Anchors for the Safety Net

"We realized there was a strong desire by resident physicians to meet with underserved patients in a clinical setting, where they could develop a relationship while addressing their unique and often complex circumstance."
- Jessica Gregg, MD, PhD
OHSU curriculum puts residents at forefront of homelessness, poverty and addiction

When the door of the Hooper Detoxification Stabilization Center opens at 7 a.m. each morning, the small, unadorned waiting room is soon overflowing with more than 60 Portlanders. Many are uninsured, and most are homeless, high on heroin, inebriated or going through severe withdrawal.

While the drug of choice might vary, and the previous night's sleeping conditions range from pavement to a thin mattress, the people arriving at the clinic share one thing in common: All have hit rock bottom.

"The patients we see at Hooper are aware that they have substance abuse problems," said Jessica Gregg, M.D., R'06, Ph.D., Medical Director of the Hooper Clinic, and Associate Professor in the Department of Medicine. "While struggling with their addictions, they somehow find the strength, courage and determination to voluntarily come to the clinic to ask for help. It's powerful."

With access to health care becoming progressively more difficult for the very poor and homeless in Oregon, Dr. Gregg helped initiate an innovative "social medicine" partnership between the nonprofit Central City Concern (CCC) and Oregon Health & Science University (OHSU).

The partnership, by way of a social medicine curriculum, places OHSU Internal Medicine residents in CCC safety net clinics—like the Hooper clinic—where they are trained to meet the medical needs of people affected by homelessness, poverty and addiction.

gregg5812"Prior to the partnership, a resident's interaction with this population was limited mostly to the ER," said Dr. Gregg. "We realized there was a strong desire by resident physicians to meet with underserved patients in a clinical setting, where they could develop a relationship while addressing their unique and often complex circumstances."

As part of the curriculum, residents serve in several CCC programs, which include: observing and participating in addiction treatment groups, accompanying case managers, and seeing patients in partnership with a psychiatrist who specializes in medication management and counseling.

While the partnership expands medical services to Portland's underserved population, it also trains a future physician work force sensitive to the needs of safety net clinics. In 2011,CCC programs and housing served approximately 13,000 unduplicated people in Oregon, with OHSU resident physicians playing a crucial role in providing this care.

"The environment is perfect for resident training because it provides access to a complex urban population, and the multifaceted systems and skills that are required to care for these individuals," said Rachel Solotaroff, MD, Medical Director of Central City Concern, and Director of the Old Town Clinic. "Residents learn not only how to care for people who lack housing, social supports, or income, but also how to try to create an environment that provides hope and safety."

Since the partnership began in 2006, hundreds of OHSU residents have rotated through CCC clinics, including Brianna Sustersic, MD, R'11, Instructor, Department of Medicine, who participated in the social medicine curriculum at the Old Town Clinic while completing her residency at OHSU.

Old Town Clinic"I've had multiple eye-opening moments," said Dr. Sustersic. "Most have centered around seeing the metamorphosis of a patient stricken with addiction and homelessness transformed after entering recovery and finding housing."

Upon completing her residency, Dr. Sustersic, who wanted to serve the underserved since medical school, said she had many opportunities for employment, but found Old Town "was the best place" where she could achieve this goal. "I absolutely fell in love with the Old Town Clinic during my training there," she said. "The physicians were great role models and mentors. These were doctors who I admired and wanted to emulate."

The partnership reflects OHSU's commitment to outreach and helping the underserved population in Oregon. "Our relationship with OHSU has been a cornerstone in the development of health services at Central City Concern," said Dr. Solotaroff. "This partnership has allowed us to build programs and serve individuals that would not have been possible otherwise."


Pictured above: (top) Dr. Gregg; (bottom) Old Town Clinic