Sentara Health is investing heavily in a future where healthcare revolves around collaborative, team-based care.
This shift — where physicians focus on the most complex cases and other trained professionals handle more routine care — is central to addressing the nation's growing physician shortage, Michael Hooper, MD, vice president and chief academic officer at the Norfolk, Va.-based system, told Becker's.
"That really is going to be the future of how we care for patients," he said.
The health system recently shared plans to invest $350 million over the next decade to support Macon & Joan Brock Virginia Health Sciences at Old Dominion University. The newly formed center brings together five academic colleges and schools under one entity, and will offer the largest portfolio of health sciences degrees in the state.
Separately, Sentara plans to establish new residency programs at four hospitals and expand several existing training programs over the next six years, which will increase its number of residency slots to more than 400.
Becker's recently spoke with Dr. Hooper to learn more about the health system's commitments to grow the healthcare workforce, the strategic importance of its academic partners and more.
Editor's note: Responses have been lightly edited for clarity and length.
Question: Let's start with a big question: The nation won't solve its physician shortage until … ? Fill in the blank.
Dr. Michael Hooper: The nation won't solve its position shortage until we have both a funding mechanism and a clinical training site mechanism for solving this problem. We need a ton of physicians out there to meet the clinical demand that's being created by our growing population and aging population, and just the advancements in medicine that allow very sick people to stay with us … , but they need a lot of care and to meet that demand. We need to figure out how we are going to pay for the training of physicians.
We also need to figure out all of the different places where that training is going to occur. In addition, we have to be very open and honest with ourselves about what the future of healthcare should look like. Who is performing what aspects of care in a team-based model, so that the physicians we do have are dealing with the most complicated, the most complex health problems, while other trained professionals are dealing with the more straightforward or simpler health problems.
Q: In August, Sentara unveiled a major residency slot expansion to add 160 positions over the next six years, bringing the total number to 400. I imagine this is a major investment on the health system's part. What can you tell us about 1., the investment and 2., how it fits into Sentara's larger strategy to bolster its physician workforce?
MH: What I can tell you is we put a flag post out there and decided that we're going to really make this a commitment on our health systems part to address the physician shortage in Virginia by training many more physicians in multiple different markets. The way that we're going about doing that is not only building new programs and expanding programs at our major campus, but also starting brand new programs in other markets at new training sites where we haven't done physician training before.
The overarching investment is going to be large — on the order of many millions of dollars. But there are some federal funding opportunities in some of those markets, particularly in the markets with hospitals that have not hosted residencies before. We tried to do this in a sustainable way where we're not only doing programs at hospitals where we have funding opportunities, but also looking at our major needs at our large teaching hospital and adding programs where there are less or no funding opportunities for those additions.
Both with new programs and the expansion of existing programs at our major teaching facility, we're not going to have the same [funding] opportunities there. So there will be an investment on the health systems part to make that work and we just decided that with our workforce needs and community mission, it's the right thing to do.
Q: Doubling your residency positions over the next six years is an ambitious goal. What challenges do you anticipate in scaling your residency programs, and how is Sentara preparing to overcome those challenges?
MH: In addition to the financial burden, many of these programs are going to be created in hospitals and clinical learning environments where there hasn't been robust teaching and robust learning before. So if we start those programs in a high-quality way and have a very high-quality product, which we intend to do, that requires recruitment of program directors with experience to lead those programs. It requires an academic infrastructure to support the training of the residents in those environments. And it also involves us developing our current faculty in those environments so that they have the skills and knowledge that they need to be effective clinical teachers.
Changing the culture and building the skill set of the faculty is a challenge. I think if you talk to anyone that has started a new residency program in any environment, building that faculty knowledge and expertise is always a hurdle. It's always something that you really have to invest in if you want that done very well.
While there is a need for physicians and a need for more training slots, there are a ton of physician training programs out there. So as we start these new programs, I think we are very cognizant of the fact that we have to compete for the best talent and we have to market ourselves to medical schools. Most importantly, we have to have that high quality training environment so that people want to come there, people will choose to rank our programs, so that we get the return on investment that we're looking for.
Q: What portion of physicians who train in the market tend to stay on and practice in the region? What strategies is Sentara employing to retain physicians and support their career growth once residency is complete?
MH: People tend to end up where they're from, where they have family or where they trained. We know that those are big variables when we're thinking about our physician workforce strategy. In the programs that we've had historically, we have a retention rate in the general market of about one-third. So there are a lot of people that exit the market — that choose to leave Virginia, choose to leave Sentara. We're thinking about that in a number of ways because we know there are training programs that do considerably better than that. We know there's examples of health systems with training programs retaining up to half the residents, and we really would like to be in that kind of company. There's many ways to think about that and many things to improve our retention of the people that we're training.
One of those is just giving the residents that train in our environment the best experience possible to really make sure we impress; make sure they know they're part of the team, they're part of the healthcare system here and that they're greatly impacting our community.
No 2 is partnering with our academic partner to recruit people into the training program that are invested in our community — so people that are not just trying to get the best education possible, but have an interest in investing in Virginia and care about our community.
Lastly, there's all sorts of training that you can do in a physician's journey from medical school to residency to fellowship to even now, secondary or sub-specialization fellowships that might occur. We want to be very strategic in the types of programs we offer and especially the new types of programs we develop. I want to make sure that people can be here in our hospital, in our academic health center and complete their training – so really finalize that last step.
Q: Over the next decade, Sentara plans to invest $350 million to support the Macon & Joan Brock Virginia Health Sciences at Old Dominion University — What tangible outcome(s) do you anticipate as a result of this partnership?
MH: Eastern Virginia Medical School, combined with Old Dominion University, is now part of Virginia Health Sciences at Dominion University, and that includes a new public health school, a nursing school, a health professional school and the medical schools. We have a very wide array of healthcare professionals being trained in that environment, which we think is a very strong partnership for our health system to have. We know that the future of healthcare is not just physicians, it's not just nurses, but a broad team-based approach to helping take care of our population and helping take care of our patients and all the members of our community.
We want to make sure that we're associated with those academic programs that are training all those important roles, and that during training of our physicians and nurses, that everyone learns how to function as part of that healthcare team. That really is going to be the future of how we care for patients. We expect that investment to help with workforce development not only for physicians, but across all the different disciplines that we need to be to be functional as a hospital system.
There is also a talent pull, a gravity, that you get when you're associated with a university that really starts to elevate the amount of discovery they do and the amount of quality that they bring into the community. So we see that partnership as very strategically important to us because we are the healthcare provider in the region that's doing all of the cutting edge care, and really bringing in those tertiary and quaternary types of programs that many of our patients depend on.
To attract the type of talent that we know we need to be innovative and deliver the best care for our patients, having that partnership is very important.
Q: What advice would you share with other systems looking to deepen their collaborations with university affiliates?
MH: Taking a big step back and big picture view, I think step one is really having those large, grandiose discussions about what you're trying to accomplish in your communities. I think what most health systems and universities will find is that they have a lot more in common in terms of their mission, their values and their goals than you might expect.
So building those high-level relationships and having those big discussions are very important to help build trust between the decision makers of both institutions. Once you do that, and really start to bridge into the community together, [it] helps to really galvanize people on all levels of both organizations, to improve those collaborations. I think very often, in the busyness of our jobs and the minutia and details of what we're trying to accomplish on a day-to-day basis, people lose the forest for the trees and you can end up in non-constructive conversations or disputes with other organizations.
Taking a step back and building that trust is incredibly important.