Creating new pathways to health care careers in Michigan

As Michigan and the nation face significant shortages of physicians and nurses, Michigan State University is leading efforts to provide sustainable health care solutions across the state that will change health care for the better by identifying and responding to current and future challenges.

The United States faces a predicted shortage of 124,000 physicians by 2033. There is also a need to hire at least 200,000 nurses each year to meet the increased demand and replace retiring nurses, according to the American Hospital Association. At the same time, inequities in delivering health care to all Michiganders remains a challenge. The existing shortage of providers is complex and includes factors such as an aging population and greater numbers of people with chronic disease as well as the limited capacity of education programs, uneven distribution of providers, and caregivers leaving the workforce due to burnout.

“Addressing the unmet needs will require a transformation of health and health care; a greater number and breadth of providers, enhanced tools to improve access for patients and better support the work of those providers and a greater emphasis on prevention and early intervention." says Norman J. Beauchamp Jr., executive vice president for Health Sciences at MSU.

“MSU is leading the effort to ensure the right care at the right time for all.”

- Norman J. Beauchamp Jr.

MSU’s health colleges are responding to these inequities in care and gaps in staffing across the state. For more than 70 years, MSU has been educating health care providers who train in community-based settings throughout the state. It’s also the only university in the country that trains both doctors of medicine and doctors of osteopathic medicine as well as nurses. The colleges of Human Medicine, Osteopathic Medicine and Nursing have more than 20,000 alums who live and work in Michigan after graduation. The colleges are expanding their current medical and health program offerings, creating new career pathways and seeking partnerships to expand training opportunities and innovative approaches to care.

Meeting the needs of the state benefits from MSU’s efforts, campus wide. Individuals contributing to health are found in virtually every college in the university. To fulfill this commitment to improve the health of Michigan’s residents and as part of MSU’s strategic plan, the university has set the goal of creating 50 new career pathways that will span areas such as communications, business and supply chain, while transforming traditional health care education with innovative programs focused on solving the state’s health care needs.

This also creates multiple pathways to fulfilling careers for MSU students. Beauchamp said according to the U.S. Census Bureau, health care and social assistance sectors continue to be the top employers across the country. In Michigan, health care continues to be the largest private-sector employer in the state, employing around 572,000 Michigan residents in 2020, according to the 2022 Economic Impact of Healthcare in Michigan by the Partnership for Michigan’s Health, a Lansing-based group that includes the Michigan Health and Hospital Association, the Michigan State Medical Society and the Michigan Osteopathic Association.

Making a difference on day one

MSU’s Physician Assistant Medicine Program is an example of a new program focused on solving the state’s health care needs. “There’s a shortage of physicians in the state, and we’re having a huge problem finding rural health care providers. It’s a crisis,” says John McGinnity, founding director of MSU’s PA Medicine Program and professor in the College of Osteopathic Medicine. “The university saw a need and wanted more health care providers to improve the care of Michiganders.”

A physician assistant holds an advanced medical degree and can provide direct patient care such as examining patients, ordering X-rays, diagnosing illnesses and prescribing medications. The 27-month program is a unique opportunity for students to practice medicine collaboratively in a team-based care approach alongside physicians and students from MSU’s osteopathic medicine and nursing colleges. While developing the program, McGinnity spoke extensively with hospitals and clinics in the state to determine the skills a physician assistant student would need to be able to begin working seamlessly the day after graduation.

“We’re laser focused on emulating the College of Osteopathic Medicine’s D.O. program results where 75% of our graduates remain in the state to practice medicine and improve patient outcomes,” McGinnity says. “By establishing new partnerships with the Rural Health Association, we have been able to identify locations where we can put these students to improve access to care in the places with the greatest needs in Michigan.”

Physician assistant students serve their community by working in different locations across the state. “We have always focused on the diverse needs of all patients, whether in urban, rural or suburban areas to serve patients of all walks of life,” says Andrea Amalfitano, dean of the College of Osteopathic Medicine. “Our students want to serve the people of this state and help us to reach and provide services to all people, including the most vulnerable populations who may have limited access to health care.”

During the program, the physician assistant students go through similar rotations as a medical school student, such as internal medicine, pediatrics and emergency medicine. Collaboration and building relationships with the physicians they will work with is key to their success, and these students sit side by side with D.O. students in their classroom lectures and laboratory work so they can learn from one another.

“During our anatomy laboratory class, we didn’t wear badges, so we didn’t know who was a P.A. or D.O. student,” says Alex Lillie, one of the first 32 students in the program. “We worked together and taught each other.”

While MSU’s physician assistant program is new, it is already establishing itself as an innovative leader by responding to changes in the health care field, such as the growing use of urgent care clinics. “Consumers want their care to be convenient, and they are going to urgent care centers,” McGinnity said. “Now, we put our P.A. students in an urgent care clinic during their clinical rotation.”

Reducing health disparities through research

Historically, a lack of understanding of the needs of underserved communities, such as rural communities, has hindered access to equitable care. With support from the National Institutes of Health’s Research to Reduce Disparities in Disease Program, medical students interested in researching and working with underserved populations can get the experience and tools they need.

Victoria Bright

The program provides students with up to $10,000 in funding to develop hands-on research geared toward reducing health disparities in underserved populations and helps medical students bridge the gap between medical and public health. It also pairs students with mentors who guide them throughout the whole research process, from ideation to publication. Started in 2018, 37 students have gone through the highly competitive program.

The program enabled Victoria Bright, a fourth-year medical student in the College of Human Medicine, to research the challenges pregnant women with substance use disorder face when interacting with the health care system. Bright was paired with Jean Kerver, an associate professor in the College of Human Medicine, whose research also focuses on health care access. “The mentoring support was invaluable to my research,” says Bright. “Kerver became a trusted mentor and she was very supportive throughout this entire process. As I became more confident, it became less of a mentorship relationship and more of a professional relationship.”

Jean Kerver

Kerver introduced Bright to Julia Riddle, a family medicine provider in Traverse City who works with pregnant women with substance use disorders. Riddle became a co-author on Bright’s paper, “Stigma Experienced by Rural Pregnant Women with Substance Use Disorder: A Scoping Review and Qualitative Synthesis,” which was published in the International Journal of Environmental Research and Public Health.

For Kerver, the program also addresses the shortage of physician scientists from groups underrepresented in medicine.

“When I was a student, I felt like things were unclear to me for a long time, like I was entering a foreign world,” says Kerver, who was a first-generation college student. “It’s important for a mentee to have someone they can trust and ask these questions to. I like to bring people under my wing and try to make them more comfortable to show that their questions and contributions are valuable.”

Improving access to mental health and addiction help

MSU recently received a $1.6 million grant from the Michigan Department of Health and Human Services to train nurses to serve the mental health needs of the state through the MSU College of Nursing’s Psychiatric Mental Health Nurse Practitioner Program.

Leigh Small

“We are seeing an overwhelming need for mental health services throughout the state, especially in underrepresented populations,” says Leigh Small, dean of the College of Nursing. “This funding will allow us to ensure current nurses and nurse practitioners have the skills necessary to identify and intervene with those who suffer with mental health difficulties.”

Dawn Goldstein

“When this program started in 2019, there was a shortage of mental health providers in the U.S. and in Michigan,” says Dawn Goldstein, an assistant professor in the College of Nursing. “During the pandemic, we saw increases in anxiety, depression and suicide rates for adolescents, an increase in substance use disorders and domestic violence, and even our opioid death rate increased.”

This grant provides a new pathway for nurses already licensed in the state to advance their degree and specialize in psychiatric mental health. Often the biggest barrier for nurses to go back to school is the cost. To help with their costs, students are provided with a stipend of up to $30,000.

A second five-year, $1.3 million National Institutes of Health grant will be used to recruit more nurses and medical doctors from Michigan’s underrepresented communities who are trained in substance use disorders through MSU’s colleges of Human Medicine and Nursing.

Cara Poland

“For every one physician we have in the U.S., there are over 8,000 patients with a substance use disorder in need of care,” says Cara Poland, an associate professor in the College of Human Medicine and an expert in substance use disorders. “In comparison, there is one cardiologist for 2,500 patients.”

This second grant pairs psychiatric mental health nurse practitioner students with medical students who have chosen to take an elective in addiction. The students learn about situations they will deal with daily in care settings. For example, one case study is about a veteran with a combat-related injury who is prescribed opioids that cause negative effects.

“Through our interdisciplinary program, we are bringing the medical students and the nursing students together virtually to discuss the case and come up with a treatment solution,” says Poland. “By the fifth week of medical school, the students have been trained to use Narcan, so they’re equipped to reverse an opioid overdose and have the ability to save a life.”

The grant also focuses on closing the gaps in health care disparities and increasing accessibility to health care.

“It's about making sure that we’re providing the care in all areas, even where people cannot afford to see a provider,” says Goldstein.

“Our mission is to support the citizens of Michigan, and we have identified this need,” said Poland. “We want to close the gap so that Michigan residents have the best health possible.”

Using technology to expand access to care

Finding new ways to keep people healthy, rather than treating them when they are sick, could lighten the shortage of medical health workers, says Roger Jansen, chief innovation and digital health officer at MSU Health Care, the university’s clinical arm.

With this in mind, his group is looking for technologies that can help improve people’s lives, starting with the management of chronic diseases. In Michigan, one in 10 people live with at least one chronic condition such as heart disease, diabetes, stroke, arthritis or asthma. For patients who live in rural areas or lack transportation, access to care is often difficult and even dangerous during the winter months.

A patient tests her glucose level at home during her video appointment with her doctor. Credit: Matthew Mitchell 

To help Michiganders access health care regardless of where they live, MSU Health Care recently rolled out the Care Everyday remote-monitoring program. Patients in the program receive monitoring instruments to track their condition, such as a blood pressure cuff or glucose monitor. The system automatically uploads the information to a database and, if triggered, sends a notification to a care management team. The team then decides on the course of action, contacting the physician if needed. They also keep regular contact with patients to make sure they’re following their management plan, medications and exercise.

Provided in partnership with consumer health company Higi, early results from the program show that patients who participated saw their systolic blood pressure decrease by 10 points during the first six months. Doctors hope the program will keep patients from the emergency room, living better lives at home.

“Our patients are able to more closely monitor their own health, and their care team can intervene and adapt their care plan if needed,” says Jansen. “It’s a win-win.” Beauchamp says it will take a lot of innovation inside and outside the classroom to ensure everyone in the state has access to health.

“MSU remains committed to working in all of our communities and with partners across the state to bring our citizens health, hope and healing,” Beauchamp says. “At MSU, we are conveners in addressing the biggest challenges across our state, and we partner with like-minded organizations to respond to the needs of our state.”

At MSU Health Sciences, Beauchamp says he’s laying the groundwork to develop internships for students from other MSU colleges who are studying things like social work, business and supply chain management, to get involved in the health care system. The idea is to have students from colleges across the university participate in internships as part of the Henry Ford Health + MSU Health Sciences partnership, which aims to increase the workforce needed to support the growing health care industry.

“Increasing the number of health care workers doesn’t simply mean more nurses or doctors,” Beauchamp says. “It also means engaging social workers and teachers, and it requires looking at digital health and developing new technologies that empower one clinician to care for more people.”