THE TEAM CONCEPT

T - Training

E - Extended

to

A - Accomplish

M - Manpower  (in Rural Areas)

Rationale - We know that the more doctors train in urban areas, the less they go to rural areas. Efforts to extend this training to rural areas decrease the amount of socialization to urban areas, decrease the likelihood of meeting an urban-dependent spouse, and increase the probability of staying in rural areas.

Methods - First year residents in Family Medicine receive information about the program. They are shown likely nearby sites which need physicians. These sites have potential supervising physicians as well. The resident chooses to participate in the program and is approved by the program director, supervising physician, and representatives of the community. Residents are encouraged to TEAM up with another resident to go to this location.

The program will provide oversight of the supervision and training of the resident by faculty review on site as well as at the program.

The community and supervising physician(s) must provide a committment to the resident to continue employment or practice support during the TEAM training and for two years afterwards.

The community must also involve the resident in health planning during this period. It is expected that a needs assessment (performed prior to the arrival of the resident on site) will determine the health and social service needs of the community. The resident will review these needs and work with the community and residency program to design a training program over the three years that will result in a physician that can optimize care based on the needs of the community.

Schedule - Residents participate in a normal first year of training. The second year they spend 6 months on site. During the first part of this year they move to the site. The next year they spend seven months on site and the final year they spend 9 months on site. They graduate a year later, but have been in their rural location two years earlier.

Budget - The residency is responsible for salary and benefits for two years of training. The community and practice cover the balance.

Expenses Income

Satisfies a need for income. It could entice more students into primary care where debt loads shape their thinking (ability to pay some amount sooner).

A major benefit would be increased rural manpower as far as the resident services go, and also the retention of the other physicians in the town who may be nearing burnout.

The benefit to the community of having adequate manpower and being able to plan over the course of the resident's training and needing to work with this present and future physician over a long term cannot be overemphasized. Communities and physicians working together is the only future for rural health.

Programs wishing to satellite to expand community-based training and preceptors should benefit from this program.

Rural physicians would continue to look to nearby residencies for long term training that could be more meaningful in terms of quality of care for their communities.

This is essentially a split residency program, which is already approved. The similarity would allow demonstration use more easily.

Programs short of office space or patient load could utilize this method to balance the needs of others.

It is obviously office-based and addresses practice needs and training.

Communities and residents may change their minds. It should be emphasized that a full long-term committment is required by both. Residents are free to leave after one year of full time service to the community.

The TEAM may not form or continue. It is hoped that two residents will work together to facilitate continuous patient coverage during the training. Designing training during lower patient loads (April - October) may help.