The “grow your own” approach to workforce development is gaining traction at health centers across the country. As workforce teams design and implement the health professions education and training (HP-ET) programs that best serve their communities, it is helpful to hear from individuals who have followed the HP-ET pathway in their own careers. This episode of the STAR² Center Talks Workforce Success features a conversation with Robyn Weiss, Director of Workforce Development at the Northwest Regional Primary Care Association (NWRPCA), and Dr. Martin Peters, Regional Director of Medical Education and Clinical Assistant Professor at A.T. Still University, who has firsthand experience as a participant in and now champion of health center HP-ET programs.

Transcript by Rev.com

Helen Rhea Vernier: Welcome to the second episode of the sixth season of the STAR² Center Talks Workforce Success podcast series. This season, The STAR² Center is focusing on health professions pathways as a tool for recruitment and retention. In this episode, we hear from Robyn Weiss, Director of Workforce Development at the Northwest Regional Primary Care Association or NWRPCA as she interviews Dr. Marty Peters, Regional Director of Medical Education and Clinical Assistant Professor at A.T. Still University. He is a board certified family medicine primary care physician at Virginia Garcia Health Center, which has five clinics in Portland and its surrounding rural areas. Dr. Peters is at the Newburgh Clinic. Here’s their interview now.

Robyn Weiss: Thank you so much for being here.

Dr. Marty Peters: Thank you, Robin. It’s a pleasure joining y’all.

Robyn Weiss: Well, let’s get started. Tell me a little bit about yourself and a little bit about your background and how you got to where you are today.

Dr. Marty Peters: Yeah, so I’m in Newburgh, Oregon right now. I’m at my home, which is part of the farm that I initially grew up on, and so my story of coming to work here in Newburgh and be back in my hometown is really an example of what a pipeline could be from a community health center to an education program and then back to a health center. Coming out of college, I wanted to pursue a pre-medical sciences and either go into a physician assistant or medical training program. I started volunteering at Outside In, which is a community health center focused on homeless youth, but also provided care to adult populations as well in downtown Portland. And I volunteered there for a couple years when a mentor that I had found at that health center really recommended this training program at A.T. Still University School of Osteopathic Medicine in Arizona.

And he said, “I think this would be a good fit for you because they have a community health center focus and they actually have a Hometown Scholar program where a community health center, a federally qualified community health center may endorse a student and that really gives them a leg up in the application process.” And so I went through that program. I was endorsed by the health center, accepted to the medical school where we spend one year in Arizona at Mesa before being transferred back to a regional campus and we had one in Portland, so that worked out really well. And in fact in the second year you get about one day a week of training in a health center and I was able to go back to the Outside In health center that I was volunteering at before. So that’s a pretty great opportunity for me to be a volunteer, know the health center, leave for a year, and then come back to the health center on a weekly basis as a trainee.

After my second year, I did the third and fourth year clinical rotations, very much interested in staying local in the Portland area, which is a challenge frankly if you want to do family medicine. At that time, there was maybe a total of 30 training opportunities in Portland per year amongst all the family medicine programs. There was the new program, the osteopathic program in Corvallis area, which is a little south of here, but I was very lucky again that our medical school had launched their own residency program based out of a community health center, Virginia Garcia Memorial Health Center, and that was right there in Portland pretty much.

So I was able to enter into that residency program as the first year and then first year resident as the first year of the program. And then as I was coming out of that program, partner and I had a newborn son and we were looking to move back to Newburgh. She’s from Newburgh as well, and a job opened up at one of the clinics of Virginia Garcia in Newburgh. So I was able to step right into that, and I’ve been there ever since 2016.

Robyn Weiss: That is just absolutely a full circle moment. It’s just amazing how everything just fit into play. So you really found yourself even as a volunteer, learning the mission of a community health center and now being able to full circle provide that mission to patients.

Dr. Marty Peters: Yes.

Robyn Weiss: As far as your experiences with the Grow-Your-Own and the health professions education and training program, can you tell us a little bit about your experience both as a trainer now of physician students as well as being a trainee?

Dr. Marty Peters: For me, when I started out as a pre-medical volunteering at a community health center, I actually wasn’t sure what type of pathway in healthcare I wanted to take. I wasn’t even sure if I was going to do medical care. I thought I might be doing more of administrative work. At that time, I hadn’t done the pre-medical path yet, so it was really both one, the culture of that clinic, it was just an exciting place to be at the time, I’m sure it still is. They had a lot of trainers, students coming through, so there’s a lot of an attitude for teaching and training that was exciting to be a part of. The mission was very exciting to be a part of, and just the people there were all very motivated, idealistic. It was just a really positive experience, really influenced the type of career that I wanted to be in.

And actually it was through that experience that I decided to become a medical doctor or in this case a doctor of osteopathy with that level of training. And so I think that’s kind of… now that I’ve transitioned into my role where I am the preceptor taking medical students, I really want to give that experience to other people, whether we do have folks shadowing that we’ve assisted in getting experience in the health center that ultimately went on to get into medical school, and then also our medical students, our second and third year medical students that rotate with us. Just really, I think caring for the student and then caring about their education makes them not only enjoy the rotation, but hopefully if I’m doing a job, I’m sharing the joys of primary care and sharing the joys of working in a health center and that can carry forward to where they might actually consider that for themselves. Kind of like what happened to me.

Robyn Weiss: Absolutely. You’ll get to see the next full circle of student coming back into the entire role. I would love to know some of the biggest challenges that you have faced or your program has faced within this health professions education training.

Dr. Marty Peters: I guess I can speak to both my experience as a trainee and trainer. I mean, that story that I told where I went from being basically a pre-med volunteer to working at a community health center as a primary care doctor, that spanned almost a decade, and there was a lot of steps that had to happen for that to be successful. There had to be that community health center that I was with that supported trainers and students, volunteers. There had to be a hometown scholar program and a medical school that was dedicated to the health center mission and then a residency program that was based out of a health center and then ultimately a job opening at that health center. So a major challenge is to keep that pipeline open. If any one of those things had not happened, I’d be on a different path. And then as a trainer, frankly, I’m sure we have fatigue of talking about it, but the pandemic was really hard on the health centers for staffing and burnout.

And one of the first things that not just health centers but clinics and hospitals in general, one of the things that they couldn’t prioritize anymore was education. So I will say things are getting better, but the last two, three years have been really challenging to keep that pipeline open. Some of the places that we send students that have taken a lot of students have taken fewer or not at all, but that’s not universally the case. There’s been a lot of providers and clinics that have stepped up and really been there to keep our program going. Without them, we would be not able to do what we’re doing. But in general, that’s the biggest stressor is that there’s not a direct major financial contribution to taking students not immediately. It’s a very long-term goal. So when things are not going as well, when the system, the clinic or the providers themselves are stressed, then the teaching will not be as available and that’s a big challenge.

Robyn Weiss: That makes a lot of sense. It really does. I do want to just kind of explore the idea a little bit more about how having a program like the one that you’re talking about, how does it affect staff recruitment and retention? You talked a little bit about the stress and not being able to fulfill that, especially with COVID times, but are there positive effects also with staff recruitment and retention by having a preceptor model or having this teaching or Growing-Your-Own?

Dr. Marty Peters: Yeah, I can speak to that again with the different hats that I wear. I’ll try not to make it too confusing. So not with medical doctors but with medical assistants, the clinic I work for, Virginia Garcia, they launched a medical assistant training program. They’ve graduated their first class and that one you can really see the effects right away where they start the program and the whole time they’re also working at Virginia Garcia. A year later, they’ve completed the program and now they’re working for Virginia Garcia as medical assistants. And you can really see the direct impact of prioritizing those training programs and then actual staff on the ground that are making our everyday lives better. With medical doctors, nurse practitioners, physician’s assistants, that’s a longer timeline. If you want to get immediate impact on that level, I mean, honestly, residency programs are going to be the best because those are people who are ending their training and they’re looking for their next step in their career.

So the best would be to have your own residency program, which is like what happened to me or just taking residence for rotations. I’ll say that that can be sometimes difficult because there’s a lot of competition for those residents. Yeah, so to answer your question, I think taking residents is going to be… when it comes to that level of training, medical doctors, PA, nurse practitioners to take a resident, you’re really able to kind of woo them into your career more directly.

Medical students, I’ve worked for the medical school, now ATSU school for about two years, and it’s just not a long enough timeline to see those students come back because they have to complete their medical education, their residency. So that hasn’t happened yet, but ATSU does have a good record, I’d say better than most for placing their graduates in primary care and also in community health centers. So I know that even though the students that I’ve trained individually, I haven’t seen one come back into my clinic to work as a doctor, I know they are going and working at community health centers, so I know that effort is paying off. I look forward to the day when it pays off directly where they come back to work for me or work for my organization.

Robyn Weiss: That would be a success story for sure, absolutely, to have them come back.

Dr. Marty Peters: Yeah. And especially we have some students now that are in their training in medical school that volunteered for our clinic, patients that are from the community, in this case, the gentleman’s a Spanish-speaking student, and boy, that’s something that we really would prioritize at our clinic. Would be very, very helpful to have a Spanish-speaking provider. About 40% of our patient population is Spanish-speaking, and that’s the kind of student that is from the area, volunteered for us, is in medical school now and would be great if he came back to work for Virginia Garcia in his hometown someday.

Robyn Weiss: Did you recommend him for the Hometown Scholar? Is he taking the same pathway that you took?

Dr. Marty Peters: We did.

Robyn Weiss: Fantastic.

Dr. Marty Peters: Yeah, so he actually got in. He didn’t end up attending ATSU, but we did endorse him as a Hometown Scholar and he was accepted to ATSU. He ultimately chose to train at OHSU, but that’s another success. He is able to stay local, so I’m very happy for him.

Robyn Weiss: Very nice. That is a wonderful success story. Do you have any other success stories that you want to talk about either in your training or any folks that you have pushed through the pipeline or are on their way to full circle?

Dr. Marty Peters: Yeah. In my role as regional director of medical education, I facilitate six or seven student rotations at our clinic a year. Prior to that, we were taking maybe three or four students a year before I worked for ATSU, but I was still taking students from ATSU. So the number of students that we’ve had is probably over 20, maybe even more over the last six years. And so yeah, a lot of them have come out. There was a student now a doctor who came through our program, was interested in addiction medicine as a student, got some great experience working with our patients around that, went into internal medicine up there in the Seattle area, came back and did an addiction medicine fellowship and is now just finishing that. Gave a great talk to our students during grand rounds last month and is now looking to work in that field in Portland.

That’s one example of somebody who came through, went away for training, and has come back to the area. But I could talk about a lot of students that have come back, but not to our clinic, that have gone through the program that we’re really proud of. There’s another question there, which is what are some of the things that I’m proud of that I’ve done and our clinic’s done to make the experience for the student really, really rich and also some kind of novel things we’re working on. I can share some of that now if that’s a good time.

Robyn Weiss: Yeah, that’d be great. Thank you.

Dr. Marty Peters: One of the things that’s really nice about the way our schedule is set up at our clinic right now is that through the pandemic we’ve learned how to do more telemedicine. And so what we’ve done is actually build our schedule, hardwire it to do two office visits and then one telemedicine. So our entire day goes like that, two office visits and then one telemedicine. And what that allows is that break of that telemedicine, I’m still working seeing a patient over the phone or over video, but the medical assistant, the clinic as a whole can kind of get caught up. So it’s made the day run so much more smoothly and to have a student in the mix, it’s made that so much more smooth as well because a lot of clinics, they don’t have the ability to give time for teaching to the preceptor. That would be the dream to really have blocks of time in the day for the preceptor to take moments to teach as they’re seeing patients, but really not set up for that.
And that would impact patient access too much. And so this model doesn’t affect access. We’re still utilizing all those slots. Our productivity, our efficiency is still great, but we have that additional time for the student to see the patients and it doesn’t get us backed up. So we have that kind of buffer for teaching, and that’s been great, not just for when we don’t have students, it’s made our clinic run more smoothly, but when we have students, it’s made the experience both for the preceptor, myself, and the other doctor I work with, my colleague, Caitlin Karplus, and the student better. And so the other thing I want to talk about, so my clinic in Newburgh went under construction. It’s under construction presently about a year and a half build out. And I mean, it’s really under construction. We are down to just a few exam rooms.

There’s drilling and banging going on everywhere. So going into the construction this summer, we realize, “Oh, it’s going to be really hard to take students and they’re not going to get a very rich experience in this kind of construction time.” So initially we thought… when I say we, my colleague, Caitlin Karplus takes a lot of the students, we share them in the training, we thought it really wouldn’t be a good opportunity for the students. So we thought, “Oh, we won’t take them this year.” But then I had the idea, “What if we took more students?” So I had this idea to reach out to the other clinics. There’s about five clinics, there’s other smaller school-based centers, but the five big clinics and see if we could coordinate rotations amongst them. So a kind of inter-Virginia Garcia training program. The idea is it might be a lot to approach a preceptor to take a student every day or most days for a four-week rotation, but what if I just approached them for one day a week?

Or what if I approach the clinic and said, “Hey, can you take a student for one day a week, maybe shared amongst a few providers?” What I’m asking of that provider then is much less. Just a half day or a day a week. And so from that idea kind of developed a pilot program that we tested out last summer and fall. Over about six months, we took six students averaging one student per month. And we really built, I think a pretty neat training program that we piloted where the students went to different clinics one day a week. At the end of the rotation, they gave a student led presentation that was either a quality improvement project or just a topic they were interested in or that was relevant to the clinic. And then the small amount of stipend money that we get for hosting rotations because it was really impractical to divvy that up and it’d be very small amounts to give it up to all the providers involved, we pooled it for an all staff lunch at the clinics, and we did a different clinic every month to kind of spread the love.
And so we built this little training program where the clinics were able to provide an all staff lunch with a student led presentation, really contributed to morale and made the preceptors proud of the training they’re doing because then the staff that’s also involved in the training, the front desk, the medical assistant, everybody got to get a little something, a nice kind of celebratory lunch at the end of the rotation for all the hosting they do of the students. And then also some things that I got to highlight to the preceptors that maybe a lot of people don’t know about maybe that are placing other students in programs or health centers that might be interested in taking students, most health centers give a CME/PTO benefit.

So I get 40 hours a year to pursue CME. Well, you get CME for hours teaching. So at the end of the rotation, I can claim that CME for hours teaching, but I can also use my CME benefit, my paid benefit to block time in my schedule for teaching. So a lot of people don’t know about that. And so if some preceptors are kind of nervous to take a student for the first time and to say, “Hey, you get CME hours and you can block your schedule to give yourself that time so you don’t get backed up and time to teach using your CME benefit, which that’s a benefit they’re going to use anyway.” So it’s not impacting access and it’s making them more likely to teach. So a combination of those types of things, emphasizing the CME benefit, the staff lunches, spreading out the precepting across multiple clinics, made our pilot successful, I think.

Robyn Weiss: Absolutely. Those are fantastic recommendations. Is there any other recommendation you would have for someone, a clinic that’s just starting out or planning to build their own program other than the ones that you gave? Those are fantastic ways to kind of manipulate the time needed. Any other recommendations for starting a program?

Dr. Marty Peters: Most of my recommendations come from the provider side of things, so I really can’t speak as much to the administration side. We do get a lot of help on the administration side with onboarding the students, making sure they have all their logins, their computer, and those things. I can’t really speak to that. There is a commitment there that’s needed. As far as recommendations for taking students, you really have to figure out the motivation for the individual providers. I mean, that is the bottleneck. If the providers are already… because of some other reason, maybe it’s kind of pandemic fallout stress or staff shortages or something, if the providers aren’t able to take a student, that’s going to be your biggest bottleneck. And so spreading out, so I didn’t go to the same providers every month. I would kind of choose different ones and approach new ones, get involved in teaching, but then also identifying your champions.

We do have providers that have historically taken students and they take more students than average. And so identifying those people and making sure that they’re involved and to really champion the program. If you don’t have any champions at your clinic, it’s going to be hard because then you have an administrative person. Any champion providers, meaning people who are really interested in teaching that want to build the program or at least support a program. If it’s coming from the administration only and there’s not a provider that’s willing to take the lead, it’s going to be an uphill battle. But if you have a provider, if you can identify that provider and put them in the lead or put them in a good spot for leadership, then that’s going to really help.

Robyn Weiss: Absolutely.

Dr. Marty Peters: So I guess a combination of having that champion kind of spreading out the workload and then really trying to see if there’s other ways that you can give some benefits to teaching. Financial benefits work. But they’re expensive, obviously expensive. That’s not something that we have the luxury of at my program. I know other programs do. You could just do direct reimbursement for time teaching, but then the other things, the morale things, lunches, other things like that really go a long way.

Robyn Weiss: I love that. Find a champion within. Maybe even a champion on the administrative side and the preceptor side would be good.

Dr. Marty Peters: Yeah, I think you need both. The administrative building is its own building in a different part of the region, so a little disconnected from what’s going on over there. But I know that our health center as a whole champions taking students. We have students from other medical schools that come through in other programs like nursing, medical assistant as well. So that’s really important.

Robyn Weiss: You have built out a wonderful program. Well, thank you so much, Dr. Peters. We really, really enjoyed having you join us today. And the listeners, thank you so much for tuning in. We hope today’s conversation has provided you with ideas, suggestions, and insights into ways that you can approach health profession pathways programming for recruitment and retention. Be sure to check out all of the free workforce tools and resources at The STAR² Center. You can check this out at chcworkforce.org and you can also check out all the NWRPCA has to offer at nwrpca.org. Thank you again.

Dr. Marty Peters: Thank you.