Hitting The Pavement

It was an unusually slow day at one of our outreach sites. Could have something to do with the long-awaited break in the heat wave, for today’s temperature is running a cool 90 degrees. Whatever the case the census is low and we have been advised that most of our patients have headed to the park.

So my nurse and I decided to take a detour before heading back to the office, so we dropped by Monroe Park. This is a common gathering place for the homeless of Richmond. As expected, the benches were full of many of our patients and a few that have been long lost to follow up.

We were welcomed with open arms. Many were shocked, saying “Dr. Stevens, you will come anywhere to find us!” My nurse and I went from bench to bench, checking blood pressures, encouraging them to take their medications, stop smoking, and to keep their follow up appointments. In fact three walked back with us over to the clinic, one for a Tuberculosis test reading, another for treatment of high blood pressure, and another who we discovered was just released from the hospital but living under a bridge.

As I was sitting on the bench and looking up at the fountain, I thought, “What a wonderful view- I couldn’t ask for better office space”. Granted not all Community Health Centers operate out of a City Park (and this is not routine for me). However, I can say that meeting patients where they are and participating in outreach is a very important aspect of community health.

I enjoy the public health tract that my career has taken; every day is something new, something different, and something worthwhile. When I woke up this morning I knew I had a job to do, but had no idea I was going to “Hit the Pavement”, but I’m so glad I did.

Each One Teach One

On the first Friday of the month we do a significant outreach campaign at The Conrad Center. It has become so popular that we have named it “First Fridays” at Conrad.

At 745am, The Daily Planet staff cheerfully starts invading the center. Their doors have long opened prior to our arrival, because they serve meals (including a belly warming breakfast) to the homeless daily.

The facility also houses several agencies that provide various services to the homeless. One of the key roles is a central point of entry to the shelters for the city.

Each Friday, The Daily Planet goes there to provide Tuberculosis and Blood Pressure screening, as well as acute care assessments. However, on the first Friday of each month we have a “Health Fair” that also includes Vaccinations, Educational Sessions, and Special Theme Services- such as Prostate Cancer Screening, Skin Cancer Awareness Day, or Family Medical History Celebrations. Other agencies join us such as The Fan Free Clinic (conducting on-site HIV testing) and Alcoholics Anonymous. We give out snacks, prizes, bus tickets, and just try to bond with participants.

My favorite part of the event is that we have a great crew of graduate health professional students from Virginia Commonwealth University who come to gain experience, practice their skills, and learn about public health. We have representation from all schools including pharmacy, nursing, medical, public health, and research departments. They join forces and work together to make “First Fridays” a huge success.

I enjoy teaching, because I will forever be a student of medicine.

My patients keep me humble and appreciative, my students keep me abreast and fine tuned. I need them both to practice my craft. And to both I am forever indebted.



If you are interested in joining the fun at First Fridays, just blog me back. We would love to have you! You may also email me at lstevens@dailyplanetva.org

For more information on the Conrad Center-Freedom House
http://www.freedomhouserichmond.org/html/ConradCenter.htm

Haiti Comes to Dr. Stevens

Today was another collision with destiny. If you have been following my posts, you know that my childhood dream was to become a doctor and go to help the people of Haiti. Well, today destiny was fulfilled. No, I didn’t go to Haiti, Haiti came to me.

I was asked by a Daily Planet employee (Mike Wilson) if I would do an assessment on two Pastors from Haiti who are visiting the States. I gladly agreed.

The great part about working in a Community Health Center, specifically a Federally Qualified Health Center, is that we are able to open our doors to those in need.

Although we all have to be cost conscious and concerned about productivity, that is not our driving force. In Community Health Centers, physicians are still able to tap into that humanitarian spirit of giving and taking care of patients that brought us to our profession.

So today, I had the pleasure of providing healthcare to two wonderful pastors and great men of Haiti. It was exciting and challenging. As we worked through the cultural and the language difference we discovered that we had more in common than we first believed to be true.

Had our meeting actually been in Haiti, I would not have been able to provide them with the level of healthcare that I was able to afford them today. So sometimes our destiny is not about our dreams for ourselves, but what we can do for others.

Check out New Hope Haiti Mission at
http://newhopehaitimission.org/Pages/MEET_US.asp

Colliding With Your Destiny

“When you walk in your purpose, you collide with your destiny”-Dr. Bertice Berry. If quotes were a theme song, that would be mine. For a year now, I’ve been colliding with my destiny and it’s been the “ride” of my life.

I’m one of those annoying people who from the age of seven have always known they’ve wanted to be a doctor. My mother was the Director of Nursing of a community hospital; therefore I spent most of my childhood in the hospital corridors being babysat by the staff and the resident doctors. My dream was to be a doctor and to travel to Haiti to help the poor.

However, like most kids by age nine I also wanted to be a teacher, then a rock star, a news reporter, author, and fashion designer. In college I discovered I could be a doctor scientist and a doctor educator, so I went for it, full speed ahead. Believe it or not, I’ve almost been all of those things, well except the rock star.

I know medicine is my purpose, but I also know that traditional medicine is not for me. Traditional in the sense, of a routine day to day office setting. Remember this is the girl who was going be rock star. Out of residency it was toss between Internal Medicine and Emergency Medicine. I loved the excitement of the ER, but overall wanted the long term relationship building of primary care.

After residency, I went home and started a practice. I was very successful and quickly developed a very large practice. However, I was not fulfilled. It was like walking around constantly with butterflies in your stomach.

Choosing what to do in your career can be just as difficult as choosing a career, especially when you excel in many areas and have a heart for doing good. I am living proof that being good at what you do does not guarantee you that satisfying feeling in your gut when you get dressed in the morning to go to work. And that’s the difference between just walking and walking in your purpose.

To be honest I was very good at what I did , everyone was happy - but me. So I tried to re-event my self. I become the TV doctor, I had a weekly show on NPR- I was good an educating the public. Giving back in a different way felt good, but it didn’t pay the bills.

I became a full time academic physician, teaching again was good, it almost felt right, but there was still something missing. I tried connoisseur medicine, no good. Sports medicine was exciting- I tried becoming a boxing fight doctor, that didn’t last long.

I did physicals for congress. Politics was very interesting, “but Senator, could you please not talk while I’m listening to your heart”. And then one day, I volunteered in a homeless clinic. It was like I was seven years old all over again. I collided with my destiny.

From that point, I begin to work with Unity Health Care for the Homeless in Washington D.C. and completed my Masters in Public Health. Then all roads led to Richmond Virginia and to the Daily Planet Healthcare for the Homeless.

Those butterflies in my stomach have finally settled. Each day is different and exciting. I travel to different locations to break up my routine. And although I am not practicing in Haiti, the needs of my patients are just as great. I don’t regret my journey, those experiences having meaning and have prepared me for my journey ahead.

I encourage you to think about your purpose, dig deep, go way back. Remember those age old questions? “What do I want to be when I grow up?” “What do I what to be remembered for?” “What contribution do I want to make on this earth?”

It’s not your parent’s dream or some obligation to do or be anything other than your purpose. And your purpose is something that only you can determine.

Just remember to walk in your purpose and only then will you will collide with your destiny.

Great books to read,
Jack Canfield, The Success Principles- How to Get from Where You Are to Where You Want to Be.

Rick Warren, The Purpose Driven Life, What On Earth Am I Here For?

Hello to Dr. Lisa Stevens Price

Dr. Lisa Price Stevens has known she was going to be a doctor since she was 7 years old. Her mother was a public health nurse and later became a director at a small community hospital, where Lisa spent a lot of time watching her while she was young. “I kind of grew up in medicine.” Idealistically, she wanted to do great things in medicine like “work in Haiti” and “help the poor.” But she fell into the more traditional career path and progression once she completed residency.

After a few years practicing and teaching in private practice and academic hospital environments she felt the call to “find her true north.” She’d had visions of being a Marcus Welby-type physician, but she just didn’t feel like she was doing what she had set out to do in being a doctor. She’d read that “if you walk in your purpose you will collide with your destiny,” so she did some soul searching to re-examine her professional life. She wanted to make a real difference in people’s lives.

Dr. Stevens had always assumed that working in community health meant living in some far off place. After doing some internet research, she discovered that smaller cities and urban areas are underserved too. She could have the best of both worlds – live where she wanted to live (Richmond) and help people in need.

So she reached out to the primary care association in Virginia, Virginia Community Healthcare Association, to see what her options might be. Faced with a child nearing college age and still paying off her own school loans, she was interested in loan repayment as well. She learned there was an opportunity for someone with her skills and experience in her own backyard, and that loan repayment could come with it.

Dr. Diane Reynolds-Cane, the Medical Director at the Daily Planet, had just accepted an appointment by Gov. Bob McDonnell to license and regulate health care providers as the director of the Virginia Department of Health Professions. The Daily Planet needed a new Medical Director. Virginia Community Healthcare Association connected them with Dr. Stevens.

After an extensive interview process, Peter Prizzio, the Daily Planet’s CEO, offered the Medical Director position to Dr. Stevens. She came aboard on July 1.”Working at the Daily Planet just feels right,” says Dr. Stevens. She gets to work with those who need her skills the most, while using her leadership skills and affecting change at a grass roots level.

What’s been the biggest surprise about working in community health? “It’s not been so much a surprise as a reaffirmation,” says Dr. Stevens. The people and community she supports are “truly caring people. They care about their families, they care about the future, and they care about their health. They could be any one of us – we’re all just a financial catastrophe away from where they are.”

The Daily Planet serves a predominantly male population in their forties, mostly African American. They are seeing more women, many of whom are dealing with homelessness or lack of insurance issues. They come from all walks of life – the previously rich who have lost everything, and those who have always been poor or abused.

Despite the challenges that face her, Dr. Stevens finds the working environment and work/life balance very comfortable. She usually sees 15-20 patients a day plus attending to her administrative duties. There is no weekend work and no on-call. The multi-disciplinary team approach used in community health creates a great whole patient-centered atmosphere, attending not just to medical needs but also to vision, behavioral health and pharmacy/medication education needs as well. She manages to keep her schedule within a 40-hour week which allows her to spend time on other leadership and grass roots activities.

One of the best things about working at the Daily Planet is the amount of time she can actually spend with her patients. There are still the quick 15 minute sick visits for many, but she has the latitude to spend 30-45 minutes with a new patient to gather information and really gain an understanding of what is going on with their health and in their lives. The other great thing is there is “no such thing as a typical day.” Every day is different and rewarding.

The biggest hurdle Dr. Stevens faces is lack of access to specialty care for her patients who need it. Since most specialists are not adequately reimbursed for treating the underserved, there is some resistance to providing specialty care to the underinsured and uninsured. That lack of reimbursement is a major issue of health care reform.

Another key component of health care reform is addressing the shortage of primary care physicians. One of the keys to combating the shortage is the National Health Service Corps (NHSC) Loan Repayment Program. Dr. Stevens has taken advantage of this program to address her own medical school debt. She never really knew that loan repayment was an option outside of being in the military or working in a far off place. When she started researching community health as a career opportunity, she found loan repayment was available to her. With most medical school grads facing $200K in student loan debt, Dr. Stevens says “it’s the only way to go,” and has become a proselytizer for the NHSC.

“The application process was not hard. The folks from the NHSC guide you through it, and all the information you need is readily available,” said Dr. Stevens. She feels the application process was fair and not difficult to navigate or terribly time-consuming, especially considering the pay-off. She has been granted a loan repayment award.

Summing up her experience working in community health, Dr. Stevens says it’s “been great.” “It’s been truly a gift,” she says. “It’s the perfect setting.”

Another life saved .. Thanks Caroline Family practice

Every day I come to clinic praying that I don’t come across a patient who hasn’t seen a doctor in years. The fear comes from the fact that constant neglect of personal health care leads to unintended consequences and the healthcare professionals feel helpless in some cases. Fortunately one of my recent experiences with a patient proved me wrong and I’m glad the way it turned out .
Recently a patient came to my office complaining that for some years he had been experiencing fatigue and loss of weight. The patient apparently thought that it was routine due to her strenuous lifestyle and attributed weight loss to the active life. Although, I was happy that the patient didn’t complain of many symptoms but as soon as the patient indicated that he hadn’t seen a doctor in years, I immediately knew that there is more to the story. We ordered a series of test to confirm the initial diagnosis of diabetes. The tests confirmed my fears. Now I was more concerned that this patient had been living with diabetes for years without knowing it. I sent him to the hospital right away to check for any heart problems that might have developed due to uncontrolled diabetes. The patient was diagnosed with blocked arteries and was operated upon immediately. The hospital informed that if he had been late, it could have been fatal. The whole family came to the office to thank me and all of them wanted to get evaluated. It turned out that all of them had diabetes and high cholesterol. They are all on a treatment plan.
I wondered what would have been the outcome if it was not for the Caroline Family practice. For me it is more than a job. It is a life savior to community which lacks access to basic healthcare and folks who cannot afford insurance. I grew in a household where it was emphasized that a doctor is a life savior. Although I agree with that notion, but at the same time I feel that you also need proper support to make difference in peoples’ lives. I’m extremely lucky that I am working at Caroline Family practice. I’m able to fulfill my childhood dream of helping needy but I’m also doing that I like the most.

Work and life Balance

The challenges faced by healthcare professionals are tremendous. There is a constant demand for high quality care and reducing medical errors. There are times when professionals in the forefront of delivery of healthcare services are affected due to the stress levels caused by the work and life balance issues. A healthcare professional needs to address the work and life balance issues effectively in order to be productive. There is a personal aspect of how people balance these issues but an effective work environment can also drastically help balancing work life issues.
Although, I have not struggled with the work life balance issues during my career due to solid family support, I’m fortunate that Caroline Family practice provides a perfect environment to balance it. I am glad that I have a great team of professionals who are dedicated to provide quality service, a management team that is always looking for ways to reducing errors and great call schedule that helps the team to be highly productive. We are encouraged to look for ways to improve productivity and voice our concerns.
Everyday I’m always ready to take on new challenges. I know that not only can I take care of my patients but I’m also home everyday enjoying the company of my loving family.

My recent experience at

Every day at Caroline Family Practice (CFP) , I come across patients who haven’t seen a doctor in years. Long gaps in annual checkups or preventive care often lead to unattended illnesses. These can lead to undesired situations for patients and their families. Recently I came across an individual who hadn’t seen a doctor in years. Every time I think about that person, I wonder if the outcome would have been different if that person had received quality healthcare earlier. That person is always in my mind and I hope the best for that person.
This person hadn’t seen a doctor in 20 years due to lack of insurance and lack of access to healthcare. Had it not been for the cough in the blood, I doubt that individual would have taken serious note of the situation. Unfortunately, I knew right away that it is serious and required attention. Several tests confirmed my fear that the person was suffering from cancer. I was worried that apart from cancer there could be other illnesses that had to be addressed. I ordered several tests and I was not surprised to find higher cholesterol but also hypertension. My heart went out to that person and his family. I choked up and wondered how I could help. Our team scrambled to develop a management plan. The family came up to me and said “You are a life savior and our God”. I know I’m not a God and but I know that I need all the resources as a doctor to help this individual. This is when I realized that I was at the right place. I am so lucky that I have all the resources, a great team and support structure to manage this patient.

MY MEMORABLE MOMENTS AT CVHS

I have been working with Caroline Family Practice (CFP) for more than a year. It has provided me with an excellent opportunity to provide care for a variety of people from different walks of life. Working for a community healthcare center like CFP has opened my eyes to the kind of challenges faced by people in these underserved areas.
Bowling Green is no more unique than any other underserved area in this country. Apart from providing care to people with access to healthcare, I routinely come across uninsured people who never had access to any kind of quality healthcare or preventive education. It is not unusual to find people who haven’t had a doctor visit in years. It gives me great sense of accomplishment that I’m able to provide basic healthcare to these individuals despite lack of insurance. The center doesn’t refuse treatment to anyone, insured or uninsured. I’m part of a team that is constantly looking for ways to reduce treatment costs for our patients, irrespective of the type of care required (i.e. office visits or drugs). We are also working hard on educating our patients on how to prevent diseases via regular office visits, annual diagnostic exams and lifestyle changes. It is very rewarding for me to see a drastic change in our community. There is better awareness among patients around managing their own lifestyles. People need access to information to manage diseases like high blood pressure, diabetes and high cholesterol.
When I joined Caroline Family Practice, I was aware of the challenges ahead of me. I learned quickly that not only would I be able to make a difference among individual patients, but I’m also able to contribute to the community in a significant way. I have been able to strike a perfect balance between work, serving the community and my own personal life. I leave everyday from the center knowing that I have been able to make a difference.

Greetings to our July Author - Dr. Rachna Dhar

Dr. Rachna Dhar feels peace in her soul because of her work in community health.  She gets to help other people, and they in turn truly appreciate what she does for them. “What else could you want as a doctor,” asks Dr. Dhar?

Rachna Dhar was born and raised in Kashmir, Srinagar in India. She was very inspired by Mother Teresa’s work in India and wanted to help people, like Mother Teresa did. Her mother suggested she could help others by becoming a doctor. The seed was planted. By age 5, Dr. Dhar was already calling herself “Dr.”

Given the unrest in Kashmir at the time, it was not feasible for Dr. Dhar to go to medical school there. So at age 17, she left home alone for Russia. She attended medical school in Moscow. Later she moved to the US, took her equivalency exams, and moved to NY to complete her residency at Brooklyn Hospital. Her husband and young son lived in CT, but the commuting was too tough given the demands on a resident, so she was only able to go home and spend time with them on weekends. It was a challenging time for the young family.

After residency, they moved to PA where Dr. Dhar began her medical work as a Hospitalist. Later she joined a private practice where her work grew to include an outpatient clinic and several nursing homes in addition to inpatient duties. Her job was very demanding and the hours were long. Then her husband was transferred to the Richmond area in 2010, and so she began to look for a job nearby.
Her husband found out about physician jobs in community health. “You will thank me!” he told her. At the time she didn’t understand what he meant.  She researched Virginia community health jobs on PracticeLink, and contacted the Virginia Community Healthcare Association about opportunities that were listed around the Richmond area.

She began working at Caroline Family Practice, part of Central Virginia Health System, in August of 2010. Now she understands what her husband meant, and she does thank him for discovering community health opportunities. She is able to balance her professional life with her family’s needs and feels like she is getting the best of both worlds. “My patients are so appreciative of everything I do.” The patients call her their “life saver” and Caroline Family Practice “heaven”.  “It’s very rewarding,” says Dr. Dhar. At the same time, she is able to be home every evening with her family.
What surprised her most about working in community health? She “never expected that people in America would have gone for so long without seeing a doctor because they didn’t have insurance or couldn’t afford it.” And her biggest challenge? “Not just caring for her patients clinically, but helping them find the ways and means to take care of themselves – like finding affordable medicines to help them, and discount programs for medications.”

Dr. Dhar would encourage anyone contemplating medical school to consider Primary Care. “It offers more diversity in the types of patients, diagnosis and treatment. There is a lot to learn and they will always be learning.” And she would also encourage them to consider working in a community health center. “CHC work is for people who became a doctor because they wanted to help people. If that’s what brought someone to medicine, they will love the job.” Like Dr. Dhar.

The Collaboration of Health Specialties

One of the best aspects of working at a community health center is the collaboration of health specialties. A hot topic amongst the healthcare community is the need to increase collaboration of specialties to increase optimal patient care. However, this collaboration occurs in many multidisciplinary community health centers on a daily basis. Patients usually visit the same community health center for medical and dental care. Hence, providers are able to care for a patient collaboratively. Examples of this include consulting with medical providers to determine if anticoagulants should be held prior to invasive dental care or asking a nurse to check a diabetic patient’s blood glucose level.

In addition to medical and dental providers, pharmacists, behavioral health specialists and other members of the healthcare community can be found at your local CHC. Community health centers are quickly transforming into patient healthcare homes. CHCs allow patients to receive comprehensive healthcare services in their communities provided by dedicated clinicians.

The Importance of Service: Venturing Outside of the Health Center

The summer months are generally quite busy. In addition to recruiting dentists for the organization, I volunteer several hours with local organizations to promote healthcare.

For the past five years, I have participated in Virginia Commonwealth University’s Dental Careers Exploration Program sponsored by the School of Dentistry. The Dental Careers Exploration Program is offered to 10th, 11th and 12th grade students from the city of Richmond and Chesterfield, Hanover and Henrico counties, who are interested in exploring a career in dentistry. In this intense two-week program, students are introduced to dental anatomy, operative dentistry and other essentials of the profession such as study skills and public speaking. I view this as an opportunity to expose these future healthcare providers to community health.

In the month of September, I speak at the Improvement Association’s yearly Head Start Orientation Program for the children of Brunswick County. In this orientation, I discuss the importance of dietary habits, proper oral hygiene/home care and lastly the importance of routine dental visits.

Involvement in your local community is another way to share the community health message ---- with future healthcare providers and patients.

Committing to Serve the Underserved Can Relieve Financial Burdens

As a former professor and relatively recent graduate myself, I know many dentists nationally who recently graduated from dental school are faced with an overwhelming debt burden. Dentists among many healthcare professionals have some of the highest student loan obligations due to the cost of dental education. In addition, many new practitioners in today’s economic climate are faced with dwindling job opportunities in private practice. It is clear that the salaries and benefits once offered by private practice are no longer sustainable in the Great Recession.

Many practitioners, including myself have been shielded from economic uncertainty due to our affiliation with community health centers. Health centers not only provide access for all, they also allow many health care practitioners the opportunity to receive loan repayment via state and federal programs. While private practices are experiencing slow times, community health centers are experiencing growth. Many patients who were previously seen in private practice are now seeking community health centers in times of need.

I have the benefit of caring for a community that appreciates the care I provide and loan repayment via the National Health Service Corps. In my opinion this is the best of both worlds.

Dr. Parris-Wilkins at work

Community Health Dentistry---The new “private practice”

There are many misconceptions on the part of students and private practitioners that community health dentistry does not provide a wide array of practice experiences. Last week I performed the following procedures:

1. Final impression for a full gold crown #31.
2. Pediatric well baby dental visit.
3. Pick up impression to add #23 to a mandibular acrylic partial.
4. Extraction of #17 and supernumerary 17 prime.
5. Referral to ENT after discovering enlarged lymph nodes on a head and neck examination.

This is in addition to performing many administrative duties like:

1. Interviewing potential dental candidates for a practice.
2. Approving order requests.
3. Monitoring clinical productivity of providers.
4. Training dental assistants, etc.

I find community health dentistry rewarding because the sliding scale fee enables me to provide care to many people who cannot afford private practice fees. Patients are so appreciative when they find a provider who is courteous, competent and affordable.

Want to know more about my love affair with community health dentistry?—Stay tuned!

Introducing Dr. Tonya Parris-Wilkins

Tonya A. Parris-Wilkins, D.D.S., F.A.A.H.D., M.A.G.D.

Dr. Parris Wilkins is the Dental Director of Central Virginia Health Services (CVHS) – the oldest and largest Community Health Center organization in Virginia. Maintaining an astounding level of direct patient care - 4 to 4.5 days per week - Dr. Parris-Wilkins also juggles the administrative complexities of supervising dental care for 10 Federally Qualified Health Centers (FQHC’s), providing for many their only access to dental care. It’s good that Dr. Parris-Wilkins enjoys diversity and problem solving because as she describes it “a typical day is one that is not typical.”

Originally Dr. Parris-Wilkins had aspirations to be a physician – NOT a dentist. But thankfully, through a program in which she shadowed a physician and was rated if she was well suited to medical practice, she determined early she loved health sciences but not in that capacity. In the process of looking for something else in the healthcare area, a graduate advisor connected her with a local dentist affiliated with the University of Michigan and the match was huge success.

After competing her Doctor of Dental Surgery at Virginia Commonwealth University, Dr. Parris-Wilkins went on to teach as an Associate Professor for three years, educating, mentoring, and inspiring a new crop of dentists. But when the unique opportunity to work at Central Virginia Community Health System opened up, Dr. Parris-Wilkins was thrilled and honored to be chosen as their Dental Director. Even better – Dr. Parris-Wilkins still feels that way after 4 years, providing direct care at Southside Health Center in Alberta, VA and managing sites in Alberta, Caroline, Charles City, Charlotte-Courthouse, Fredericksburg, Hopewell-Prince George, Louisa, Petersburg, New Canton, and Westmoreland.

In addition to juggling professional work at multiple sites, Dr. Parris-Wilkins is also a wife and mother with young children. Although Dr. Parris-Wilkins loves to be a “Jack of all trades” and has increased the quality and efficiency of dental care in her Community Health Centers, the balance of work and personal life is still a challenging process. Many of Dr. Parris-Wilkins accomplishments such as the Central Virginia Health Services Dental Digest, a quarterly teleconference schedule, and initiation of an annual dental department meeting including providers and supportive staff have all been instrumental in the 80% dental department productivity increase within 24 months.

One of the perks of the job, Dr. Parris-Wilkins met First Lady Michelle Obama when they were on a panel together at the Caroline Family Practice site last year. As both a mother and as a clinician serving the needs of the underserved, Dr. Parris-Wilkins felt a kindred spirit as they celebrated the opening of another Virginia Community Health Center improving access to care.