|The Future of Medicine in the Central Valley|
|Monday, 19 March 2012 20:15|
By Dominic Dizon, M.D.
During these times of economic woes and uncertainties, it is good to acknowledge an industry that has served as a beacon of hope and stability for the Central Valley. Our healthcare industry has grown in leaps and bounds over the past few decades, has improved standard of living for everyone, and has committed to serving our Valley population in the past and for generations to come.
However, even such a strong force is not immune to threats and problems. Cutbacks in reimbursement, a severe shortage of primary care and specialty care physicians in the Valley, and the ramifications of legislated healthcare reform have all challenged our system and will continue to engender novel and innovative ways of delivering healthcare in the future. This makes it imperative for all of us to continue to support our local health endeavors and to nurture them for sustainability and further growth.
EDUCATION – The Pipeline to Growing Valley Doctors
Essential to a continuous pipeline of doctors, is the strength and stability of education and training programs that produce them. After high school, it takes another four years of college, four years of medical school, and at least three years of residency before someone can be a licensed, full-fledged practicing physician. If one wants to subspecialize in a particular discipline, like cardiology or pulmonary medicine, they need to do another 3 years of what is called fellowship training. In terms of meeting the demands of future access to healthcare, we have absolute gems that have carried the flag of educating the next generation of doctors through the years, and we are now building the bridges that will lead to the full spectrum of medical education and training here in the Central Valley.
At any given time, there are approximately 285 residents and fellows receiving training at UCSF Fresno and the program graduates more than 70 new physicians each year. About 40 percent of these graduates remain in the Valley to practice.
Since its inception, the teaching program has trained more than 2,500 doctors. Current residencies include: Internal Medicine, Family and Community Medicine, Pediatrics, Orthopaedic Surgery, Obstetrics and Gynecology, Psychiatry, Emergency Medicine, and Surgery. UCSF Fresno also provides training for more than 30 fellows in 13 subspecialties including Acute Care, Cardiology, Pulmonary/Critical Care Medicine, Gastroenterology, Hospice/Palliative Medicine, Infectious Disease, Hospitalist Medicine, Minimally Invasive Surgery, Wilderness Medicine, Psychosomatic Medicine, and Trauma Critical Care Surgery.
This is critical to our region, where there is a definite shortage of physicians and specialists to serve our population. Because of the long process of training a doctor starts early in life, UCSF Fresno also started the Doctors Academy and Junior Doctors Academy for students interested in pursuing health careers. Both programs seek to increase the number of educationally disadvantaged students who go on to become competitive applicants to health profession schools. The Summer Biomedical Internship Program was established as well, to provide a quality biomedical research experience for high school students. The program matches high school students with UCSF Fresno faculty members who have or are developing research projects.
The UC Merced San Joaquin Valley Program in Medical Education (SJV PRIME) is an innovative approach to training future physicians, a pathway that will emphasize the quality of care anchored in community-based research and educational experiences. The diversity of the San Joaquin Valley, including health systems, diverse patient populations, and broad community partnerships, is a core component of the effort to improve the health and healthcare of the region.
The new program is a collaboration between the UC Davis School of Medicine, UC Merced, and UCSF Fresno, to train the next generation of San Joaquin Valley physicians. It is the latest addition to the University of California’s innovative Programs in Medical Education (PRIMEs), which seek to increase the diversity of the medical profession and remedy the uneven distribution of physicians in California.
On August 1, 2011, the first five students of this program matriculated and attended their first classes at the campus of UC Davis School of Medicine. Chosen from more than 150 applicants, these “Valley 5” came from Modesto, Fowler, Salinas, Fresno, and Bakersfield. Applicants to the program must possess significant knowledge of and experience in the San Joaquin Valley, including familiarity with underserved populations, public health issues specific to the region, and a desire to practice medicine in the Valley.
University Centers of Excellence
Created in 2006, the University Centers of Excellence partners with UCSF Fresno to recruit top-notch clinicians who participate in scholarly clinical research projects, help educate and train the next generation of Valley doctors studying in Fresno and provide specialized patient care. They now have 17 distinct sub-specialty facilities throughout Fresno, including the recently launched University Gastroenterology and Hepatology Associates in January of 2012.
TECHNOLOGY AND INNOVATIONS
From cutting-edge diagnostic tools to ultra-precise mapping of high-dose radiation treatment, several facilities here in town boast world-class technology that enable local doctors and specialists to effect cures and treatments without having to refer patients to the San Francisco or Los Angeles areas. Furthermore, having multiple options right here at home means that patients have choices when it comes to their healthcare and don’t necessarily have to travel far for high-quality care.
Community Regional Medical Center
Two recent innovations at Community Regional Medical Center were honored by Business Street’s Heroes in Healthcare Awards. The Lung Nodule Program at Community Regional is the only one of its kind in the Central Valley and provides patients with an expedited treatment approach designed to give a faster diagnosis and treatment for lung cancer. This cutting-edge program works in an expedited manner where patients are evaluated by a team of specialized clinicians – all targeted to occur within a week of referral. Patients benefit by reduced waiting times from detection to treatment, which ensures a greater likelihood of positive outcomes. Community Regional is also one of very few hospitals in the country to perform placement of the HeartMate II LVAD (left ventricular assist device) pump for patients who have severe congestive heart failure and are awaiting cardiac transplant. The objective is to extend these patients’ lives long enough in order for them to get a heart transplant.
The Level III NICU at Community Regional has grown from 65 to 84 beds – making it one of the largest in California. Community Regional serves as the high-risk pregnancy and birthing center for a five-county region, and has delivered the most under three pound babies in the state for the past several years.
Community Regional Medical Center was the first hospital in the Valley to earn the Gold Seal of Approval™ from The Joint Commission for Primary Stroke Centers. It’s the only program certified at that level between San Francisco and Bakersfield. Community Regional’s stroke team consists of neurologists, emergency doctors, specialty stroke physician’s assistants, stroke-trained nurses, a neuro-interventionalist and radiologist. The high-quality care continues with a special intensive care unit for neurology and stroke patients, a 20-bed unit with nurses dedicated to stroke patients, and physical, occupational and speech therapy designed and dedicated to helping stroke patients recover their abilities.
Saint Agnes Medical Center
Saint Agnes Cancer Center offers Valley patients access to advanced cancer care with its Trilogy® Rapid Arc Linear Accelerator. This technology, among the most sophisticated of its kind, combines imaging and radiation therapy in one device, giving patients access to both conventional treatments (smaller doses over several weeks) and stereotactic treatments (higher doses for smaller lesions or tumors over a shorter period of time). Trilogy® uses image-guidance technology to help clinicians identify exactly where the tumor is so they can target it more precisely, thereby protecting healthy surrounding tissue. Trilogy’s RapidArc technology also delivers doses of radiation two to eight times faster than conventional accelerators, improving accuracy and patient comfort.
Saint Agnes Cancer Center also offers the most advanced forms of breast cancer treatment – the breast SAVI® applicator. Used primarily for early-stage breast cancer, the SAVI® applicator allows physicians to customize treatment and target radiation based on patient-specific anatomy. The SAVI® applicator also significantly reduces treatment time (five days compared to six to eight weeks), minimizes exposure or harm to healthy surrounding tissue, decreases toxicity levels, lowers persistent seroma rates, and reduces the risk of infection.
Saint Agnes also boasts the world’s most advanced robotic surgery system – the daVinci SiTM. This state-of-the-art model comes with even greater capabilities than the medical center’s previous system, enabling surgeons to perform more complex surgeries than ever before. The da Vinci SiTM robotic surgical system is used for cardiac, thoracic, urological, gynecological, and general surgeries. This type of robotic surgery results in reduced post-operative pain, less blood loss, lower risk of infection, faster recovery times, and reduced length of hospital stays.
Early March 2012 marked a new chapter in Saint Agnes Medical Center’s history with the opening of its brand-new $10 million patient care floor. The addition boasts 28 new private patient rooms for post-surgical patients and an eight-bed critical care unit. With the recent opening of 6-North comes the expansion of other key areas, including the Emergency Department, which has added 20 new patient beds.
In the age of electronic medical records and telemedicine, Kaiser Permanente has led the Valley in innovative ways to help patients gain access to primary care physicians and specialists, including dermatologists. Last year, Kaiser Permanente Fresno implemented a computer program called Telederm at its four primary-care facilities in Fresno, Clovis, Selma and Oakhurst. While visiting their primary care physician, patients can now have real time consultations with a dermatologist by using the Telederm program. Photographs of suspicious rashes, lesions and other skin abnormalities can be photographed and securely sent through a computer program to a dermatologist, who can review the information, make a diagnosis, and recommend a treatment plan.
Fresno Heart & Surgical Hospital
Fresno Heart & Surgical Hospital is the first hospital in the region to install the 256-slice CT scanner. The CT scanner captures sharp, 3-D images of the heart between beats. With other slower CT scanners, drugs that slow the heart are needed to capture images of the heart and vessels. But not with the 256-slice scanner, which is also faster and needs less contrast for scans, exposing patients to less radiation.
The 256-slice CT has a larger table size and increased weight limit of up to 650 lbs. Other advantages include less patient time spent in the scanner and integration directly into the cardiac catheterization labs at Fresno Heart & Surgical.
VA Central California Health Care System
Not a stranger to using innovation and technology to improve access and quality for their patients, the VA system was the first full-spectrum adopter of electronic health records throughout the country. Recently, the VA Central California Health Care System implemented the Rural Telehealth Network for its Valley veterans and patients.
One program in particular, the Care Coordination Home Telehealth Program for CHF (Congestive Heart Failure) patients, utilizes a multidisciplinary team of nurses, primary care providers, and specialists in closely monitoring the daily nuances of this complicated chronic disease. Through this network, veterans from remote areas such as Mariposa, Yosemite, Ahwanee or Squaw Valley have direct access to much-needed health services via telemedicine when it counts the most.
Tulare Regional Medical Center
Looking further south, Tulare Regional Medical Center has brought together highly qualified urologists and sophisticated medical technology to benefit residents of the Central San Joaquin Valley. The Urology Center of Robotic Surgery at TRMC showcases an alliance with the Keck Doctors of USC in offering minimally invasive urologic robotic surgery as an alternative to both open surgery and laparoscopy.
The affiliation with USC and the purchase of the robotic surgery system precedes the opening of TRMC’s 115,000 square foot state-of-the-art Medical Tower. The Medical Tower, opening in early 2013, includes an expanded emergency department, imaging department, five surgical suites (including a hybrid operating suite with capabilities of all procedures short of heart transplants), one entire floor dedicated to labor, delivery, recovery and postpartum, and 26 new private patient rooms. TRMC will be the first hospital in Tulare County with an on-site heliport.
FACILITIES– A Welcome Growth Spurt for the Central Valley
Especially during these times of general economic slowdown, it is important to appreciate the expansion and/or creation of acute care facilities and hospitals that serve the Valley. Not only do these changes have a tremendous impact on the well being of Central Valley patients, they also provide a boost to the local economy and much needed employment source for the local workforce.
Clovis Community Medical Center
It is hard to drive East on Freeway 168 now without noticing the huge building expansion that is occurring on the campus of Clovis Community Medical Center. This multi-year $300 million project started in 2008 with the renovation and expansion of the Marjorie E. Radin Breast Care Center, a new endoscopy center, four new operating rooms, and additional room for the only Level 3 (highest level) fertility center between Los Angeles and Sacramento.
When construction is finished in 2013, the expanded hospital will have tripled in size and will have all private rooms as well as a dedicated Women’s and Infants’ Pavilion, a new Special Care Nursery, 24 intensive care unit (ICU) beds, 11 inpatient surgical suites, and a 24,400 square-foot emergency room.
Mercy Hospital of Merced
Mercy Medical Center Merced is a modern, 196-bed Joint Commission-approved hospital that recently went through major renovations in order to continue its mission of serving the Merced community, as it has for the past 85 years. It boasts a large emergency room, a 24-bed ICU/CCU/TCU, and is the major obstetrical hospital in the area. It also has diagnostic facilities often found only in larger community hospitals such as a Cardiac Catheterization Lab, CT Scanner, and MRI.
Within the medical center, the Wound Healing and Hyperbaric Medicine Center is dedicated to providing state-of-the-art, outpatient clinical wound care and hyperbaric medicine. Any patient with a wound that has not started to heal in two weeks or is not completely healed in six weeks may be a candidate for advance wound therapies. The staff and physicians at the center specialize in the treatment of chronic, non-healing wounds and utilize the newest clinical tools and clinical practices available in wound healing.
Adventist Medical Center - Hanford
Kings County recently welcomed a milestone in healthcare with the opening of Adventist Medical Center - Hanford. This new state-of-the-art accredited hospital features 142 private medical-surgical beds, six large operating rooms, a Cardiac Cath Lab, 26 emergency treatment rooms, complete radiographic imaging, an automated laboratory, 22 intensive care beds, a helipad, and computerized medical records. Each room offers a 32-inch flat-screen television with GetWellNetwork, an interactive education and entertainment system that includes a keyboard and wireless Internet access.
Kaweah Delta Medical Center
Turning over to Tulare County, we can’t help but be awed by the sprawling 581-bed Kaweah Delta Medical Center located in Visalia. Kaweah Delta’s new Acequia Wing is home to the cardiovascular center. New amenities include 12 dedicated emergency beds in the emergency room for incoming heart patients, a dedicated 20-bed Cardiovascular Care Unit, four state-of-the-art Cardiovascular Cath Labs, three dedicated Cardiovascular Surgery Suites, a dedicated Endovascular Surgery Suite (featuring a robotic imaging system), a 26-bed Cardiac Telemetry Unit, and 20-bed Cardiac Intensive Care Unit. Kaweah Delta was the first in the region to do endoscopic vein harvesting and continues to be a leader in this technology.
Children’s Hospital Central California
Finally, Madera County is home to the only children’s hospital in the San Joaquin Valley and the second largest children’s hospital in the state. The 348-bed facility is one of the 10 largest hospitals of its type in the nation.
In mid-2010, Children’s opened the Willson Heart Center’s new $4 million, state-of-the-art Pediatric Catheterization Laboratory. In May of 2011, the 60,000 square-foot, $66 million hospital expansion, named Paramount Farms Plaza, opened to its first patients. This project included new surgical suites, increased medical imaging, an expanded emergency department, and an extension of the Hospital’s Pediatric Intensive Care Unit (PICU).
Children’s Hospital Central California was also the first children’s hospital west of the Rockies to receive Magnet Nursing designation, the highest nursing benchmark in the world, and they are one of fewer than 10 pediatric intensive care units in the nation to have received the Beacon Award for Critical Care Excellence.
Medical EXCELLENCE in the Central Valley
Excellence— that is indeed a good word to use to sum up the standard to which we associate the different Central Valley programs and healthcare facilities. It generates a sense of local pride and determination that we hold our own here in the Valley and are second to none when it comes to world-class healthcare for each and every member of our region. It also embodies our hopes for generations to come and makes us believe in a bright and sustainable future for medicine in the Central Valley.
About the Author: Dominic Dizon, M.D. received his undergraduate and medical school degrees from UC Davis. He is currently medical director at CRMC and is proud to be among the core faculty at UCSF Fresno. He received his MBA degree from the Craig School of Business at Fresno State. He and his wife live in Clovis with their eight children.