Underserved Contributions of the UNMC Department of Family Medicine

Response to inquiry about domestic violence services

Organizations name: University Medical Associations Family Practice Clinics

Executive director Chair of Department is Mike Sitorius, M.D.

Address 42nd and Emilie Omaha, NE 68198-3075

Service area: Underserved areas in eastern Omaha (North and South Omaha), 100,000 people in area, 30000 visits a year to clinic, recent cuts in day care and transportation and cuts of 15,000 people off Medicaid in our service area plus co-pay for Medicaid prescriptions have hit patients hard and reduced our visits and income greatly.

A paragraph about your program

We offer primary care and counseling services to current and previous victims from counselors and family physicians. These include Medicaid patients, self-pay, and no pay. We train all UNMC medical students and family practice residents in domestic violence issues during all 7 years of their training.

A description of the type of funding you receive

We receive a portion of the Graduate Medical Education funding that is given to our hospital as well as funding from the medical school and state. We have had to give back some of the funding to the state so that Medicaid funding matched by the federal government could continue. We have cut staff and face further reductions in personnel and services. Other faculty are no longer as available to address subjects such as domestic violence as their time has been converted to increased clinical services to help shore up the deficits. These include research and teaching efforts. One faculty with an interest in this area has left so far. Her efforts ranged from Native Reservations to South Omaha in domestic violence and prevention efforts in English and Spanish.

This effort in domestic violence is not atypical of the 470 Family Practice Programs nationwide. Many have taken on the functions of community and migrant centers, but do not receive this funding. Some such as Worchester Mass lead the nation in research and information in this area. Our department donates faculty and residents to underserved areas of the state in South Omaha to the One World Community and Migrant Center and also 6 rural towns. In addition our faculty on a voluntary basis are primary supervisors for the student-led Sharing Clinic Tuesday evenings which has been nationally recognized. This effort on the behalf of underserved populations is 30% of our department budget. This large percentage is truly atypical of family medicine programs and departments and indeed any medical school program. We received the National Rural Health Association program of the year award in 2001 because of these efforts with special recognition from Wayne Myers MD, the past Federal Office of Rural Health director. Over the past 15 years we have converted our family practice residency slots from 20 general FP slots to 10 rural training track slots, 4 accelerated rural training program slots, 2 accelerated inner city training program slots, and 2 MBA training slots. Our rural graduation rate has risen from 40 to 60% and our inner city graduation rate has risen to over 10%. This is three times the FP rural graduation rate nationwide and twice the inner city graduation rate of FP.

I am hoping that such efforts can continue, but doubt that they will be able to do so. It is truly a sad situation that departments such as this face on the burden of service, and even more tragically the reduction of such services, without the resources to accomplish these crucial tasks.

Robert C. Bowman, M.D.

rbowman@unmc.edu

402-559-8873 mornings