HJNO Mar/Apr 2024

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2024 33 Graduate Medical EducationMartin Levine, DO, FACOFP, who agreed that VCOM selected Monroe because of significant pro- vider shortages in the region. The school previously opened campuses to reverse primary care shortages in Vir- ginia, South Carolina, andAlabama. It ranks 13th nationally in the number of graduates practicing in primary care, and it’s nation- ally recognized for the number of graduates who practice in rural and medically under- served areas. “We’ll be graduating our first class this year at VCOM-Louisiana, anticipating 60 to 75% [of our graduating physicians] in primary care, general internal medicine, family medicine, pediatrics and OBGYN,” said Levine, adding that the school aims to select applicants with rural backgrounds who intend to practice in underserved areas. VCOM has partnered with several Loui- siana hospitals to help them sponsor new GME programs in provider shortage areas. “We’re working with whomever wants to work with us,” said Levine. “We’ll do a pro forma for them, and we’ll do it for nothing because the more GME we have, the better it is for the state.” Creating New GME Programs National experts report that navigating the complex maze to become an accred- ited GME program often requires a sizable up-front investment of more than $1 mil- lion to hire directors and faculty, establish training sites, and demonstrate program sustainability. Medicare provides limited funding for medical residents under caps Congress placed on the programs in the 1990s. “You have five years from the time you obtain approval to be a sponsoring orga- nization to being able to declare howmany residency spots you can support,” said Logue. “After that, you can open up more spots, but you’re not going to get any federal funding for that.” In 2018, leaders at St. Francis Medical Center in Monroe saw VCOM developing and decided to become an internal medicine residency sponsor focused on rural and pri- mary care. The hospital’s president, Thomas J. Gullatt, MD, said the program received more than 3,000 applications before match- ing with 15 residents last July, and he antic- ipated that it will grow to 45 residents by its third year. He estimated the hospital has already invested $3 million in startup costs and expects up-front expenses to grow as classes expand. He said the programmight not have been possible without the sup- port of non-employed subspecialists who help with clinical rotations in their individ- ual practices. Looking forward, he said he hopes to receive accreditation to launch a family medicine GME program in July 2025. Speaking of the important value of these investments, he said, “eventually you’re going to have more doctors to serve your community and have a healthier population in the long run.” Moreover, the economic benefit of bringing one new physician to a Louisiana community amounts to more than $900,000 per year, according to the Robert Graham Center. In Shreveport, Willis-Knighton Health System (WKHS) is working to gain accred- itation for a new rural family medicine GME program where residents would train the majority of their time at Claiborne Memo- rial Medical Center (CMMC) in Homer, Louisiana. “By having the residents train at a site like that, we think they’ll be very well equipped to practice in rural settings going forward,” saidWKHS GME Director Luke Nelson. CMMC CEO Tina Haynes described this rural residency program as a way for her retiring physicians to leave a legacy. “This will allow our doctors to retire at their own pace, to come into the teaching program and continue doing what they love,” she said. She also mentioned the benefits of inter- acting with VCOM’s medical students who enjoy shadowing her physicians, working as scribes, and rotating in her emergency department. She recalled 16 second-year students who provided health education for older adults in Homer. “The commu- nity loved them,” she said. “They’ve asked me to have them come back because it was so much fun.” To encourage rural training, the federal government provides up to $750,000 in grant funding to assist new rural residency programs with start-up costs through the Rural Residency Planning and Develop- ment Program (RRPD) administered by the Health Resources & ServicesAdministration (HRSA). Eligible grantees must demonstrate needs for family medicine, internal medi- cine, preventive medicine, psychiatry, gen- eral surgery, or obstetrics and gynecology. HRSA recently awarded Franklin Medi- cal Center in Winnsboro, Louisiana, with an RRPD grant to assist with startup costs. “I want a pipeline for all northeast Louisi- ana hospitals,”said FranklinMedical Center “According to the U.S. Department of Health & Human Services (HHS), ‘only two percent of residency [GME] training occurs in rural areas and training physicians in rural areas increases the likelihood of practicing in a rural community.’”