The aim of this project was to assess the strengths and limitations of student teaching for
midwife-led clinical practices in California through an anonymous survey. Decades of research
shows that midwives dramatically decrease maternal and fetal morbidity and mortality in labor.
and postpartum. As of 2020, in the US there are approximately 4 midwives per every 1,000 live
births. According to the American College of Nurse Midwives, to be on par with other
high-income countries with better outcomes, we need to aim for a minimum of 25 midwives per

Staffing crises have become endemic in healthcare. The costs go far beyond the financials, deeply affecting morale and patient care. Balancing patient needs, staff morale, equity, and future expectations is a challenging skill set. This project will describe a leadership journey through a staffing crisis, and highlight lessons learned.

Clinicians at Keck Medicine of USC are burned out due to the COVID 19 pandemic, competing demands on their time and insufficient support to achieve work life balance. This project was designed to establish a team-based care program at Keck Medicine of USC to reduce clinician and staff burnout in the Family Medicine Department. Burnout affects over 50% of physicians and nurses and leads to reduced access to care due to sick calls, reduced patient safety and lower quality of care.

In recent years, there has been increased focus on health equity, galvanized by events such as Black Lives Matter, and increased awareness of the porosity of borders during the COVID19 pandemic. In my role as faculty lead for DEI efforts within Stanford’s Division of Primary Care and Population Health (PCPH) as well as faculty lead for the division’s global health partnership in western Kenya, I realized that many of the challenges to health equity globally are at play domestically.

My project has been to create a physician leadership program called Site Medical Director University (SMD-U) at AltaMed Health Services, the largest Independent Federally Qualified Health Center in the nation. With clinics throughout Los Angeles and Orange counties, our current leadership structure consists of a Chief Medical Officer, 3 Regional Medical Directors, and 15 Site Medical Directors (SMDs) that oversee each clinic. Thus, the SMDs are the functional leaders supervising over 250 Providers.

Today, nearly 70% of healthcare providers are employed by large corporate entities. While there are benefits to large healthcare systems, providers in these organizations are feeling disengaged and disempowered due to the inability to effectively advocate for their patients or themselves. This lack of voice contributes to provider burnout, directly affecting the quality of care being delivered and physician attrition.

Due to the COVID-19 pandemic, participation in recommended routine screening declined across the country – in the first six months of the pandemic alone there were 10 million missed cancer screenings. As a result of this decline, individuals are not receiving appropriate early screening and diagnosis, resulting in an increase in cancer diagnoses at advanced stages of the disease. Delayed diagnosis is expected to lead to a higher cost of care, loss of productivity, and increased morbidity and mortality that would have been avoided with appropriate screening.

Care coordination among patients with severe mental healtillnessesss has been a long-standing challenge. Patients seen in mental health clinics oftentimes have inadequate control of diabetes, hypertension, and dyslipidemia. In addition, more than 60% of this population also suffers from co-occurring substance use disorders. Without addressing these chronic medical problems, patients with poorly managed medical conditions often were lost to follow-up.

The two largest patient groups in California are Kaiser members (9 million) and patients served by California’s FQHCs (7 million), but you could not find two more dissimilar health systems. Kaiser and nearly all other health systems organize their providers in medical groups; FQHCs are private non-profits that employ and support their providers independently. The separation between individual FQHCs results in inconsistent access and quality, an inability to retain talent and resources, and diminished voice in the broader health care system.

Rather than seeing COVID-19 as an insurmountable obstacle, I, along with my team at Community Health Centers of the Central Coast (CHCCC), Inc., viewed it as an opportunity to accelerate the pace of innovation. To better meet the needs of the community, the CHC Behavioral Health and Psychiatry Departments are committed to moving beyond brick-and-mortar clinics to a ‘click and mortar’ clinic in the sky, the Cielo Center for Integrated Health. Like many health centers CHCCC quickly shifted to virtual care not long after the pandemic emerged.