Finding joy daily in all that you do may seem hard for most people. Yet, Dr. Radhakrishnan’s contagious and never-ending smile even while discussing even the toughest subjects will make you a believer. She remains a happy person whether helping patients, peers, or the young physicians she’s helping to shape.
Priya Radhakrishnan, MD, is multi-talented and compassionate of others. Her journey in medicine began humbly in Kerala, on the southeastern tip of India. Her father, who always wanted to become a doctor but never got the opportunity, pushed all his children to achieve his goal. Priya succeeded.
Developing a Love for Medicine
In India, young physician hopefuls must pass the difficult Entrance Test for Medical School right after high school. During the subsequent five years of undergraduate medical education, Dr. Radhakrishnan, “developed a passion for medicine and what it can do to help people.” At Calicut University, now known as Government Medical College in Kozhikode, Kerala, she met the man who became her husband while she completed her undergraduate medical studies. After passing another entrance exam for postgraduate medical education in India, she began her MD in Pathology.
Dr. Radhakrishnan passed another gate on her journey by completing the United States Medical Licensing Examination (USMLE). She would go on and have the options of either internal medicine or pathology residencies. She interviewed for both and found that pathology was missing one powerful component, that of human interaction. She decided on internal medicine. With her residency in New York, her husband received a fellowship in Chicago. Having a young family, she was fortunate to transfer as a third-year resident in Evanston, Illinois.
Taking on Multiple Roles
Dr. Radhakrishnan wears multiple hats. She is Chief Academic Officer and Vice President of Health Equity at HonorHealth, outgoing Governor of the American College of Physicians, Arizona Chapter and Professor at the University of Arizona College of Medicine, Phoenix. In addition to helping to shape the next generation of physicians, she continues to see patients. “I think, particularly in medicine, it’s important to have that connection. I love seeing patients and healthcare delivery,” says Dr. Radhakrishnan.
When John C. Lincoln Health Network and Scottsdale Healthcare merged in March 2015, Dr. Radhakrishnan became the Chief Academic Officer of the new entity called HonorHealth. The locally owned, nonprofit, integrated health system has 6 hospitals, 70 primary and specialty care clinics, a cancer care network, research, and community services. In her role, Dr. Radhakrishnan has crafted the system’s GME as the Designated Institutional Official. Since its inception, HonorHealth has grown to 14 GME programs that will have graduated 126 residents as of June 2023. From residency programs in Internal Medicine, Family Medicine, General Surgery and Physician Medicine & Rehabilitation to fellowship programs in Addiction Medicine, Clinical Informatics, Cardiovascular Disease, Electrophysiology, to Hospice and Palliative Medicine, it makes Dr. Radhakrishnan smile. Today’s HonorHealth GME programs coincide with the GME needs she helped map out.
GME in Arizona Today
Since its inception in 1965, the Centers for Medicare and Medicaid Services (CMS) has been the largest funder of graduate medical education. Federal investments in GME occur through various programs that support physician workforce development. Unfortunately, CMS has not increased GME slots to keep up with demand states Dr. Radhakrishnan. This year, for example, CMS funded 200 additional slots which is way too low for the entire country, let alone in Arizona.
Medicare is the largest funder of GME in Arizona, accounting for around 90% or $459 million of total support, according to the University of Arizona’s Center for Rural Health. Based on 2018 figures, according to the Association of American Medical Colleges, there are 19 teaching hospitals and 1457 residents in Arizona. Since 1997, a cap has been placed on Medicare-supported residency programs. Some additional residency slots have been added but hospitals do not receive Medicare payments for those trainees. That means hospitals must fund the remaining percentage of slots.
“Arizona ranks 42 out of 50 states for primary care and 31 out of 50 for actively practicing physicians per the Arizona Primary Care Physician Workforce Report,” says Dr. Radhakrishnan. She says, “COVID-19 caused a huge exodus and premature retirements, so the current pool of physicians is even smaller.” Of residents and fellows per 100,000 population, Arizona ranks 37 out of 50. Having too few residency slots for the population served leads to medical school graduates leaving the state. Building personal and professional relationships and becoming ingrained in the local culture tends to keep residents close to where they train. GME slots should parallel medical school graduates to ensure most if not all Arizona trained physicians stay. Residents like the Grand Canyon State. Per Dr. Radhakrishnan, Arizona ranks 17 out of 50 in post-GME retention. Having more residency slots would translate to physicians making Arizona their home to practice medicine.
Dr. Radhakrishnan acknowledges Arizona now has a larger and stronger base from which to grow its future residents unlike in the past. Until 1995, Arizona had only one medical school in Tucson. There are now five medical schools in Maricopa County. The bottleneck to match with coveted residency slots has become tighter.
Producing The Physicians Arizona Needs
Are GME programs doing what’s needed to produce qualified physicians? Dr. Radhakrishnan states, “lots of work needs to be done.” The landmark Flexner Report of 1910 had a century-long impact on graduate medical education. Many aspects of modern American GME come from this competency-based report. It was widely hailed as the standard until the early 2000s, when physicians began to realize the damage, it had created through the closing of several historically black university medical programs, widening the gap between white and nonwhite students going into medicine. For Arizona, there is a gap in the number of American Indian physicians serving its uniquely high proportion of federally recognized tribal members.
Progress is being made in some areas. Dr. Radhakrishnan believes that today’s medical education community is doing a great job across the board to ensure that residents are well equipped for the rigors of working in medicine. That includes teaching residents about financial information, dietary habits, physical fitness, support networks and the need for stronger mentor-mentee relationships. A silver lining of the COVID-19 pandemic is that it helped residents to learn how to care for each other. That would help them gain more compassion for their patients.
The Future for Residency Programs
In an ideal world, we would want federal and state governments to invest more in the sustainability of GME, states Dr. Radhakrishnan. “Currently there are federal and state policies for funding GME, but that hasn’t always been the case” says Dr. Radhakrishnan. States like Arizona in the past have eliminated GME funding or greatly reduced the money dedicated to GME. She remembers when that resulted in attrition and the closure of many residency slots. Her hope is that we don’t go back to those days.
Dr. Radhakrishnan hopes that a better understanding of healthcare workforce needs in a growing Arizona will help to shape policy priorities and increase residency slots. She would like to see greater emphasis on eliminating the demographic disparities between the physician workforce and the populations they serve.
The future of residency programs is also tied to retention. There are ways to entice physicians to stay in Arizona. One is loan repayment, since many physicians are saddled with large amounts of school loans. Second, residents should have a voice at the workplace when it comes to the profession they will be joining. That includes being heard when it comes to employee policies and advocacy at the county and state levels. A third way is continuing to help these young physicians through organized medicine in areas such as policy advocacy and mental health wellbeing.
Final Thoughts on GME
Ultimately, new innovative funding models should be put together by both government and private funders to ensure GME is prioritized and keeps up with medical school graduation rates. That will ensure Arizona isn’t losing topflight new physicians to other states that better prioritize the retention of residents. Our booming population in Arizona includes a vast younger and older population that will likely have a much higher need to access healthcare in both urban and rural settings. Dr. Radhakrishnan’s work will continue to highlight the need for prioritizing GME as a tool to keep physicians in Arizona and to ensure patients are getting the care they need. Patients will be able to select physicians to help them with their healthcare needs in the surrounding areas in which they live.
About the Author:
Edward Araujo serves both as Managing Editor for Arizona Physician Magazine and Communications Coordinator at the Maricopa County Medical Society (MCMS). He has over 15 years of digital marketing and non profit operational experience.