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Becker’s Healthcare Podcast
Transforming Pediatric Care in Rural Georgia with Marc Welsh & Dr. Jean Sumner
00:20:04
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- [00:00]
A
Welcome to the Becker's Healthcare Podcast. I'm Chris Sosa, your host, and I'm thrilled to be joined today by Mark Welch, who is vice president of Children's Advocacy for Children's Healthcare of Atlanta, and Dr. Jean Sumner, who is dean of the Mercer University School of medicine. Mark and Dr. Sumner, thank you so much for joining us today.
- [00:16]
B
Thank you. Glad to be here.
- [00:17]
C
Thank you for having us.
- [00:19]
A
Excellent. Thank you, guys. We are, of course, here to talk about your Kids alliance for Better Care program. I'm so excited to learn about that. But off the top, could you just please introduce yourselves and tell us a bit about your backgrounds? Dr. Sumner, why don't you go first?
- [00:33]
B
Well, I'm Jean Sumner. I'm an internist by training. I'm the dean at Mercer University School of Medicine, and I'm approaching my 10th year. I've spent most of my life practicing in rural Georgia, some of the poorest counties in the state. And the school is driven by its mission, which is helping alleviate health disparities in rural Georgia.
- [00:54]
A
And Mark, how about you?
- [00:56]
C
I'm Mark Welch, as you mentioned, the vice president of child advocacy here at Children's. I've been with the organization for eight years, and our work here focuses on how do we impact the community. My team does both prevention work in the community, but also is so proud to do work like this rural health initiative. I am a epidemiologist by training, but have spent most of my career leading large public health focused programs.
- [01:19]
A
Fantastic. All right, as we've mentioned, we're here to talk about a wonderful program that you have combined forces to launch into the healthcare sphere, so to speak. Dr. Sumner, I want to start with you. So could you paint a picture of what health care for kids looks like in rural communities and also what inspired you to work to address this lack of access?
- [01:39]
B
Well, thank you, Chris, for the opportunity to talk about something that we're passionate about. Health care in rural Georgia for children is probably the most underserved area of care. There are 120 of the 159 counties in our state that are considered rural by Georgia's definition, which is 50,000 or less. Of the hundred and twenty counties, 65 do not have a pediatrician. And of the ones that do, many have one pediatrician. So I believe that the most underserved area of medicine is care for children. Now, there are great family medicine docs who fill in and take care of kids as well. But having a pediatrician that's accessible, I think in many ways offers things that improve the care of children across the state. We're fortunate to live in a great state, and our legislators have been very focused on trying to improve care. And Georgia has invested a great deal of resources into rural health, but making the health status better has not happened. I do believe that we're very honored to have an alliance with Children's healthcare of Atlanta and that this program is laying the foundation for a program that could be used as a model nationally to make a difference in these communities.
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A
It's a worthwhile program, to say the very least. And I'm sure both the organizations are very proud of the work you're doing and will continue to do for one of you. Let whoever wants to take this question tackle it. Just looking for an overview of the collaboration between both your organizations?
- [03:13]
C
Yeah, I mean, I can take the first go, and I'm sure Dr. Sumner will jump in and fill in what I miss. You know, for us at Children's, we, in any given year will serve kids from all 159 counties across the state. The 120 rural counties that Dr. Sumner mentioned we know have unique needs and that those families are doing amazing things to raise kids, but face unique challenges in ensuring those kids get care. And so when we set about this project, we really looked at, okay, how do we ensure that we are not only thinking about what will best impact those kids, but. But that we engaged with a partner, engaged with an organization that would allow us to really understand the needs of rural communities. And that's why we began this work with the Mercer School of Medicine and the Rural Health Innovation center, because these are folks who live in rural communities and dedicate every single day to serving communities across our state. And so we set about really trying to better understand how to meet those needs. And from an initial meeting that Dr. Sumner organized with pediatricians from the communities and hospitals, we landed on four core areas of focus. The first is really helping rural hospitals be better able to meet the needs of kids in their communities. These are wonderful facilities that are doing amazing work to serve their communities, but they're primarily serving adults. And in many of these cases, they weren't really ready and prepared to respond to the needs of kids. We set about understanding how do we best support them, best meet those needs, and ensure that they have what they need to meet the needs of that kid that may walk through their doors. The second was really supporting pediatricians. And so we heard from a wonderful group of pediatricians who said, hey, we are doing great things for our community, but often we're out Here on an island, we're on our own. They don't have a partner down the hall who they can go and say, hey, come and take a look at this case. So they really wanted to not only create that connection amongst each other, but have that ongoing support through telehealth and. And through opportunities for ongoing learning from the experts at Children's. So there was an opportunity to facilitate that. The third area of behavioral and mental health, we know that that's a challenge across the nation, certainly a challenge in metro Atlanta. But in our rural communities in particular, that challenge is amplified by not only the continuation of stigma around mental health, but also a lack of access to care. And so we wanted to think about how do we best work with schools to not only do screening, but. But more importantly, as Dr. Sumner always stresses, connecting kids to care, it's not about just screening and identifying and leaving. You have to close the loop and connect to care. So really thinking about models that allow us to do that. And the last area is probably the area that I continue to be the most proud of, and that is thinking about sustainable ways to build the healthcare workforce across the state. Dr. Sumner mentioned the number of counties that are without a pediatrician throughout our state. We set about, through the guidance of the Mercer School of Medicine, to say, what would it look like to offer scholarships to med students who in turn commit to serving rural communities post their training? And so we are excited to have 27 young people who made that commitment. They have scholarships that will cover their full med school tuition, and they'll commit to four years of serving in a rural community post that training. In addition, we said, hey, that's working. That's amazing. What would it look like to do that on the side of mental health? And so we begun that same program for marriage and family therapists who are also making a commitment to serving in rural communities. Those thinking about these sustainable models to build the workforce in rural Georgia.
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A
Yeah. And that commitment to collaboration, Mark, that you just outlined so eloquently, I'm glad it's alive and well. And not only with your organizations, but as I speak to other healthcare leaders, it's alive there as well, which is terrific. And now, Dr. Summer, I want to give you an opportunity to. To have the floor and Discuss Just what MRSA's role looks like in this program and this effort.
- [07:09]
B
Chris Mercer was created back in the 80s to be a medical school that trained physicians and healthcare professionals for rural Georgia. Everything we do here, from our research to our selection of students, is focused on making Georgia healthy and finding sustainable solutions to rural health. I don't know of anything we do that has been more impactful than this effort, because in order to impact a rural community. Rural communities are often looked at as unsophisticated, as not educated, as not caring about their families, or not caring about their community. And nothing could be further from the truth. They're actually resilient. There may be less levels of education, but people care about their families and they want to do well. But there's so many obstacles to care in these communities. They've been left out of the loop. They have to drive many miles for care. They're often implied to be not motivated to care for themselves, when actually it's so hard to access care that often they give up. What we do is build long term trust with these communities. When MRSA comes, we don't go away and we listen to the community and we learn what the issues are. You will find that every rural community in Georgia is different. It has strengths and it has weaknesses, but it always has. You will find a group of people who will work together to engage their community and to rise to the challenge of changing the health in that community. So trust is very important in health care, but it's required if you're going to impact the health of a rural system. You can't be a mobile doctor. The scholarships that Mark mentioned, these students are by contract or required to live and work in those rural communities. They don't commute. But our students, mersa is a little different in that we only accept Georgians and we preferentially accept rural students. So if you look across the country, about 5% or less of students in MD programs came from a small town. And at Mercer, we're between 40 and 50% and we continue to rise. And 70% of our students come from outside of metropolitan Atlanta. We will always take Atlanta students, but we look for young people who love where they grew up, who want to go home, and we find a path for them. And so they're very motivated to get the skills. I personally think to be an independent practitioner in a small town, you need stronger skills because you can call a code or need help. And as Mark said, there's nobody there to help you. So you need to build a team around you and you need to be really good at what you do. But we, we impact those by doing what we say, not giving up listening, understanding the needs of the community and providing the resources they need and also the training they need to use those resources. And we build a coalition I think the coalition between these counties is so important. The counties geographically are large, and you may be in Coffee county and not realize that there's a pediatrician two counties over that you could pick up the phone or chat with a telehealth unit or share a case. So we build that coalition, and best practices come out of that coalition. It's really been inciting to work. You know, I was. Had an interview one time, and the woman who was interviewing me said, when you, when this is over, they'll just go back to their bad ways. And I said, you've never lived in a county, in a small town, you know everybody, you know, you know who smokes secretly, you know who drives too fast, you know who does other things, but you care about you. It's a diverse group of people who need each other and they care about each other. And so you're the doctor and you know that patient. You're the nurse in that er. Your children probably go to play softball with with the other kids. They go to school with the other kids, you know, the mothers, the grandmamas, the great grandmothers. So you want to be the best you can be, and you want them to have confidence in your institution. When. When you have a major emergency in a child, you have a short time frame to get that child to a center. You have to stabilize them. And that is one of our goals, being able to stabilize critical emergencies. But there are also so many things that could stay home and be treated well. We've set up through this initiative the ability for these hospitals to regain their foundational values in pediatrics and the skills they need to care for that child at home and then refer, if appropriate. But many of the cases can be kept at home. A family that has to go to Atlanta or go 60, 100 miles for care, that means days off from work, it means gas they don't have. It means missing school. And so if we can provide care at home with guidance and with building an inner world team that can help each other, or maybe sending them to the next county instead of sending them 100 miles away, that helps the family, children do better in school and are just healthier and more happy with what their lives are like. And so we help families achieve the care they need, and we hope we change that culture.
- [12:39]
A
Dr. Summer, thank you for signing a very powerful spotlight on all the issues that are affecting rural communities and rural children in particular. I mean, I love how you illuminated the connectivity that exists in all these communities and how important that is and how resilient they are. And I'm so glad that you two have found each other, you know, not only you know yourselves as colleagues, but as organizations. On that note, Mark, you've given us a lot of details, wonderful details on how Children's Healthcare of Atlanta plays a role in this. What else do you want our audience to know about how your organization is involved with this effort?
- [13:25]
C
Well, I mean, I think one of the things I want folks to know is really to shine a light on all of the wisdom that Dr. Sumner just shared. And I use the word wisdom on purpose. I think it's easy to sit in a big city and say, I know best. I know what is best for this community. We're the experts. We know we'll never have that wisdom and the lived experience of what it means to live in one of these, one of our rural communities, to understand that interconnectedness, to understand the importance of trust and building trust. And so I think the biggest thing for us here at Children's has been to be willing to have the humility to come and say, hey, teach us, help us understand where we can make the biggest impact. And from that perspective, we've done really two core things. We've said we will invest in this initiative financially, and we will invest in terms of the pediatric expertise that sits at Children's, but we will look to our collaborators at MRSA to say, how do we best impact the communities that we want to serve and that you all are so interconnected with? I think that that's important. As others listen to this podcast and as other health systems think about how they can do more, it is important that you connect with folks who are in the communities you're trying to serve. I think it's vital to hear those voices, to understand those needs, and then from there, think about how you can best make an impact.
- [14:48]
A
Looking ahead. Certainly, this is a program that I understand is in its third year, which is terrific that it's come this far. So looking ahead three to five years. Even beyond that, Dr. Sumner, Mark, what do you see this program looking like in that time?
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B
Children's has committed to 10 years of this program. And, you know, we hope that we. We use the resources that are available to us to help these communities, and we use their expertise to guide these communities. I hope this is a lifelong commitment. I think that you will see that mothers and daddies care about their children, and healthy children become healthy young people become healthy adults, and children's health transforms the family. And so Georgia needs. Rural Georgia. Rural Georgia is like wealth of industry in Terms of mining and farming and food and timber. But industry won't come to communities where there is no health care, particularly health care for children. Children who are well, do better in school. They have more opportunity. And so we believe that not only are we transforming the health of children and will continue to work diligently to do that, we're transforming economically some of these communities that give the opportunity for industry to come in or businesses and have good health care and have expertise in children. I have to say that the children's healthcare of Atlanta is a treasure, and they do things that nobody else does. They didn't have to do this, but we're so honored to be in alliance with them and to have this association that allows us to go into these communities and transform them with the help of the local people. And don't underestimate the value of those local communities that are 110% engaged. The communities where we be, where we are and we never leave over the every. Even though we had the third year, we stay very close and visit with the first and second years. We don't abandon them, but we're building this family of network that we will stay in touch with and continue to bring them the best that we can bring them. We have continuing education every month. It's free. We have specialty clinics where if a child in Worth county needs a nephrologist, there's a clinic where that child can be in Sylvester, see the nephrologist in Augusta, and never have to take a day out of school or a day mama didn't have to take a day out of work. So there's so many things to this project that grow. And then we learn every day new things that we could do and new approaches that we could have. And a lot of that comes from suggestions from the community. What do you think about this? And so we listen intensely and then we try to address those needs. So it's exciting. I've spent my whole life in rural health, and I don't know anything more exciting to me than this project. We're committed to transforming the care of children in our state. And I think also we ask our young people to live and work in rural communities. But the children's scholars, both the marriage and family therapist and the pediatric scholars, I'm always interested when I interview them. These young people seem to know they wanted to be a pediatrician when they came to medical school. They all recount interactions with their doctor or their pediatrician. But now that pediatrician's not there. He went away. So we're giving hope again to those communities and having a workforce that will be sustainable, we hope.
- [18:37]
A
Mark, anything you would like to add to that?
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C
I think Dr. Sumner covered it really well. I think the biggest thing for me as I look ahead to the next five years is that we will continue to innovate and look for new ways to make an impact and learn. The way that this has been developed and the way that it is set up is exactly what Dr. Sumner expressed. It's an opportunity for us to continue to hear and learn from the communities that we serve. There's already been that example. We started with the pediatric scholars and we said, hey, why not think about how we can impact mental health? And began with the mfts. Those are the types of things that I think will continue to happen. Innovation to meet the needs in these communities. And also I think a lot about the growth that will happen in these communities. I think about the kids that will be exposed to a pediatrician because of the work that we're doing, that they themselves will decide that they want a career as a pediatrician because of the exposure that they're getting. I think those are the transformative things as we look five, ten years down the line that I think we'll begin to see the real impact of this program.
- [19:38]
A
I, for one, can't wait to see where this program goes. Gene. Dr. Sumner. Mark, thank you so much for being part of this. Your passion for this program definitely shines through, and that is not to be underestimated in any respect. So thank you again for being on the podcast and sharing what this program is all about. And honestly, we can't wait till our paths cross again.
- [19:58]
C
Thanks, Chris.
- [19:59]
B
Thanks, Chris. We appreciate your interest.