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Turn Up the Volume

Head for the Hills isn’t the only event for rural healthcare providers this fall; the Virginia Rural Health Association will be hosting their annual conference October 13 & 14.

For twenty years, the Virginia Rural Health Association has served as “The Voice for Rural Health in Virginia.”  Now they are asking you to turn up the volume on that voice.  Rural hospitals, clinics, providers and students are under greater pressure than ever to provide services in an increasingly challenging environment.  For their 20th Anniversary, VRHA is asking all rural health stakeholders to raise their voice with us and help call attention to the needs of Virginia’s rural citizens.

The Annual Conference of the Virginia Rural Health Association is an opportunity for the people and organizations that serve Virginia’s rural population from across the Commonwealth to meet.  The event is filled with workshops, keynote speakers, poster presentations, networking and an Exhibit Hall.  The people who attend the event are as diverse as the VRHA membership: hospital executives, academic faculty, clinic staff, government officials, health professions students and more.

Bringing the people who care about rural Virginia together provides an opportunity to discuss how we can ensure the sustainability of rural Virginia through policy, access, economics, education and more.

Turn Up the Volume!  Click here for details.

Lodging at the Hills

Oh, the views…170-Stateline-Overlook

One of the highlights of the Head for the Hills event is being able to stay in accommodations with views like this:


If you’ve attended Head for the Hills in the past, note that lodging arrangements are a bit different this year.

You will need to reserve your own room.  For reservations please call BREAKS INTERSTATE PARK directly at 276-865-4414 Ext. 3201.  They will require your credit card to hold the room.

PLEASE NOTE that your card will be charged at the time you make the reservation.  BUT – when you attend Head for the Hills, you will receive a check from us for $75/night (room fees are $70 + tax). This policy has been implemented to preserve funds lost due to no-shows. Everyone who attends will reimbursed for their room costs.

Note that the deadline to reserve a hotel room is September 15th.  That’s also the deadline to cancel a room you have reserved and still be able to get a refund from the hotel.  In the event of problems or questions making a hotel reservation, the park contact is Vickie Swiney ( 276-865-4413 Ext. 3203).

Because you don’t want to miss out on the views…



What to do in the Hills?

Let’s face it – while Head for the Hills is a fantastic educational event, it also reflects the old adage, “location, location, location.”  Why do the educational sessions end at 12:30 each day?  So you can go have fun!

Head for the Hills will be held again this year at the Breaks Interstate Park.  It will be October, so the fall leaves will be at their peak.  That means:

“Bountiful nature, as richly colored as our mosses underfoot, our mountains on the horizon, and our sky overhead.”

The Breaks Interstate Park boasts 4600 acres, more than 25 miles of walking trails, and a 5-mile gorge plunging to 1650 feet known as the “Grand Canyon of the South.”  Activities include guided hikes, biking, geocaching, birding, pedal boats/canoes and fishing (some activities have a fee).

If you’ve been to the Breaks before, that might sound too familiar, so check out their new activity – Elk Watching!

Not into the great outdoors?  You can venture off site to the Ralph Stanley museum in neighboring Clintwood, or ACT Theatre in Elkhorn, KY.

Bringing the kids?  There is child care available during the educational sessions, hay rides later in the day, a playground, and magician Joseph Young!

Visit the main Head for the Hills page for details about registration, lodging and links to the educational session descriptions.  See you there!





More Head for the Hills

Here’s a few new session descriptions for the upcoming Head for the Hills event:

Curbside Consults, Bob Franko

Embedding behaviorists into primary care has many benefits in both clinical and financial outcomes, but to achieve those outcomes is often harder than it looks. Cherokee Health Systems (Knoxville, TN) offers a mature integrated practice that has nearly 40 years of development to its credit, today serving over 65,000 patients in 56 clinical locations across 15 counties in east Tennessee.  We will describe the clinical model and define the key roles, as well as talk about the specific billing and coding challenges related to an integrated practice. “Curbside consults,” “warm handoffs,” and team meetings are terms associated with integrated care, but are widely misunderstood by both providers and payers. We’ll define these practices and how to discuss them with payers.

Nutrition Economy in a Food Oasis, Kelley Pearson

Living on a tight budget means careful consideration of food choices. Chef Kelley Pearson discusses how a family of two adults and five kids at the poverty line shops local and eats mostly good stuff. Kelley also runs a restaurant that serves non-processed foods, and has “fought the good fight” on what patrons will and won’t pay to eat. Listen to her witty, wise, and informative discussion of the difference between “medical advice” and “plausible lifestyles” in SW VA. Extra Q&A time has been scheduled so you can get insights from someone who has been there, done that.


Click here for the main event page and here for additional session descriptions.

Head for the Hills!

What’s on the schedule for the 2015 event?  Check out these great presentations:

Anxious Kids – A Primary Care Approach- Meds & More: C. Allen Musil, MD

A discussion of the 3 classes of medication commonly prescribed to treat childhood anxiety, appropriate reasons to initiate medication in an anxious child, common side effects of SSRI treatment in children.  Will include things a primary care provider can do when interacting with school systems, when treating a child/adolescent with school refusal second to anxiety.

WIC Works:  Jessica Arney, MS, RD, LD

Overview of the WIC program including the immediate benefits of nutrition education, counseling, supplemental foods and breastfeeding support.  I will also talk about the long term positive health outcomes associated with participation in the program.  I will be able to discuss the differences between WIC and SNAP and answer any questions about the program.

Opioid Abuse and Overdose: Recognition and Management: Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP & S. Hughes Melton, MD, MBA, FAAFP, DABAM

REVIVE! is a program of the Commonwealth of Virginia which makes naloxone available to lay rescuers to reverse opioid overdoses. A collaborative effort with the Virginia Department of Behavioral Health and Developmental Services (DBHDS) taking the lead, the project includes the Virginia Department of Health, the Virginia Department of Health Professions, recovery community organizations such as the McShin Foundation, OneCare of Southwest Virginia, the Substance Abuse and Addiction Recovery Alliance of Virginia (SAARA), and other stakeholders.

Cheap Meds:  Melody Counts, MD

Medical schools often teach us the best medications for a given medical condition without much regard for the cost to the patient.  In the real world, prescription medication cost can be a huge barrier to uninsured or underinsured patients.  This presentation will review the various resources for discounted and free prescription medications, as well as the reasons why a practice would want to invest time in utilizing them.

ADHD: What’s new? Roger Hofford, MD

This session will review some of the new information published, review the current treatments, present a treatment algorithm, and review recent Virginia and North Carolina Medicaid data plus CDC data.  Dr. Hofford recently chaired a work group of the Virginia Department of Medical Assistance Services Managed Care Physician Liaison Committee created by the Governor and the General Assembly in 2013.

Visit the main Head for the Hills page for registration and lodging information.

More session descriptions are posted here.

Check out that map!

JMH inaugural residency class dinner

Opening slide for Johnston Memorial Hospital’s Inaugural Residency class  dinner presentation



Double-click for a full-screen version.

So what’s on that map?  These are the Family Medicine, Internal Medicine and Pediatric residencies in Virginia (blue = MD, red = DO).   The counties are color coded by their County Health Status ranking.  Very light colors are the best rankings, dark green – the opposite.

Here’s the full list of the residency slots depicted on the map:

  1. Wellmont FM (DeBusk)
  2. MSHA Norton Community Hospital FM
  3. MSHA Johnston Memorial Hospital FM and IM
  4. HCA Lewis Gale Hospital – Montgomery FM
  5. HCA Lewis Gale Hospital – Montgomery IM
  6. OMNEE Carilion Clinic IM
  7. OMNEE Carilion Clinic FM
  8. VCOM Carilion Clinic FM with Pediatrics
  9. VCOM Danville Regional Medical Center IM
  10. VCOM Danville Regional Medical Center FM
  11. Centra Health FM
  12. UVA FM with Pediatrics
  13. UVA IM
  14. Bon Secours FM Rural VCU (St Francis)
  15. UP KYCOM Shenandoah Valley FM (Front Royal)
  16. VCU Shenandoah Valley FM
  17. VCU Chippenham and Johnston-Willis Hospitals Chesterfield FM
  18. VCU IM
  19. VCU Falls Church FM with Pediatrics
  20. Inova Fairfax Hospital IM with Pediatrics
  21. National Capital Consortium Ft Belvoir Hospital FM
  22. OMNEE Riverside Regional Medical Center FM
  23. VCU Riverside FM
  24. Eastern Virginia Medical School Portsmouth FM
  25. Naval Medical Center of Portsmouth IM with Pediatrics
  26. Eastern Virginia Medical School Ghent FM
  27. Eastern Virginia Medical School IM with Pediatrics

Do you have comments on the implications of this map? Do you know of other residency programs that should be included? Let us know!


GMEC logo

Why the wait?

What makes a general practice doctor good?  Or even great?  Sometimes, it’s how long you have to sit in the waiting room.

One Appalachian doctor was recently asked why an appointment for 2:40 wasn’t seen until after 3:00.  Her fantastic response outlines the realities for many physicians.  A test result came back positive for cancer – advanced cancer.  One patient can’t afford medication. Another’s spouse died.  All in a single day.

“One reason we are late: we take time.” 

Great doctors don’t see their patients as data on a chart.  They see real human beings with unique problems that can often only be addressed by their primary care provider.

Visit the Rapha Family Wellness site to review the full article.

Hands On!

Active learning vs. lecture:  What works best?  According to a recent review of students in STEM classes, those with hand-on lessons have higher test scores , while those in traditional lecture classes were more likely to fail.  As one article notes –

We know that learning is harder from the sidelines. If deep understanding is the objective, then the learner had best get out there and play the game. 

So how does that apply to medical education?  Students who are in a rural track at medical schools and students who have a preceptor in a rural region are able to interact with patients sooner – and learn more.

For example, at the Quillen College of Medicine, medical students can start working directly with patients as early as August in their first year by volunteering at the College’s free clinics.  Whereas students in urban programs may not have any patient interaction until well into their second year.

Click here for more on the new active learning research.

Graduate Medical Education – Part 2

Last week, we started a discussion on, the 22nd report from the Council on Graduate Medical Education, titled; “The Role of Graduate Medical Education in the New Health Care Paradigm

Let’s look at one of the recommendations in the report (p. 14):

Recommendation 1: GME training should be expanded in ambulatory and community sites to reflect the current and evolving practice of medicine.

Rationale: As the proportion of health care delivered in ambulatory sites increases, the percentage of GME training that occurs external to inpatient units in ambulatory sites needs to be expanded to prepare graduating physicians for medical practice. GME trainees must be provided with educational experiences in practice environments where new competencies are utilized.

Consider the practice environment of Southwest Virginia –  Rural communities, high percentage of persons who are uninsured/underinsured, high percentage of persons with comorbidities, limited access to behavioral health and specialty care.

GME is responsible for upholding a social contract with the public it serves.  A physician in this area must be able to do multiple things and needs a broad scope of training.  Southwest Virginia is a great training area for those who want to do many things very well, not the same thing over and over.

We want to hear from you!  What do YOU think could be done to make sure physicians trained in Southwest Virginia are “provided with educational experiences in practice environments where new competencies are utilized.” ?





The Role of Graduate Medical Education in the New Health Care Paradigm

Recently HRSA released the 22nd report from the Council on Graduate Medical Education, titled; “The Role of Graduate Medical Education in the New Health Care Paradigm

We’ll spend the next few weeks providing some highlights and commentary.

Challenges and Opportunities in Expanding GME Experience (p.17)

“Although the data on the impact of training sites on the quality of care provided by GME graduates is limited, there is a common misperception that only training in large academic centers can produce graduates who have the skills to provide high quality care. Asch and colleagues have found obstetrical outcomes are affected by training site, linking quality of training site with the outcomes of care provided by the trainees. However, other studies on this topic leave doubt about which markers should be used to evaluate physician practice quality in relation to residency training sites.

“In addition to concerns about quality of teaching and patient care in community and ambulatory settings, another barrier to expanding GME training to these sites is the lack of financial support for community-based programs. Present payment and training incentives for community-based training are insufficient to develop and maintain these ambulatory and community-based programs, even though it costs less to provide patient care and GME training in these sites, than AHCs and other teaching hospitals. The increased costs of AHCs and other teaching hospitals are in part due to their higher patient care costs. This includes the number of underinsured, biomedical research missions, and the maintenance of standby capacity for medically complex patients, in addition to the expenses incurred by teaching programs.”

For GMEC, this is key as training in Southwest Virginia offers the local, ambulatory, outpatient experience.  On page 23, the report states, people “expect the medical education system to produce physician specialists who reflect the cultural and economic characteristics of the patients they serve“.

With this expectation in mind – the medical education community needs to recognize that the only way to fully prepare a future physician to serve in rural Appalachia is to train that student in Appalachia.  Reviewing information about rural Southwest Virginia is not sufficient to produce a culturally competent doctor – immersion is required.