Health Report: Training the doctors of the future

SAN DIEGO (KUSI) – Each year thousands of students graduate from medical school and can finally call themselves doctors of medicine.

But additional years of training are required before they can treat you as fully licensed physicians.

That training is commonly known as an internship or residency, and is done under close supervision often at teaching hospitals. San Diego County has some of the best in the nation.

Scripps Mercy Hospital San Diego is one and has the longest existing education program in the region. Its sister campus, Scripps Mercy Hospital Chula Vista, as well as Scripps Green Hospital are also teaching hospitals.

What’s it like to train the next generation of doctors?

Marianne McKennett, M.D., director of the Scripps Chula Vista Family Medicine Residency program, trains primary care doctors and discussed the challenges the next generation of doctors faces amid a changing health care landscape.

Q. Where is the greatest need in medicine today and what is being done?

A. As traditionally underserved communities gain more access to care through the Affordable Care Act, it will be important to have enough primary care physicians to provide preventive care and chronic disease management.

Last year, the American Academy of Family Physicians launched a campaign to address the growing primary health care needs of the nation. Evidence shows that access to primary care can help us live longer, healthier lives. A primary care-based system may cost less because of the need for fewer hospitalizations, less duplication of services and more appropriate use of technology.

Q. What is training like today for primary care physicians?

A. I trained as a family medicine physician 30 years ago. The general principles of providing comprehensive primary care for people of all ages remains largely the same today but the structure is different. Back then, we were on-call in the hospital for 36 hours at a time, several times per week. There was less direct supervision from attending physicians. This may have led to more independence but was not ideal for resident well-being or patient safety. 

We did not have access to the immediate or real time clinical resources that we have today. We carried our “peripheral brain” as a notebook in our coat pocket. With expanding technologies, medical residents today can use their smartphones to look up the latest clinical guidelines and use apps to direct patient care in the exam room or at the hospital bedside.

Q. What are some medical challenges that our next generation of doctors are preparing to meet?

A.  New skills and competencies are needed for today’s patient-centered, medical home model of delivering primary care. These include leadership skills to perform effectively in an inter-disciplinary care team. At Scripps Mercy Chula Vista, our residents get hands-on experience as part of a multidisciplinary care team that includes a nurse, medical assistant and behavioral health professional. They learn to provide care using innovative models such as group prenatal visits and integrated behavioral health services.

Q.  What are health care providers doing in our region to address border health needs?

A. The Scripps Family Medicine Residency Program is sponsored by Scripps Mercy Hospital Chula Vista but it is really a collaborative effort with many partners, including the University of California at San Diego, the San Ysidro Health Center, and the San Diego Border Area Health Education Center.

Our family medicine residents see more than 12,000 patients every year at the Chula Vista Medical Plaza.

We know this type of collaborative model is needed in our border communities. Data shows that more than one third of U.S. border families are living at or below the federal poverty level. Many lack of access to primary health care, health insurance and adequate transportation. There is also a shortage of bilingual and culturally competent health professionals.

Q. What do you look for in prospective residents?

A.  We look for commitment to community medicine, cultural competence, and scholarship. Half of our entering residents are members of under-represented minority groups, reflecting the cultural and ethnic mix of the region. Seventy percent of our graduates have chosen careers that address the needs of underserved communities.

For more information, visit www.scripps.org/KUSI or call 858-240-5075.