Delaware Health Care Commission
DELAWARE INSTITUTE OF MEDICAL EDUCATION & RESEARCH
December 12, 2007
Delaware Tech Terry Campus
Corporate TrainingCenter – Room 400B
Dover
MINUTES
Board Members Present: Sherman Townsend, Chairman; Brian M. Aboff, MD, FACP; Michael Alexander, MD; David Bercaw, MD; John A. J.Forest, Jr., MD; Brian W. Little, MD, PhD; Vincent Lobo, Jr., DO; Betty J. Paulanka, EdD, RN; James Richards, PhD; Ileana M. Smith, EdD; and Wayne A. Smith.
Also Present: Carol Fox, PhiladelphiaCollege of Osteopathic Medicine.
Staff Present: Carylin Brinkley, Higher Education Commission; Judy Chaconas, Division of Public Health; Stuart Drowos, Deputy Attorney General; Marlyn Marvel, Delaware Health Care Commission; Fait Rentz, Office of Management and Budget; and Paula Roy, Delaware Health Care Commission.
CALL TO ORDER
Chairman Sherman Townsend called the meeting to order at 4:00 p.m. He introduced new DIMER Board member Wayne Smith, President and CEO of the Delaware Healthcare Association and former Delaware State Representative. Mr. Smith is filling the vacancy left by Joseph Letnaunchyn.
MAY 16, 2007AND SEPTEMBER 26, 2007 MEETING MINUTES
Dr. John Forest made a motion to accept the May 16, 2007 and September 26, 2007 meeting minutes. Dr. Brian Little seconded the motion. There was a voice vote. Motion carried.
ACTION: LOAN REPAYMENT PROGRAM RECOMMENDATIONS
Paula Roy reported that the Loan Repayment Committee met on Thursday, December 6, 2007 and made the following recommendation for funding:
- Funding Updates:
-$50,100 available in State DIMER funds (through June 30, 2008)
-$88,000 available in Federal matching funds
- Applications to Review:
Health Professional: Coleen Brogan, Certified Nurse Midwife
Site: La RedHealthCenter, Georgetown
Site: La RedHealthCenter, Georgetown
This federally qualified health center has previously been approved as a loan repayment site and qualifies for federal matching funds.
Coleen Brogan, Certified Nurse Midwife – La RedHealthCenter
Ms. Brogan graduated from CaseWestern ReserveUniversity (Ohio) with a Master’s in Nursing in 1996 and from the Frontier School of Midwifery (Kentucky) in 1999. She is certified by the American Midwifery Certification Board. Her employment with La Red Health Center (40 hours per week) began in September 2007. Ms. Brogan has $74,000 in loans and is requesting a three-year contract.
Recommendation:
The Loan Repayment Committee recommended that $30,000 be allocated to Coleen Brogan, ($15,000 State funds and $15,000 Federal funds) for a two-year contract to practice at La Red Health Center.
Discussion
Mr. Townend questioned the reasoning for recommending a two year contract, rather than a three year contract as requested by Ms. Brogan.
The decision was made based on the fact that payments are progressive, beginning with small payments and gradually increasing each six months. A shorter contract would be more beneficial to the applicant because she would be able to pay down the principal more quickly.
Dr. Brian Aboff questioned how the award amount is determined.
There is no formal structure for determining the amount of an award or award recipients. The Committee matches applications to areas where there is a known need. There has been discussion about whether or not preference should be given to physicians over allied health professionals. In the case of Coleen Brogan being placed at La Red Health Center, clearly SussexCounty is underserved. The fact that La Red Health Center qualifies for federal funding also weighed heavily on the decision.
Dr. Michael Alexander said there are less state funds than federal funds available. He asked if spending all of the state funds means that the balance of the federal funds cannot be accessed.
The state fiscal year and federal fiscal year are not the same. Additional state funds will be allocated on July 1, 2008 that may be used as matching funds to use the balance of the federal funds before September 30, 2008.
Dr. Alexander suggested that this situation should drive legislators to allocate additional state funds in order to be able to use the federal funds. Ms. Roy explained that this is part of the argument used when requesting additional funds. She added that it has been a bit of a challenge to spend the federal funds because people cannot be recruited to practice in a private setting. It must be a public nonprofit setting in order to qualify for the federal funds.
Action
Dr. Michael Alexander made a motion that the DIMER Board accept the Loan Repayment Committee’s recommendation that $30,000 be allocated to Coleen Brogan, ($15,000 State funds and $15,000 Federal funds) for a two-year contract to practice at La Red Health Center. Dr. Betty Paulanka seconded the motion. There was a voice vote. Motion carried.
2008 DIMER ANNUAL REPORT
The 2008 DIMER Annual Report was distributed for review. Board members were asked to contact the Health Care Commission staff with suggested additions or revisions.
Ms. Roy called attention to two changes in the report. A brief description of the State Loan Repayment Program is included on page 9. In addition, the statistics reported on pages 10 through 14 have been presented in tables, rather than narrative format, to make them easier to read.
The Health Care Commission is required to submit an Annual Report to the General Assembly by January 15. The DIMER Annual Report will be included as part of that report.
DISCUSSION: INCREASED FUNDING FOR MEDICAL EDUCATION
DIMER’s budget falls within the Health Care Commission’s budget. The Commission’s support is necessary to request additional funds.
Mr. Townsend is invited each year to attend the Commission’s annual strategic planning retreat to provide a summary of the activities of DIMER and receive input from the Commission on DIMER’s programs. Mr. Townsend and Dr. David Paskin attended the retreat this year and gave a presentation requesting additional funds for medical education at both JeffersonMedicalCollege and Philadelphia College of Osteopathic Medicine.
They explained that the funds appropriated to JeffersonMedicalCollege have not been increased for the past 19 years. In 1991, JeffersonMedicalCollege’s budget was $76 million. Tuition was $18,200. In 2007, Jefferson’s budget was $285 million. Tuition was $39,000. The intent of the presentation was to illustrate what occurred in the cost of medical education over the years and howDelaware’s contribution compared as a percentage of the cost. Mr. Townsend does not believe Delaware is paying its fair share of the contribution it is receiving from the two medical schools in educating physicians for Delaware.
An additional $2 million was requested. It was anticipated that a request for increased funding would be included in the Commission’s operating budget request, as well as submitted through the Delaware Health Fund. Unfortunately the request was not included in the operating budget request or submitted through the Delaware Health Fund.
A letter was submitted to Jennifer Davis, Director of the Office of Management and Budget asking for reconsideration of the request. Mr. Townsend and Dr. Vincent Lobo also met with Governor Minner to let her know that DIMER plans to request an additional $2 million for medical education in the Fiscal Year 2009 budget request.
The budget hearing before the Joint Finance Committee is scheduled for 3:00 p.m. on January 29, 2008.
Dr. Bercaw said that traditionally when third and fourth year medical students were surveyed, they indicated that their debt burden had nothing to do with their choice of field of medical practice. That was when the debt burden was below $200,000. During the last couple of years, with a debt burden in excess of $250,000, students have responded that is does influence their choice of field of practice. Interest in primary care has decreased significantly.
Dr. Little pointed out that the number of people over 65 years old is expected to increase significantly in Delaware. This fact coupled with an anticipated significant decrease in the number of primary care physicians will present serious problems in the future.
Mr. Smith suggested inviting Governor Minner and Lieutenant Governor Carney to a meeting to discuss the need for increased funding for medical education. He will also ask the Delaware Healthcare Association and Medical Society of Delaware for support.
DISCUSSION: FUNDS PREVIOUSLY ALLOCATED FOR AHEC/PRECEPTORSHIP PROGRAM
A few years back Delaware was invited to join the state of Pennsylvania with an Area Health Education Center (AHEC) program. Rather than attempting to start a separate Delaware program, a program was started in cooperation with Pennsylvania and Delaware became the eighth region of Pennsylvania. The name of the organization was changed to the Pennsylvania/Delaware AHEC. Delaware received funding from Pennsylvaniaand hired an executive director and health educator. Just as the program was about to be launched the funding was cut by 50 percent.
When funding was sought from other sources, $100,000 in state funds was appropriated for the AHEC in Fiscal Year 2007. Due to funding and staffing issues, the AHEC closed. The funds were returned to the State of Delaware, and are currently included in DIMER’s budget.
Two primary missions of the AHEC were to provide a health educator and create a preceptor program. Pennsylvania is continuing to support the Delaware AHEC. Funding is currently being sought for an audit and other things required in order to officially close the organization.
Paul Lakeman,at BayhealthMedicalCenter,has been working with the Pennsylvania AHEC to continue the mission of the Delaware AHEC under the Delaware Rural Health Initiative. It is an existing 501C3 corporation, whichmeets all the qualifications for the federal funding. The new organization will be taking over the AHEC mission.
The organization is in the process of beginning to deliver a preceptor program within the near future. Mr. Lakeman is working closely with Philadelphia College of Osteopathic Medicine and several people are lined up to begin preceptorships downstate. JeffersonMedicalCollegerequires that the preceptor become a credentialed member of the faculty. The process for achieving that is quite involved.
Mr. Townsend would like to use a portion of the $100,000 in DIMER’s budget to fund the preceptor program. In order to access the funds it is necessary to present a plan to the Director of the Office of Management and Budget and Controller General for review and approval.
Ms. Roy added that having a health educator to visit schools and talk with children about pursuing health careers is an important long term strategy for increasing the health care work force. Mr. Townsend said he believes the funds can be used for both a preceptor program and a health educator.
Mr. Townsend suggested inviting Mr. Lakeman to attend the February 20 DIMER meeting to present his plan and required funding. DIMER could then contract with the Delaware Rural Health Initiative to provide a preceptor program on behalf of DIMER. The Board may be able to convince Mr. Lakeman to hire a health educator, as well. The programs would be funded through the Pennsylvania AHEC.
OTHER BUSINESS
Federal Grant to Assist with Attracting Physicians to Underserved Areas
Mr. Townsend said that Howard Rabinowitz, a professor at the Jefferson Medical College Department of Family and Community Medicine, asked him to join him on behalf of DIMER in applying for a federal grant to assist with attracting physicians to underserved areas. The grant was awarded to Jeffersonat the end of August. It will provide two seats in the class. Jefferson will specifically target Kent and SussexCounties in attempting to recruit students to fill the two seats and will assist them with mentoring, if necessary.
Dr. Bercaw added that, under the Physician Shortage Area Program, Jefferson recruits students from rural areas and asksthem for a written statement of commitment to primary care. They are not held to the agreement if they change their minds. However, Jefferson has found that the percentage of physicians who end up in primary care is good.
Some students from Jefferson do their required rotations with the Family Medicine Department at Christiana Care Health Services. Dr. Bercaw would like to find some downstate rural physicians who would be willing to have those students in their office for a week or two during their rotation.
Dr. Thomas Nasca, Senior Vice President & Dean of JeffersonMedicalCollege
Mr. Townsend reported that Dean Nasca is leaving JeffersonMedicalCollege to accept a position as CEO and Executive Director of the Accreditation Council for Graduate Medical Education (ACGME) in Chicago. He has been a tremendous asset to both JeffersonMedicalCollege and the DIMER program and will be missed. A request was submitted that Delaware be allowed to nominate a person to participate in the selection process of a new dean, and that request has been granted.
Dinners with Students at PhiladelphiaCollege of Osteopathic Medicine and JeffersonMedicalCollege
A dinner with students at Philadelphia College of Osteopathic Medicine (PCOM) was held on Tuesday, November 13. A dinner with first and second year students at JeffersonMedicalCollegewas held on Monday, December 3, 2007.
These annual dinners serve two very important purposes. First, they underscore the fact that Delawareans who attend PCOM and Jefferson are there as the result of a close relationship established by the state through DIMER, which allows them preferential entrance status. Second, they offer them a glimpse of career opportunities in Delaware following the completion of their medical education. Both dinners were well attended and successful.
A dinner with third year Jefferson medical students will be held at La Bucca Restaurant in Philadelphia on Monday, January 7, 2008. The purpose of this event is to have the students meet with representatives of Christiana Care Health Services, A.I.duPontHospital for Children, and St.FrancisHospital to gain greater insight into the residency training programs in Delaware.
Mr. Townsend will work with Carol Fox to have a dinner with third year PCOM students.
Pilot Program Targeted at Young People
Judy Chaconas said that the Division of Public Health has had discussions about creating a pilot program to interest young people in pursuing health professions as a career. Such a program would coincide with the DIMER Board’s desire to have a health educator. She would like to have a meeting to talk and assist with that through the Office of Primary Care and Rural Health. Discussions have been held about interest in health careers, as well as how they might work with the educational system to make sure students are not only interested in health careers but they get the academic preparation in elementary, junior high and high school to allow them to be successful in getting into a college that will lead them to having the ability to be a successful applicant to a medical school.
Delaware Technical and Community College
Dr. Ileana Smith said that enrollment at Delaware Technical and Community College grew by 7.5 percent this fall with approximately 40 percent of the enrollment in nursing and allied health programs. The college continues to address the need for a funding solution to its lack of space problems and intends to build a HealthSciencesBuilding in every county in order to accommodate the growth and demand for health career programs.
University of Delaware
Dr. Betty Paulanka suggested that DIMER address the Board of Nursing to discuss creating some flexibility regarding the regulation that limits the number of nursing students in a clinical group to 8. It would be helpful to be able to negotiate the number based on what the students are doing and how much experience they have had; perhaps using a range from 8 to 12. Mr. Townsend suggested that all of the schools that offer nursing programs in Delawarebe asked to approach the Board of Nursing about this requirement.
Dr. Paulanka shared that the Department of Medical Technology is exploring options to expand the size of their undergraduate program and considering a clinical laboratory doctorate to address the shortage of Medical Technologists and Clinical Pathologists.
The University of Delaware’s nursing director is working with JeffersonMedicalCollege to share resources.
Dr. James Richards said that the University of Delaware is currently exploring the possibility of increasing student access to the Medical Scholars degree by including it as a concentration within specific majors in the College of Health Sciences. The Medical Scholars program offers students the unique opportunity to gain early acceptance into JeffersonMedicalSchool. However, many students prefer to enroll in related majors that 1) enable them to keep their options for medical school open and 2) provide them with a curriculum of greater personal interest and additional career options. Because they are forced to make this choice, many highly qualified students are prevented from taking advantage of the early acceptance option, and last year, only one student from the Medical Scholars program matriculated to Jefferson.
The University’s solution is to explore implementing a version of the Medical Scholars program as a concentration within degree programs (such as Health Studies, Nursing, and Exercise Science) that require many of the same courses as the Medical Scholars degree program. The concentration would consist of the coursework that is unique to the Medical Scholars program. The University is in the early stages of exploring this option, and is not yet ready to approach Jefferson with a proposal, but hopes to address the issue in the next few months.