草榴社区

Richard Henriquez 鈥�12 was a senior at 草榴社区 when he took a medical mission trip to the small town of Sumpango, Guatemala, that changed his life. He recalls thousands of people waiting patiently in line to see healthcare providers, after they had already waited six months since the last mission trip.

鈥淚 had a patient who walked 18 miles with her twin babies on her back,鈥� Henriquez says. 鈥淎nd this would be the only time she would be able to have access to any type of doctor.鈥�

He describes the experience as a light bulb moment that changed his career path from psychology, in which he earned his bachelor鈥檚, to medicine. Even as he pursued a medical degree from the Ross University School of Medicine, he kept going on these mission trips because of his desire to help underserved people.

Now an attending physician at the Orlando Veterans Affairs (VA) Medical Center in Lake Nona, Henriquez continues to care for underserved populations, particularly people struggling with substance use disorders.

Between his Doctor of Medicine studies in the Caribbean, clinical rotations in New York and the start of his professional career in Central Florida, Henriquez made another impactful journey that changed his overall path: completing an internal medicine residency through the 草榴社区-HCA Florida Healthcare Graduate Medical Education (GME) Consortium.

鈥淲hen I found out I matched at 草榴社区, it was literally one of the happiest moments of my life,鈥� says Henriquez, who was also a chief resident for the Greater Orlando/Osceola GME Program. 鈥淚t was a full-circle moment. For everything that 草榴社区 has given me, I wanted to give back to 草榴社区, to the medical school, to the faculty, to all the patients in Orlando.鈥�

Attracting Future Doctors

Medical school graduates cannot practice medicine independently until they finish residency training, which takes three to seven years, depending on the specialty. During their fourth year of medical school, students interview with residency programs and then rank their choices. Residency programs do the same. Then a computer matches the two. Some students may also choose to pursue fellowships after this training for further specialization.

When Henriquez made the trip back to Orlando for his interview, he says there was a different feeling here than other programs he interviewed with.

鈥淚t felt like home,鈥� says Henriquez, who is now a faculty member in the GME program鈥檚 inaugural internal medicine residency.

He was also impressed by 草榴社区鈥檚 facilities and the leadership of the program鈥檚 director, Abdo Asmar, a professor of internal medicine who helped found 草榴社区鈥檚 inaugural residency program 10 years ago. 草榴社区 now has 29 residency and 11 fellowship programs in varying specialties across the state, including more than one-third in the Greater Orlando area. With around 650 residents, it鈥檚 one of the fastest-growing GME programs in the state.

That growth is critical as Florida is No. 5 in the nation for a shortage of healthcare professionals, according to Kyruus Health. More than half of medical residents stay and practice in the region where they completed their residency, the Association of American Medical Colleges states.

鈥淚nternal medicine and primary care are the pipeline for all healthcare and subspecialties to branch from.鈥�

草榴社区-HCA鈥檚 six internal medicine programs are notably important because primary care physicians make up the majority of this shortage 鈥� the Florida Hospital Association predicts the state will need nearly 6,000 more by 2035.

鈥淚nternal medicine and primary care are the pipeline for all healthcare and subspecialties to branch from,鈥� Asmar says. 鈥淲e have been proud to train and retain internists 鈥� to be the captain-of- the-ship physicians where they can coordinate the care of patients in a very complex healthcare system.鈥�

The best doctors are also prepared to treat complex and diverse populations, which is a major benefit of the GME program. 草榴社区 residents train across North and Central Florida in HCA Florida Healthcare hospitals. In Central Florida, they also work in the Orlando VA 鈥� 草榴社区鈥檚 first partner for residency programs 鈥� plus the 草榴社区 Health Faculty Physician Practice and numerous outpatient centers.

Most traditional academic centers provide training for residents at one main, larger facility where there鈥檚 one program for each of its specialties. At 草榴社区, most residents have options for which region of Florida they want to work in, and they often get a chance to train in various facilities nearby.

鈥淥ur patient mix is varied, depending on which hospital you鈥檙e in,鈥� says Stephen Cico, 草榴社区鈥檚 associate dean for graduate medical education. 鈥淲e have some that are more rural and some that are more urban. And since all of them are really [caring for] underserved populations, the residents get great exposure to a very broad breadth of patients and medical problems.鈥�

Advocating for Better Addiction Treatment

During the COVID-19 pandemic, there was a national surge in people with substance use disorders, a condition that healthcare professionals are more recently learning how to recognize and better treat. In 2020, the Florida Department of Health reported a 36% increase in fatal overdoses, marking the second-highest number of cases in the U.S. Numbers have continued to rise slightly in recent years, with nearly 7,800 deaths in 2023.

In that same year, 48.5 million Americans ages 12 and older, or about 17% of the population, met the criteria for substance use disorders, according to the National Survey on Drug Use and Health. But only about one in four of them received treatment.

Among those living with this condition are veterans, who experience higher rates of undiagnosed mental health issues, Henriquez notes. As many deal with these issues and the transition to civilian life, substance use disorders can develop out of coping methods.

Education is slowly making progress on how to recognize the signs of substance use disorders and how to administer naloxone, a medication that can reverse narcotic overdoses. Since the height of the COVID-19 pandemic, there鈥檚 been a 30% increase in naloxone use, according to the Florida Department of Health.

鈥淭he patient population that suffers from addiction is also a population that has received minimal attention,鈥� Henriquez
says. 鈥淔or so many years, people would just label them as 鈥榓ddicts鈥� or 鈥榡unkies.鈥� And truly, as we鈥檙e starting to learn more about the science and the neurological aspects of substance use disorders, you really see that a lot of these patients want to treat this disease.鈥�

鈥淎s we鈥檙e starting to learn more about the science and the neurological aspects of substance use disorders, you really see that a lot of these patients want to treat this disease.鈥�

When Henriquez joined 草榴社区 as a faculty member in 2021, he immediately advocated for and led the development of addiction
medicine education. Current internal medicine residents learn about how to treat different addictions throughout their three-year training program 鈥� from appropriate terminology to the neuroscience of addiction to attending Alcoholics Anonymous meetings. This year, the Greater Orlando/Osceola GME internal medicine residency program is incorporating a new addiction medicine rotation where residents work in detox centers.

鈥淭his field has been underrecognized in the past, and teaching our residents how to actively and successfully treat this population is going to change the medicine landscape significantly,鈥� Henriquez says.

He鈥檚 also developed substance use disorder curriculum for VA centers across the state, and he鈥檚 creating a national educational program for training internal medicine doctors in this field, too. Last year, about 3,000 people attended virtual sessions he led on the topic.

鈥淭he veteran population has given so much for us, for our nation, that I feel it鈥檚 my duty to help this patient population as best as I can,鈥� Henriquez says.

Filling Gaps in Mental Health Care

Forbes ranks Florida as the No. 4 worst state for mental health care. And by 2035, the state is predicted to have a psychiatrist shortage of 1,230, according to a Florida Hospital Association-funded study. However, growing awareness for and decreasing stigmas around mental health are contributing to increasing interest in psychiatry careers, says Anuja Mehta, a 草榴社区 College of Medicine associate professor and director of the GME residency program. Over the past five years, the National Resident Matching Program indicates 25% more medical students have matched into psychiatry programs.

Since 2018, residents in 草榴社区鈥檚 psychiatry program have made a difference in Central Florida through their rotations across hospitals and clinics. Two years after the Greater Orlando program launched, third-year residents began contributing to the local healthcare system in a larger way by working at a new HCA-affiliated outpatient clinic. It鈥檚 known as the HCA Florida Behavioral Health Specialists – Moss Park, a center developed by and run entirely through the Greater Orlando GME psychiatry residency program.

鈥淚 think that鈥檚 the single most thing that I鈥檓 proud of,鈥� Mehta says. 鈥淭his residency allowed me to start this clinic from [the] ground up, because if there was no residency, there wouldn鈥檛 have been that impetus.鈥�

鈥淲e are actually filling this need in Orange County and Osceola County because a lot of times, good psychiatrists, especially in Florida, don鈥檛 accept insurance.”

At the clinic, residents work under two full-time psychiatrists and Mehta to provide psychotherapy and medication management to insured adults. Since the clinic opened in 2020, it鈥檚 helped hundreds of individuals with mental illnesses.

鈥淲e are actually filling this need in Orange County and Osceola County because a lot of times, good psychiatrists, especially in Florida, don鈥檛 accept insurance. Patients have to pay out of pocket,鈥� Mehta says. 鈥淎nd otherwise, in many of those cases, they would have to see providers who are not trained adequately to do complex medication management.鈥�

One of the full-time psychiatrists at the clinic is Karla Flores-Perez, who completed the Greater Orlando GME residency in 2023. She鈥檚 now helping educate current residents as a full-time supervising attending physician.

The clinic鈥檚 education includes training residents on administering long-acting injectables, which are used to treat psychosis, schizophrenia and sometimes bipolar disorder. Clinic leadership has also developed a psychotherapy-based series for those living with eating disorders.

鈥淚 became a psychiatrist to help people,鈥� says Flores-Perez, who earned her medical degree from San Juan Bautista School of Medicine in Puerto Rico. 鈥淧articularly living in Orlando, being able to help the Hispanic population, personally, is very rewarding.鈥�

Improving Healthcare Inclusivity and Access

As a native Spanish speaker, Flores-Perez often helps Hispanic patients seeking someone who can speak their language and understand their cultural background. Studies show that patients often have a more positive experience with healthcare professionals of a similar background. Florida has the third-largest Hispanic population in the U.S., and about 46% of Osceola County residents speak Spanish at home, according to the U.S. Census Bureau.

While many hospitals have translators or sometimes use translation technologies, occasionally bi- and multilingual healthcare professionals step in to help when there is a long wait or if devices fail 鈥� which underscores the need for more diverse doctors, training and resources to reduce language barriers. Jomaris Centeno Girona, an internal medicine doctor at the HCA Florida Osceola Hospital and another recent Greater Orlando/Osceola GME residency graduate, says she鈥檚 taken on that role many times throughout her healthcare career.

鈥淭he impact of not understanding language can lead to [issues], from having the wrong medications prescribed to not understanding what they鈥檙e in the hospital for,鈥� says Centeno Girona, a new faculty member in the Greater Orlando/Osceola internal medicine residency and former chief resident.

In one case she recalls, a Spanish-speaking patient was mistakenly thought to have dementia when, in fact, no one who spoke their language had interacted with them. In reality, the patient was alert, aware and able to provide information about their medical issue and history. They just spoke with slower speech.

鈥淭he impact of not understanding language can lead to [issues], from having the wrong medications prescribed to not understanding what they鈥檙e in the hospital for.鈥�

About half of adults with limited English proficiency say they encountered at least one language barrier in a healthcare setting in the past three years, according to KFF, a health research and policy nonprofit. For each of those instances, there鈥檚 a chance major errors could be made, and patients may not feel comfortable asking questions about their health issues or the care they鈥檙e receiving. Centeno Girona notes that it also introduces opportunities where biases may be presented, such as an assumption of a patient鈥檚 insurance status.

But finding resourceful solutions for patients who do lack insurance is an important skill for doctors 鈥� a skill that Centeno Girona says the GME program helped equip her with. In Osceola County, this is especially necessary as the region is designated as medically underserved by the U.S. Department of Health and Human Services. The partially rural region has continued to face issues with adequate access to healthcare since 1978. In 2022, Osceola County had over one-third more uninsured residents than the national average, according to data from the Florida Health Department and U.S. Census Bureau.

Professionals across the GME program鈥檚 internal medicine and psychiatry residencies in Greater Orlando/Osceola note a lack of insurance as being nearly as big of an issue as the physician shortage. U.S. Census Bureau data indicates Florida has the fourth-highest rate of uninsured people across the nation. Even as more doctors are brought to Florida through residency and medical school programs, they won鈥檛 be able to help patients without insurance.

Keeping Physicians in Florida

Ten years ago when the GME program launched its first residency, just 16 medical school graduates made up the internal medicine cohort. Today there are 827 graduates of the statewide GME program, which includes emergency medicine, family medicine, obstetrics and gynecology, psychiatry, rheumatology, surgery and more.

鈥淲e鈥檝e added over 400 physicians to the workforce here in the state of Florida,鈥� says Cico, who began leading the 草榴社区-HCA Florida Healthcare GME Consortium in 2022. 鈥淲e鈥檝e really been transforming what have been traditionally community hospitals into teaching and academic hospitals.鈥�

鈥淸Over the past 10 years], we鈥檝e added over 400 physicians to the workforce here in the state of Florida.鈥�

The program is also contributing to Florida鈥檚 physician workforce by helping retain doctors who are already practicing.

鈥淚鈥檝e had community physicians who never had the opportunity to teach before [our programs] call me out of nowhere to say, 鈥楳y career has been rejuvenated because I just was taking care of patients and planning to retire. Now I have a different energy because I鈥檓 educating [a new class of physicians],鈥� 鈥� Asmar says.

The program has a history of turning its graduated residents into educators for the cohorts that follow in their footsteps, which Henriquez, Flores-Perez and Centeno Girona can all attest to.

Among this group is a graduate whose professional career has mirrored the program鈥檚 expansion. Mustafa Kinaan was a resident in the inaugural internal medicine residency program. He completed the GME program鈥檚 endocrinology fellowship and then became a core faculty member. Now he鈥檚 program director for the same fellowship he once trained in.

鈥淲hen I started as a resident, we were the only people training in the hospital in Osceola,鈥� says Kinaan, who is also an endocrinologist at the HCA facility. 鈥淭o see now multiple graduate medical education programs and over 180 residents and fellows running the medical services in our Greater Orlando/Osceola and VA hospitals is very inspiring. It just speaks to all the progress and hard work that went into [growing these] residencies and fellowships.鈥�

With nearly 18,000 new physicians needed by 2035, every doctor certainly counts. In the next three to four years, the GME program aims to add potentially 20 more offerings across the state, Cico says. Each program will enhance a network of essential and compassionate caregivers.

鈥淲e try to not only give them skills to be good doctors, but we really model the honor and the privilege [it is] to be a physician, to work in a team setting and to understand that medicine is a team sport,鈥� Asmar says.