Elisa Arespacochaga (Host): Health system leaders are facing persistent workforce shortages and widening access gaps, particularly in primary care and rural and underserved communities. But what if part of the solution is already in the pipeline?

Welcome to the AHA Bringing Value Series from the American Hospital Association. In this series, we speak with AHA business partners and learn how they support AHA hospital and health system members.

I'm Elisa Arespacochaga, Group Vice President of Clinical Affairs and Workforce at the AHA. And today, I'm here with my good friend, Dr. Robert Cain, President and CEO of the American Association of Colleges of Osteopathic Medicine. Join us as we explore the immense opportunities for hospitals and health systems to strengthen their physician workforce by partnering with their local colleges of osteopathic medicine. Dr. Cain, welcome.

Dr. Robert Cain: Thank you for having me.

Host: Let's start with the issue at hand. Over the next decade, we know that physician shortages are expected to worsen, most acutely in rural and underserved communities, as I said, specialties like primary care. At the same time, you've got an aging population. You've got Americans seeking quality healthcare that's affordable, accessible; provides better health outcomes. How is osteopathic medicine already training physicians to meet these needs today and into the future?

Dr. Robert Cain: Well, thank you for the question. And certainly, there's a lot packed into that, isn't there? And I think the good part about osteopathic medicine is that, over a century, our community has been quietly developing within this healthcare system, and we've reached this sort of critical mass where we're a lot more visible and able to be talking in shows like this about how we can contribute to changes the healthcare system. We have been building our schools in locations where they're needed. We've been connecting to the community side of the healthcare system. And we're prepared to be able to deliver care in the places where Americans need it most.

And as you said, you mentioned that rural and community piece as a community, a significant portion of our schools, a little less than 50%, are actually in rural adjacent areas. So, that's important. Over half are in underserved areas. That's important. And when we think about our graduates, first of all, 30% of medical students today are earning the DO degree. Almost 10,000 students entered our schools this year, so significant from a workforce standpoint. And when they graduate, over half will enter into primary care residencies.

Host: Well, and I love the fact that we know where you train, where you go to school very much drives where you end up practicing. So, I love that you're already putting the schools in the communities where they're in of most need. Dr. Cain, can you tell me a little bit about how osteopathic medicine is uniquely addressing the challenge of access, particularly in rural and underserved areas?

Dr. Robert Cain: You know, our history is really pretty interesting. Our first school was founded in rural Missouri. And so, our whole history as a profession is tied to rural. So, this, for us, is not just a conversation. It's very much part of who we are. It's in our DNA. And if you look at our College of Osteopathic Medicine, let's start with placement.

First, we have a significant number of our schools that are rural adjacent, and we have a significant number of our schools that are in underserved areas. Our schools have expectations for our students to complete either rural rotations or rural training, or rural is a component of their education. We actually have completed a set of rural competencies so that we're better preparing our students for those locations.

The outcomes from our standpoint, I think I've mentioned that, over half of our graduates go into primary care. But if you actually look at the results, we are placing students above the national average into rural settings after completion of their residency and into underserved settings. So both of those, I think, are important in terms of the outcomes.

How are we doing that? So, it's not just that we have expectations for the students to do rotations and to be involved in those communities, although that community connection is really important. It's the idea that the schools have a mindset of draw from a certain area, train in a certain area, and then retain in a certain area. So if you bring students who are from small communities and rural areas, they are much more likely to end up practicing in those rural areas and then entering primary care as well in those areas. So, the schools have set themselves up well based upon their missions to select people who are more likely to enter and practice into those spaces.

Ultimately, our data are showing great placement from that. In some of our states, Mississippi and Alabama in particular come to mind, over 30% of graduates staying in rural areas. And if you look at the results, recently of US News & World Report, our schools dominate in the top 10 for rural practice and primary care entry.

Host: So, how are you seeing those partnership models? And what's being effective as those colleges that are in these communities? How are they partnering with the hospitals and health systems locally to really build a sustainable pipeline?

Dr. Robert Cain: So, one of the things we talk a lot about within the association with our colleges is the triad of medical school, teaching institution, and the community. And again, if you think about the first part of my answer, we've been building our schools in a part of the healthcare system that has been, in many ways, traditionally overlooked. It's not where people would have thought to put medical schools or to connect into the teaching institutions. But we've been bringing that part online and making it an important, contributor to this model.

So, that particular triad we think is important. We have some great examples of how we have managed to make those connections. In northeastern Pennsylvania, the city of Scranton, a few years ago, we were approached by the community government, the city government, a local college, and the healthcare systems to bring together several of our colleges to say, can we help them to meet some of their needs to create the clinical rotations and to strengthen the healthcare system?

And through that strong partnership created a consortium that now involves several of our schools all aligning their work, to put students into that community. And the good part is by including the community as part of the conversation with the healthcare institutions, you had them looking far into the future trying to think about what it is that Scranton needs.

And as we are working to complete that pilot, we find ourselves now thinking, "Well, how many other Scrantons are there in America where we could have those types of conversations and perhaps help those local communities meet their healthcare needs?"

Host: I love that example because it's really about how you are coming in and not as we know everything, but we want to be your partner. We want to work with you to provide the care and the team that you really need here. I just love everything about the approach in Pennsylvania.

So, how can hospital leaders start to do that work that Scranton has done, understand what their community level workforce needs are, their economic needs, strengthen that business case to make those partnerships because they do take work to build. Like, how do you get everybody to the table and wanting to stay at that table to do this work?

Dr. Robert Cain: You know, I don't know that there's any particular secret to how that happens except persistence and real commitment, what you were already talking about. Sometimes what happens in these conversations about building teaching sites for students or even creating graduate medical education, it becomes very transactional and the endpoints become very transactional.

And I think one of the keys that we've discovered over the years, certainly as I've been in this role and in prior roles, is that we have to care as much about the pain points that the people have on the other side of the table as they do if we really want to move these conversations forward. And again, being inclusive to make sure we have all the right people in the conversation.

In the past, I think the tendency was medical school and institution. But by adding that dimension that we did in Pennsylvania of the community and other local education resources, it really helped to accelerate that. And of course, trust takes time, right? Getting to know each other and to outline where you want to go. But having a vision for what that future could look like, and beginning to put the right people at the table.

The other thing I might mention, I think it probably is appropriate here. In the past, we worked off of a lot of anecdotes. You know, that we could see this happening, a century of work. We could see the effects. But over the past two years, we've actually created two foundational reports for us, one that looks at the workforce and economic impact of osteopathic medical education, and one that looks at the research being done by our colleges of osteopathic medicine. And the good part is, just like those organizations, the institutions are doing their workforce and economic impact studies, it really creates the space to start to line those up and say, "Well, where can we help each other? What are we doing to make sure that you're getting the workforce that you need, reducing some of your recruitment costs by actually doing that training on site?" As we think about research, the idea that there are so many aspects of research that could be done in those community settings to advance many of the major problems that we see in terms of chronic diseases, and what effect in aging population. So, I think part of the answer to what you're asking is sitting down, getting to know each other, and building out that plan.

Host: Yeah, I love that. And I think that's part of this. The other piece that I might ask you about is I know that one of the things that we hear quite a lot at the Hospital Association is the importance of being able to keep people in their communities when they're receiving care and being able to have that access where they are so they're not driving 100 miles to see some specialist for a specific need without having that support at home. And I think that's one of the things that you're getting at a little bit is just being able to really understand what's going on in the community. Do you have any additional data around some of the impacts that's having?

Dr. Robert Cain: One of the areas of interest, this is an anecdotal story, but it's an important one that addresses what you're talking about. I appreciate that many of the larger centers have started reaching out into smaller communities and are in some places trying to salvage hospitals that might otherwise close.

But the question is, how well are they coming to understand those communities, right? And to really be able to support them. And we actually have an example within our osteopathic community, the Cleveland Clinic, that, as it could have chosen any medical school in the country to partner with as it was looking how best to support its community-based institutions, it selected the Ohio University Heritage College of Osteopathic Medicine.

And they did it because of the things we're talking about, this idea that they could connect to those communities and the primary care experience that our schools were able to bring to the table so that that could help to create a stronger partnership for both institutions and to better meet community needs. So, definitely a critical part of that as the healthcare system continues to evolve and change, that those voices aren't lost and that those local communities are heard.

Host: Absolutely. I think there's a lot of value in being able to understand what are the ways you can build those partnerships. And at the end of the day, we're all here to make care better for patients. And so, how can we take advantage of the amazing skills and connections that exist locally while also making sure we're making available all the expertise that exists nationally?

As we start to wrap up, if you could ask or tell AHA member hospitals and health systems three concrete actions, I like the number three, that they can take in the next year, what would they be and how can AACOM help support that work?

Dr. Robert Cain: My first one is, actually, I think relatively simple: get to know us. We are a growing community and growing organization. I started this off by talking about the number of students that are earning their DO degree, how they will ultimately contribute to the workforce, our growing number of colleges.

We are trying to make sure that we are addressing challenges in the healthcare system and trying to be part of the solution. So, I would say please try to get to know us. Become partners with us to build pipelines to practice for rural and underserved communities for a more sustainable environment. And certainly, from our standpoint, we can serve as a connector and convener, right? We have the data, as I was already mentioning, and those reports to be able to share with interested parties. And we could certainly talk about best practices in that community setting.

I guess for the second, consider how you can expand training capacity in the community-based settings. And so, the experience of Scranton was to look at—they had some history of training medical students. And it turned out when we looked at that community, there was actually more capacity than they realized. And so, the idea that by getting creative and thinking about what's available, that you may be able to do more.

And what we appreciate about that community-based setting is students training in those settings mirror the places where everyday Americans are receiving their care and the bulk of healthcare is being delivered, right? So, I think, consider that. And again, our ability is to try to bring groups together and actually try to convene those conversations, putting our member institutions at the table with the healthcare institutions and thinking about what that might look like.

And finally, consider working with us to address the long-term workforce strategies in this sector of the healthcare system. that's where we have the most experience as a community is dealing with small and medium-sized communities and rural settings. And so, there's an opportunity to use that history to work with institutions that have the same history to try to think about ways that we could better produce physicians for their communities.

Host: Wonderful. And I think we could probably do a whole another podcast on the subject of how training has to keep up with AI and technology and all of the things that are happening and all the changes that are happening to healthcare. So really, those partnerships are so essential to being able to react and be ready for what the community needs.

Dr. Robert Cain: I appreciate your comment about technology because especially as we think about rural settings and smaller communities, making sure those institutions have the access to the same technology and the same capabilities so that patients get no less in those communities than in other parts of the country, definitely major challenges and certainly conversations that are happening inside our institution as well.

Host: Absolutely. Well, Dr. Cain, thank you so much for joining this podcast and sharing your insights, and I know we could talk for another probably two hours. For our audience, if you would like to learn more about the American Association of Colleges of Osteopathic Medicine, please visit aacom.org. This has been the AHA Bringing Value Series, brought to you by the American Hospital Association. Thanks so much for joining us.