UNC Health is aiming to build a new pipeline of OB-GYNs equipped not only to practice in rural communities, but to take on leadership roles where they can address longstanding disparities in maternal care access and outcomes.

The Chapel Hill, N.C.-based system recently created a first-of-a-kind obstetrics and gynecology fellowship training program dedicated to rural women’s health. The two-year program will train physicians out of UNC Health Rockingham in Eden and UNC Health Lenoir in Kinston, which both serve rural counties. Fellows will be able to split their time evenly between providing patient care and non-clinical education, with opportunities to focus on leadership, research or quality improvement, depending on their interests.

On Sept. 3, Becker’s spoke with Kavita Arora, MD, director of the fellowship program, to learn more about the strategy behind the initiative and what the health system hopes to accomplish through the program.

Question: What factors most influenced UNC Health’s decision to launch a rural women’s health fellowship, and how did you weigh this initiative against other potential investments in maternal care?

Dr. Kavita Arora: We all know there’s a worsening problem in terms of rural maternal health care outcomes and disparities, and there are severe pipeline issues in terms of a shortage of OB-GYNs and other maternal care providers nationally, but especially in rural areas. What we have seen through supply and demand is increasingly robust offers to come practice in rural underserved areas with still not as much traction. So we wanted to approach it in a very different way — to try to think, why is it that OB-GYNs are not practicing in rural areas and filling these workforce needs?

I think some of it is that it is not how we are trained. The vast majority of us are trained in tertiary or quaternary care academic teaching hospitals that are often in urban underserved areas rather than rural underserved areas. So we’re taught to practice medicine in that system and structure and culture. For example, if you take me who is only trained and practiced in that environment, and put me in a rural critical access hospital, I wouldn’t be able to practice medicine the same way as I do currently. I wouldn’t be able to thrive, and my patients necessarily wouldn’t have the best outcomes as they would with a clinician who knows how to work within that system; who is ingrained in that local culture, understands the people, the community, the needs, the goals, and has a true partnership with the nursing and health system leadership.

So that is where the idea for this fellowship came from. We didn’t simply want to train an OB-GYN who could go practice in a rural North Carolina hospital, but rather, we wanted to train the next leader of rural OB-GYN care. So we are investing in not just a clinical portion, where fellows work clinically as a board certified or board eligible OB-GYN in the community, but they also have 50% non-clinical time. That is an investment in them, and that is almost a choose your own adventure. They can choose to invest their time in research training and get a Masters of Science in Clinical Research, so they have the skills to better research rural health disparities and apply their questions firsthand to the data that they generate through their clinical care and hopefully improve outcomes through research.

They could also decide that they’re interested more in healthcare leadership and understand some of the business, finance and leadership decisions that go into running a critical access rural underserved hospital, especially in the complex and challenging policy times that we are in now, where there are continuing and evolving threats to funding for rural healthcare. Or, they could decide that they’re interested in quality improvement and quality assurance work and want to get training in that and work in interdisciplinary teams to make bundles, transfer protocols, resources to improve the quality of care that is being delivered on site. Those are just three examples. There are potentially many more, or a sort of a mix and match approach that could be done. Our goal is that we use this two-year fellowship to really augment the clinical part, so that once the fellows graduate, they are poised to not just enter the rural health workforce, but hopefully change the workforce and the system they’re working in for the better.

Q: What does success for the program look like in both the short and long-term? What metrics or criteria are you evaluating to measure success?

KA: This is, to our knowledge, the country’s first fellowships [in this area] so we don’t have an external benchmark. But rather, for me, it would be successful if we recruit highly motivated, skilled applicants who are passionate about leading rural OB-GYN care and that they exit this program continuing to stay either at the sites where they trained or serve in other rural areas around the country, and go on to be part of the solution to reducing rural maternity care disparities.

In some ways, it’s almost sort of a proof of concept — that this is the gap that is needed in terms of pipeline building. It isn’t the only gap. We need to obviously train more OB-GYNs and we need to think more comprehensively about the whole workforce, including midwives, nurse practitioners, family medicine physicians, pediatricians, etc. But I think it is a start. I also think UNC is a unique place and the right place for it, because it is a true partnership between the academic and the community. By being a partnership fellowship between UNC Chapel Hill School of Medicine and UNC Health physician network at the structural level, we’re demonstrating that partnership between the academic and the community arms. We each bring strengths to this relationship, which allows us to be very dynamic and flexible and mold the fellowship in a way that is best tailored to each individual fellow.

Q: How is UNC Health planning to ensure these providers stay and thrive in rural communities beyond their training?

KA: We have data from the residency literature to show that where people train, they are much more likely to practice. And the same goes for fellowship. So our hope is that by being fully immersed in a local community and culture, putting down roots, living there for two years, joining a hospital, being an active member of the medical staff and having access to hospital leadership at each site will really catapult the fellows’ sense of belonging in that healthcare system.

It would be amazing if they stayed full-time as our OB-GYNs at either Rockingham or Lenore, and we would welcome that. It would also be great from a patient continuity and care standpoint. But whether fellows choose to focus on leadership, quality improvement/quality assurance or research, those are lifelong learning processes. But that’s not new for physicians, right? Providing clinical care is all about lifelong learning, and so I think the two goals really mesh together.

Q: What do you think the healthcare system continues to get wrong about addressing maternal health, particularly in rural communities? What needs to change to drive real progress in improving outcomes and closing disparities at the national level?

KA: There are three sequential phases of doing disparities research or disparities work. The first is detecting, the second understanding, and the third is reducing. That’s a framework from Kilborn. Traditionally in academia as researchers, we are mostly poised at detecting. So we report on ‘there is X, Y, Z, disparity’ period, end sentence. And then historically, our role was over. What is really important for academia and for healthcare systems to do is to move past that to the understanding and ultimately the reducing — not just passively comment, but actively get in the field and work together with community members, with community organizations, with patients and with community hospitals, to actually make changes and make those improvements. This fellowship is a prime example of that; moving past simply talking about the problems and actually working on the problem.

I also want to note that I don’t think it is solely a function of the healthcare system to solve. I think it truly is a structural, a political and a legal problem, and we need to approach it from multiple levels to make sure that we are fully investing in women’s health, in maternal care, in family outcomes and community outcomes — because when we elevate the care of women, entire families and communities thrive. We need to start there at that basic fundamental level in order to improve public health, in order to ameliorate long-term disparities across multiple axes, whether by geography, race, ethnicity, language spoken, etc.

The post Inside UNC Health’s 1st-of-a kind rural women’s health fellowship appeared first on Becker’s Hospital Review | Healthcare News & Analysis.