Q&A with Donald L. Weaver, MD, Chief Medical Officer at the National Association of Community Health Centers

Dr. Weaver is the Chief Medical Officer for the National Association of Community Health Centers (NACHC). In this position, he is the lead for clinical workforce activities, working with state and regional primary care associations. He previously served in a number of positions with the U.S. Department of Health and Human Services, including Deputy Associate Administrator for Primary Health Care in the Health Resources and Services Administration (HRSA), National Health Service Corps (NHSC) Director, and Acting Surgeon General. Health Workforce News had the opportunity to interview Dr. Weaver about how his experiences have influenced his current work; workforce issues in community health centers; model residency programs; and updates on programs developed by NACHC.

What do you see as the most critical workforce issues for community health centers? What is NACHC doing to help address those issues?

We continue to focus on the most effective ways to staff health care teams, to support the goals of expanding the number of people we serve to 40 million by 2015 and having all health centers recognized as patient centered medical homes. Our approach requires integrating primary, behavioral, and oral health care. To maximize this outcome-driven, efficient approach, each team member needs to be able to work at the top of their licensure/certification.

To assist with the retention and recruitment of many of the team members, NACHC is actively working with our state partners to maximize the opportunities available through the National Health Service Corps.

We recognize that there is stiff competition for the limited supply of primary care clinicians. We want to do everything we can to make these clinicians aware of the variety of opportunities available at frontier, rural, and urban heath centers.

In 2010, Dr. Thomas Curtin highlighted a couple of NACHC’s programs, a partnership program with A.T. Still University (ATSU) and Hometown Partnerships for Health. Could you give us an update on these programs and their outcomes so far? Has NACHC developed more programs like these?

Both the ATSU Arizona School of Dental and Oral Health (ASDOH) and ATSU School of Osteopathic Medicine in Arizona (SOMA) were founded with the goal of seeking students with a commitment to improve the health of underserved communities. The Hometown Partnerships for Health program encourages health centers to support the applications of members of their community who have the “right stuff” to become a caring and compassionate healer who will make a difference in an underserved community. Along with helping educate clinicians who reflect the rich diversity of our country, the results speak for themselves:

1. Of the ASDOH class of 2011 graduates going directly into practice, 65 percent are choosing community settings to serve the underserved and nine are going into active military service.
2. The SOMA graduated their inaugural class in June, 2011. These are students who spent their first year at the main campus in Mesa, Arizona and the last three years in community health center based campuses. In July, 83 percent of these Doctors of Osteopathic Medicine began residencies in specialties needed by health centers.

NACHC is working with leaders of schools and programs who have expressed interest in joining a community of educators who are willing to train individuals committed to improving the health of underserved communities and vulnerable populations. We are always looking for other interested individuals, and I would be more than happy to speak with them.

The Affordable Care Act (ACA) provided funding for training in community settings, including community health centers, to encourage health care providers to practice in those areas. How is that going so far? Do you have any outcome data on whether providers are staying in those areas?

The Teaching Health Center provision of the ACA recognized the results of studies indicating physicians who do their residency training in health centers are much more likely to practice in an underserved area. Given the timing of the initiation of funding, there have been no graduates to date. NACHC is working with other organizations to track the results as we believe they will document these graduates serving in high numbers in underserved areas (hopefully in health centers).

How are community health centers using interprofessional health care teams?

Health centers continue to feature the team approach to caring for the whole person. These teams include primary care physicians, nurse practitioners, physician assistants, certified nurse midwives, dentists, dental hygienists, psychologists, social workers, nurses, and health coaches/navigators/promotoras. The goal is to have patients participating in their care with each appropriate member of the team.

Do all health centers use care teams?  Is this required by their grant?

While the team approach to service delivery is not a grant requirement, teams have been the foundation of health center services rooted in community-oriented primary care.  The composition of interdisciplinary teams varies by health center.  Team composition is determined by community needs and what is allowable in a given state.  Team members provide a range of services including primary and preventive care, oral and behavioral health care, and enabling services. We believe the team approach to care maximizes opportunities to become patient centered medical homes and achieve the “triple aim” of improving the patient experience, improving the health of the community, and bending the cost curve.

Could you share examples of community health center programs that are training health care providers to work in teams and use health information technology?

We have examples that range from a long-standing residency training program in Worcester, Massachusetts to an evolving consortium in Southwest Georgia; and from a Teaching Health Center in Central Washington to a residency program that became a health center in Texas.
The majority of health centers are in the process of meeting meaningful use standards for HIT and NACHC is in the process of finalizing the results of our survey on health centers involved with the education of health professionals. We were not surprised to find a large number of health centers who teach. At a recent meeting of our Clinical Practice Committee, one of our members said teaching is “part of a health center’s DNA.”
Recognizing the need to strategically extend and improve our education efforts, NACHC’s Chair recently appointed an Educational Health Center Task Force to build on the “DNA” that is already in place.

You bring a lot of experiences to your current work with NACHC – having served as a NHSC physician, Acting Surgeon General, and Deputy Associate Administrator for Primary Health Care at the Health Resources and Services Administration. How have these experiences influenced you? How do they inform your current work with NACHC?

These experiences have provided opportunities to see what can be done to improve the health of underserved communities and vulnerable populations from the local, regional, and national perspectives. The common threads of success include patient/community participation and committed leaders with a “can do” attitude.

Dr. Don Weaver can be reached at dweaver@nachc.com or 301-347-0400.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.