News and Commentary Providing Collaborative Care and Education: A Conversation with Wesley Health Center

The Wesley Community Center was established in the 1950s in south central Phoenix, providing programs, classes and after-school activities for primarily Hispanic families. The Wesley Health Center opened in 2003, and became a Federally Qualified Health Center in 2009.

With support from the Josiah Macy Jr. Foundation, Arizona State University and the University of Arizona at Phoenix are implementing a graduate-level primary care curriculum. The Wesley Health Center is one of the clinical sites participating in the program. Macy sat down with Wesley’s Betty Mathis, CEO, and Kathleen Brite, M.D., Chief Medical Officer to discuss the project.

Why is interprofessional practice and education important to a place like Wesley?
Mathis: Our philosophy is to take care of the whole person. To do that, we need a team; one that can work with our patients and empower them to improve their health. We’ve always been interprofessional and fostered collaboration and teamwork to make sure that our patients have high quality care and that we are making a difference for our patients. Teaching students interprofessionally was a perfectly natural thing for us to do.

Brite: Wesley is a full-service patient-centered medical home with four physicians, nurse practitioners, a social worker, a promotora, a visiting dermatologist and a visiting podiatrist. We try to provide everything in one setting. We believe in team care and collaborative practice—everyone brings a special talent to the table and has something unique to offer. We also believe in training all health professionals together. Our students all have so much to offer each other. For example, we’ve had nurse practitioner students who have been trauma nurses and have a lot of real world experience to teach our medical students.

Why are you engaged in health professions education?

Mathis: What we do with underserved populations is extremely rewarding. We want to give these students, these future health care professionals, the best opportunity possible to interact with families and individuals they never may have had a chance to meet, and to understand those patients and where they come from. We want them to have empathy, to be put in the shoes of those folks, and to want to care for these patients.

Brite: For me it comes down to humanism. Every single student and resident that rotates through here gives back at a much higher rate after graduation. It’s good to show students at a very early time in their training that we don’t need to compete with the other professions, but that we should appreciate each of the professions. With the provider shortage in our state, we need every one of them and we need to work together.

Mathis: I’m very proud of our work with students. When we do exit interviews with our medical students they tell us that the experience of working here, with our staff and patients, was 100 percent positive. I know we’ve made a difference in their careers and their lives, and they’ll certainly never forget the experience.

What do you hope to get out of this Macy-funded academic partnership with Arizona State University and University of Arizona-Phoenix?
Brite: We believe in interprofessional teams and this is an opportunity to show that our model is effective. We’ve had interprofessional student teams in the clinic since 2003, but this project is helping us to formalize what we are doing and chart patient outcomes to prove that interprofessional practice is beneficial to our patient population. We have a group of “frequent flyer” patients—patients with complex medical problems who spend a lot of time in the hospital. Our goal is to keep them out of the hospital. We will be assigning each patient a whole health team—a team that includes our students—and measuring our impact on reducing ER visits and hospital readmissions.

Mathis: Through this partnership, we hope to illustrate that ours is an effective model and to provide other clinics with a model they can replicate. And of course we hope our patients will benefit.

Brite: So far, the project is in its infancy and we’re still ironing out scheduling issues so that when our patients are sick, they can get into the clinic and still meet with our students. We have two medical students who alternate each week, one nurse practitioner student who comes each week, and a social work student starting in January.

Why is it important to have students train in primary care settings like your health center?
Brite: There is huge shortage in primary care in our state. Residency programs and medical classes have not been expanding but our population continues to grow. What I like to tell my students is, if you look at 1,000 patients, maybe half of those have access to a primary care provider and of those 500 we maybe send nine to the hospital each year. We don’t need more inpatient care, we need providers who are working to keep the other 991 out of the hospital—providers who are working in primary care clinics like Wesley.

It’s a really rewarding career. It’s never boring, you really have to stay sharp and practice evidence-based medicine. The more exposure students have to primary care practice, the more rewarding it is for them. Our students are never unsupervised, but we make sure to give them some autonomy, for example, they’ll take a patient’s history, come up with a plan and then we’ll do the procedure together. This hands-on approach gives them more ownership of their patients; they care for them from beginning to end.

We have residents who’ve just come off an inpatient rotation and they come here and they have a shot gun approach, they want to order every test. It wastes so many resources. At Wesley, they learn a lot about high quality, cost-effective medicine.

Mathis: We hope others see the value of community health centers and what they can do for our future healthcare workforce. We’re pleased to have this chance to show the opportunities that exist for training professionals in places like Wesley and to share our experiences with other academic centers and clinics that might also want to do this.

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