The William F. Ryan Community Health Center (Ryan Center) operates in some of New York City’s most vulnerable neighborhoods, serving medically underserved patients in Northern Manhattan-Upper West Side, Central Harlem, Washington Heights, the Lower East Side, and Chelsea/Clinton.
Many of these communities have a shortage of primary care providers, which results in emergency room visits for non-emergency and treatable primary care conditions. These types of visits account for 39% of overall emergency room visits in New York City, according to the New York City Health and Hospitals Corporation. As many as 11% of patients in Central Harlem and 9% of patients in Inwood and Washington Heights use emergency rooms as a source of primary care. Widespread poverty further exacerbates the problem—in Central Harlem, more than 59% of residents have incomes that are 200% below the poverty level. Patients living in poverty have a more difficult time getting high-quality medical care and maintaining healthy lifestyles. While community health centers (CHCs) can serve as a crucial source of care and other safety-net services to underserved communities, many primary care doctors are not familiar with and do not have experience working in a CHC environment. This leads to difficulty in recruiting and maintaining a community health care provider base. In 2011, the New York Health Foundation (NYHealth) awarded the Ryan Center a grant to fund the relocation of St. Luke’s-Roosevelt Hospital Center’s (SLRHC) Internal Medicine Program to the Ryan Center. By serving as a teaching and primary care rotation site, the Ryan Center would play host to dozens of medical residents, further increasing their exposure to community-based care. In addition, thousands of patients would have increased access to affordable, comprehensive care.
The Ryan Center trained and educated 50 medical residents on community-based care to ensure that they have the knowledge to work in a CHC environment and care for a high-need, multi-racial/ethnic population. Two medical preceptors were retained to provide continual guidance and mentoring to the medical residents. The Ryan Center reconfigured and streamlined health center operations (e.g., patient flow, appointment scheduling, space utilization, additional licensing for electronic health records use); reviewed and revised quality assurance and improvement policies; trained and prepared current Center staff for the cultural and logistical changes; and created a resident training booklet and other training tools for dissemination.