Into the Breach
Date: April 1, 2010
A new training program prepares young doctors to meet the challenging health needs of inner-city families.
It’s not uncommon for medical students like Paul Doherty, working and studying in an urban academic hospital, to witness firsthand the toll poverty takes on the health of inner-city residents—addiction, abuse, a child with severe asthma living in substandard housing, adults with AIDS.
But while other medical school graduates head off to train in more traditional specialties, Doherty and three other newly minted physicians will take part in a new residency program launched by the departments of Medicine and Pediatrics that focuses on addressing the health needs of inner-city families.
The residents will receive six years of training at The Johns Hopkins Hospital to manage the myriad health problems—from high blood pressure and diabetes to alcoholism, AIDS and domestic violence—that plague the inner-city poor.
After four years of joint training in medicine and pediatrics, graduates will be board eligible in both internal medicine and pediatrics, so they’ll be able to treat the whole family, says internist and pediatrician Rosalyn Stewart, who is the associate program director. The urban health residency graduates will then undertake a two-year work-study program, most likely with Johns Hopkins Community Physicians and primarily at inner-city Baltimore sites.
The young doctors will also receive tuition support to obtain a master’s degree in public health, a master’s in business administration, or a similar advanced degree in their area of interest while practicing part-time as primary care physicians.
When he was interviewing for residencies, Doherty, a 33-year-old from Waynesboro, Va., says he was most impressed by Hopkins’ determination to work with city agencies and organizations to improve public health. Hopkins professors not only introduced him to Olivia Farrow, the city’s acting health commissioner, but also discussed preliminary plans to establish relationships with the city prison and a shelter for women who are victims of domestic violence.
“The urban focus emphasizes the social medicine issues that people tend to skip over,” explains internist and pediatrician Lenny Feldman, the program director. “Our residents will learn in depth how to best treat substance abuse, psychiatric illness, urban violence issues and HIV.”
He says confronting urban violence or substance abuse requires treating “all of the facets of that issue.” By treating an entire family, these specially trained physicians can address problems that are difficult to treat in isolation.
The directors hope that the urban health residency will also build better ties to the community that surrounds Johns Hopkins’ East Baltimore campus. “Many people believe that there’s a large chasm between what goes on in research institutions [like Hopkins] and what’s actually happening in the community,” Feldman says. “One of the goals of this program is to help bridge that chasm.”
Funding for the program comes in part from the Osler Center for Clinical Excellence at Johns Hopkins and the Josiah Macy Jr. Foundation, as well as a grant from the federal Health Resources and Services Administration. Feldman credits the “phenomenal” support from the Hopkins Medicine leadership and administration for the speed at which the program has developed in only 18 months.
“Hopkins is in the business of creating leaders, and we all know that we haven’t created enough urban health primary-care leaders,” he says. He’s confident that physicians emerging from the urban health residency program will be able to improve the health care of patients in urban settings around the country.
That mission is tailor made to Paul Doherty’s interests and background. After graduating from the University of Virginia with a degree in biology and environmental science, he served in the Peace Corps, working first on sustainable agriculture in Kenya, then increasingly on HIV education and prevention. Later he worked in legal services at the Whitman-Walker Clinic, an urban health center in Washington, D.C., that treats the uninsured and underinsured and offers culturally sensitive care to patients who are gay, lesbian, bisexual and transgender and those with HIV.
“A number of people who live in the community have chronic diseases,” Doherty says, “and come to the hospital more often than they would if their outpatient care better met their needs.”
The system is just not set up, he adds, to be sure people are doing OK day to day. “All of a sudden they’re coming to the ED because they can’t breathe, or they come into the hospital every couple of weeks suffering complications from heart failure, chronic obstructive pulmonary disease, or another condition that isn’t being well managed,” he says.
“Not only is that an inconvenience to that person, but is that the best way to use our health care resources?”
Doherty and his three other residency colleagues are poised on a professional journey to answer that question.
Linell Smith and Stephanie Desmon contributed to this article
Learn more about the urban health residency program at http://www.hopkinsmedicine.org/medpeds_urban_health/.
The inaugural trainees in the urban health residency program
Paul Doherty (Johns Hopkins University School of Medicine)
Monica Mix (Yale Medical School)
Deanna Wilson (Yale Medical School)
Sara Mixter (Harvard Medical School)