Innovative Practice Interview with Dr. Richard Bunio of Cherokee Indian Hospital
February 28, 2019
Interview with Dr. Richard Bunio of Cherokee Indian Hospital Regarding the Implementation of a MedServe Fellow
Q: Please describe the MedServe Fellowship Program in your own words.
A: The MedServe program links college grads with an interest in a healthcare field with private practices, hospitals, clinics etc. where they spend two years serving that community. It’s like the Americorp for healthcare. They are dually “sponsored” by the program and by the clinic they’re working with.
Q: What were the reasons you decided to participate in the MedServe Program?
A: It seemed innovative and we’re always looking for new recruitment strategies. We even make efforts at the high school here to try and spur interest in healthcare. The hope with the MedServe fellow(s) is that they will pursue a healthcare career and will come back and practice in the area.
Q: Have you learned any Key Lessons adopting this program?
A: Yes, absolutely. As a health system, it’s challenging for us to identify what the fellow wants to do and what they’re allowed to do. In private practice, there’s more flexibility for the fellow to do a broader scope of things. For the fellow here at CIH, it gives them an interesting perspective of the functioning of the healthcare system.
The other lesson we learned was that the fellows do not make much money and housing is a problem in the area. We got lucky, as we have a provider who has a house in Cherokee who is spending some time out of state and he’s allowing the MedServe fellow to live in his home, but that’s not a guarantee for other fellows. This is a challenge we’ll need to think about in the future.
Q: What aspects of the program that are working well?
A: The MedServe fellow is awesome. She’s enthusiastic, eager to learn and a joy to have around. It’s good for morale. She reminds us all of why we started practicing. We’re getting better at figuring out where she can be of the most benefit to our staff and what work she can do to gain useful experience. We’ve been realizing there’s more opportunity for the her to be hands-on, as she doesn’t want to just shadow. She wants to be active, helpful and involved. Having someone who’s eager and asks a lot of questions is fun for the providers.
Q: What challenges have you experienced with the program?
A: As I mentioned, housing was an issue and there are were some other minor logistical challenges around the contract and agreement we had to work out. We also had to come up with a vision for what the fellow would do so that she could get some hands on experience without violating any privacy rules.
Q: How would you describe the impacts and outcomes of the fellowship?
A: The fellow is spending half of her time in physical therapy acting as an aid and the other half is in the performance improvement department. She’s been able to see many different areas of the hospital which is a benefit for us because she understands some of the challenges like data entry. This has allowed us to complete more projects than we anticipated. She contributes more man power and at a low cost for us. For the amount and quality of work she can provide, the MedServe program allows us to have an additional staff member that we otherwise maybe wouldn’t be able to afford. We employ her, so she gets all of the employee benefits like health insurance.
Q: Did you have influencers or mentors who helped make the decision to adopt this program?
A: We didn’t know anyone who had used MedServe before. We saw the opportunity and talked as a team and thought it was worth a shot. We’re always looking for new and innovative ways to do things. It’s great learning that the fellow is a good fit with CIH. If she were to come back as a doctor or PA in a few years, we would be happy to hire her because we’ve already worked with her.
Q: Do you have any advice for other health systems thinking about taking on a MedServe Fellow?
A: For a health system like ours, start early. It took longer than we thought to get all the pieces in place. For private practices, just do it. It will be a win for your practice.
Q: Are there any other innovative strategies CIH has implemented?
A: We’re really proud of our integrative care team. We have a four person team with a nutritionist, pharmacist and mental health specialist. This has been really helpful in meeting patients where they are. We’re also doing some innovative work in MAT and suboxone treatments. We’re using suboxone in our residential treatment facility with the idea we need to keep people there long enough to benefit from the program. Suboxone treatment is available at the hospital and the residential site is in another county.
Q: Are there any other innovative recruitment strategies you’ve used? How have they worked?
A: The National Health Service Corp has been effective. We’ve been advertising through them. Word of mouth is also effective. We get a lot of providers who come to us because someone came to us through another health system. We tried attending some CME events in Asheville as a recruitment tactic, but that has proven less effective. We do our best to be the provider of choice. We’re trying to create a health system that is welcoming and world class. The design of the hospital is meant to reduce feelings of trauma. It’s very intentional. I think we’ve all experienced going to a hospital and it’s stressful. Our community has experienced a lot of trauma from various things so we want our hospital to be welcoming. We hope creating this unique environment will encourage both providers and patients to join our community.
About Dr. Richard Bunio
Dr. Richard Bunio is the Executive Director of Clinical Services of Cherokee Indian Hospital. Dr. Bunio received his Doctorate of Medicine from the University of Manitoba in Winnipeg, Manitoba, Canada in 1987. He completed a residency in Family Medicine at the Foothills Hospital in Calgary, Alberta after which he was certified by the Canadian College of Family Practice. After completing his training, he stayed in Calgary where he owned and operated a solo family practice for five years.
After this, he worked in Saudi Arabia, served the Inuit tribe near Canada’s Arctic Circle, and did volunteer work at St. Jude’s, a small rural hospital in St. Lucia. He is Board Certified by the American Board of Family Medicine and is a Fellow of the American Academy of Family Practice.
He began his service in the Cherokee community in 1999 when he accepted a position at the Urgent Care Clinic under the Tribal Health and Medical Division. In 2008, he transferred to Cherokee Indian Hospital where he has worked to develop the new Immediate Care Center and other satellite clinics. Dr. Bunio is from Winnipeg, Manitoba, Canada. He has lived in Cherokee since 1999 and now calls the Whittier community home.
About the MedServe Fellowship Program
The mission of MedServe is to “immediately improve the health of communities and vitality of primary care practices while exposing tomorrow’s most promising future providers to the great potential for community impact possible through primary care practice in “medically underserved” communities.” They believe that “immersion in the best of rural and other community-based primary care is a necessary step to encouraging the next generation of primary care providers.”
MedServe understands that there are communities in North Carolina with a great deal of health need and that these are also communities where primary care physicians and practices are doing amazing work. By joining MedServe, Fellows have an opportunity to learn from and help amplify the good work of these practices. MedServe Fellows spend two years at the clinic or hospital they partner with.
About Cherokee Indian Hospital
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The core purpose of CIH is “to enhance the prosperity of the next seven generations of the Eastern Band of Cherokee Indians through relationship based quality healthcare.” Their mission is “to be the partner of choice for the community by providing accessible, patient and family centered quality healthcare with responsible management of the tribes’ resources” and their vision is “to be significant in the lives of Tribal members, chosen for excellence and exceeding customer expectations, recognized for improving the health of the Eastern Band the Cherokee Indians.” Cherokee Indian Hospital values “Integrity, Excellence, Engagement, Stewardship, Group Harmony, Compassion, and Accountability”.