By: Melissa Jones—
MUNCIE, IN — According to Robert Wood Johnson Foundation, Delaware County has the fourth-highest number of primary care physicians per capita in the state—a ranking that should mean the county is one of the healthiest. But it’s not.
Of Indiana’s 92 counties, Delaware County ranks 85th. So where’s the disconnect?
Even with Indiana’s fourth-highest primary care physicians per capita, the county has just one primary care physician per 1,030 patients. In fact, the United States as a whole is facing a shortage in physicians. So in an effort to boost local physician training programs and retention, a number of healthcare entities in Muncie have partnered to form a long-term initiative, with funding from Ball Brothers Foundation, called Optimus Primary.
“Optimus Primary is about taking all of the best pieces that we have in healthcare assets in Muncie and assembling them together in a way to improve the health outcomes of our community,” said Derron Bishop, associate dean and director of Indiana University School of Medicine–Muncie.
Bishop was a founding member of Optimus Primary, which officially formed in 2016. He worked with Jud Fisher, president and chief operating officer of Ball Brothers Foundation, and Dr. Jeff Bird, president of the IU Health East Central Region, to bring the program to fruition.
The key to Optimus Primary, Bishop says, is the number of “anchor institutions” located in Muncie: IU Health Ball Memorial Hospital, IU School of Medicine–Muncie, Ball State University, Meridian Health Services and more.
“We’re all basically co-located together, and that’s extraordinarily powerful. Communities all across the country would love to have this,” Bishop said.
By connecting each of these healthcare organizations in a strategic partnership, Optimus Primary positions Muncie as one of the leading physician training centers in the state.
“Muncie is the only place outside of Indianapolis that you could take someone from high school, into college, into medical school, into residency, and ultimately become a board-certified position in multiple areas—and you’d never have to leave Muncie,” Bishop said.
But the effects of Optimus Primary extend beyond training physicians. There’s a huge economic benefit too, Bishop said. He explained that every physician who establishes a practice generates, on average, six to seven jobs and approximately $300,000 in regional tax revenue.
“On a larger scale, Optimus Primary initiatives have powerful potential to strengthen the broader pipeline of medical professionals being trained in Indiana, to make a significant economic development impact and to improve population health in East Central Indiana,” Ball Brothers Foundation’s Jud Fisher said. To date, the foundation has committed $1.8 million to Optimus Primary efforts.
With Ball Brothers Foundation backing the initiative, Bishop said the partner organizations have been able to explore innovative solutions to affect positive change to Muncie’s medical landscape and health outcomes.
“The way that Ball Brothers Foundation does their funding is that they give you a chance to try something,” Bishop said. “They really allowed all the different groups in Optimus Primary to innovate together with a common goal.”
One of these innovative ideas was to partner with Muncie Threat Assessment Center in a “Law Enforcement Operations 101” course for medical students. The course was designed to help the medical students bond and improve their communication skills.
“A good team-building activity has to be fun, it has to be something they’ve never experienced, and also it needs to be something where they make really difficult decisions together under stress,” Bishop said. “So we said, ‘What’s the most difficult decision to make under stress?’ And what we came up with was probably when a law enforcement officer has to pull the trigger.”
In Law Enforcement Operations 101, medical students learn firearm safety and how to shoot a gun (all guns in the course used non-lethal rounds). They even learn how to conduct traffic stops, how to negotiate domestic disputes and how to clear houses—and they’re put to the test through life-like run-throughs of each scenario.
The innovative idea was a bit of a risk, as Bishop said he didn’t exactly know if it would work as he had hoped. But in the end, it was a success—some of Bishop’s students told him they had bonded more in the three hours of the course than they had in the past three months of school.
Bilal Jawed, a former IU School of Medicine–Muncie student, was one of the first students to participate in the course.
“On the surface, it seems like shooting firearms and clearing houses is not a very applicable experience for medical professionals, but I would definitely argue against that,” Jawed said. “I learned a lot about working as a team in high-pressure situations and also how to communicate effectively and efficiently when time is of the essence. It was also very informative to actually interact with law enforcement officers, because medical professionals often work indirectly with them.”
Jawed was part of several other Optimus Primary programs too, like a full-body assessment at Ball State University’s Clinical Exercise Physiology Program.
Jawed and his classmates were put on treadmills and hooked up to machines to measure their own strength, pulmonary function, muscle composition, bone density and more.
“It was neat—also very scary—to have the performance of my own body plotted on a graph and compared against averages,” he said. “I’m seeing a lot of little ways and reasons to integrate these practices into care of future patients. It’s all about the little interactions you’re exposed to, and we’ve honestly been exposed to so many special, cutting-edge experiences.”
And that’s exactly the purpose of Optimus Primary: to train future physicians to think differently about medicine.
“If we can get our physicians that we train to understand the benefits of exercise, they’re more likely to advocate for this for their patients,” Bishop said. “We want them to directly see the benefits of lifestyle modifications, because this is a way that we can fundamentally change the way we do medicine—to really infuse that idea of lifestyle.”
No program embodies this emphasis on lifestyle better than the Healthy Lifestyle Center, a student-run clinic formed in partnership between Ball State University, IU School of Medicine– Muncie and Meridian Health Services. The HLC has two clinic locations—one in the new College of Health building at Ball State University and another on Meridian Health Service’s Tillotson Avenue campus. Jawed describes the HLC as “the future of medicine.”
“Right now, in medicine in general, our system is a very reactive system, where people come in with illnesses, get those illnesses resolved, and then move on,” he said. “What the HLC is doing is very unique. We’re actually dealing with issues proactively—addressing illnesses before they even become illnesses—and that’s how it’s going to be in the future.”
HLC is a free resource to the community, offering a range of services from dietetics, to audiology, to diabetes management and more. Students and professionals from various majors and fields come together to prepare comprehensive health and wellness plans for each patient, creating an inter-professional setup that is very rare.
“Medicine really is a team sport, and I’m learning how to be a team member by being in these roles,” Jawed said. “It’s really incredible to be able to work alongside all these different professions to actually help the community at such an early phase in my medical education.”
Bishop said Muncie has “the best available infrastructure” to help patients change their lifestyle and improve their health. By leveraging the community’s existing assets, Optimus Primary is changing the way physicians in Delaware County will provide care, ultimately improving overall health outcomes for the region.
And, just four years after first taking shape, the strategic initiative seems to be working.
“There’s such a diverse group of experiences with Optimus Primary, both from the health providing side and from the health receiving,” Jawed said. “It’s been nice to plant little seeds on how I’m going to incorporate these lessons in my future practice.”
Some of these other diverse programs supported through Optimus Primary include:
• Ivy Tech Community College’s newly renovated “School of Nursing” and “School of Health Sciences” in downtown Muncie with state-of-the-art simulation spaces that mirror the setup of operating and patient rooms at IU Health Ball Memorial Hospital. The new spaces allow for expanded program capacity and can be used as actual healthcare delivery rooms in the event of a major disaster.
• IU Health Ball Memorial Hospital’s partnership with Ivy Tech to match nursing students with mentor nurses for more hands-on patient care and customized learning in a groundbreaking program that re-imagines nursing rotations.
• IU School of Medicine–Muncie’s development of a new “scholarly-concentration” in community health promotion and disease prevention to recruit students to Muncie who are specifically interested in improving patient health through lifestyle modification and healthy behaviors.
• IU School of Medicine–Muncie’s new “Bachelors to MD program,” which launched in fall 2019, to allow eight Ball State University pre-med students per year to also be granted simultaneous, provisional admissions to the IU School of Medicine–Muncie, working to attract high school students to commit to local universities and to encourage them to stay in the surrounding community to practice medicine when they graduate.
• Maplewood Mansion Learning Laboratory, which provides short-term accommodations for IU School of Medicine–Muncie students in one of the Ball mansions along Minnetrista Boulevard. A recent publication stated that it “may be the finest medical student housing anywhere in the United States.” Under the direction of Ball State University Professor Chris Flook, a team of BSU telecommunications students recently produced a video on Optimus Primary, showcasing Maplewood Mansion and some of the other unique aspects of IU School of Medicine–Muncie.
• IU Health Ball Memorial Hospital’s hiring of a licensed psychologist to serve as inpatient behavioral health faculty, expanding its behavioral health services across the continuum of care.
• Meridian Health Services’ exploration of creating an Integrated Care Institute that would train individuals and organizations in the model of integrating physical, mental and social health.
As Optimus Primary turns toward its next phase of operations and funding, Bishop said they’re looking to get the community involved more. One way they plan to do this is through “standardized patients,” which are community volunteer actors. Each actor is given an extensive backstory and symptoms to exhibit, and then they are placed in a mock clinical setting with medical students.
“What happens in this is we have community members helping to train future healthcare workers in the community and they become better patients in the process, because they’re learning what’s supposed to happen,” Bishop said.
Bishop also said, now that Optimus Primary has a few programs under its belt, the next phase of the partnership is to begin quantifying data and, hopefully, spread the momentum to other communities.
“We’re looking now at how we can quantify the work that we’re doing and then we can begin seeking additional funding sources from outside entities,” he said. “Ball Brothers Foundation gave us the base to do this next level, which is going to be the large community-based research where we can say whether something is working. If we find out something is working, we can take it and we can export it to other communities.”
In all, Bishop is confident about where Optimus Primary is headed.
“The future is very bright,” he said. “I have dedicated our regional medical campus to doing this. This is our future.”
About Ball Brothers Foundation
Ball Brothers Foundation is one of the state’s oldest and largest family foundations. Annually, the foundation makes approximately $8 million in grants to support arts and culture, education, the environment, health, human services, and public affairs. The Muncie-based private foundation gives priority to projects and programs that improve the quality of life in the foundation’s home city, county and state.