Community Physicians

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See a snapshot of our locations at the conclusion of FY23.

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First, You Hire More Recruiters 

Johns Hopkins Community Physicians boosted its primary and specialty care hiring in fiscal year 2024 after hiring a third physician recruiter. Compared with the previous fiscal year, hospital-based provider hires increased 19%, while primary and specialty provider hires rose 32%.

“Sourcing physicians and advance practice providers is challenging in this market,” says Leslie Rohde, executive director of human resources. “These physicians are very busy people and they’re working full time, so we have to go and find them.”

Kathy Gallagher & Geralyn Azizkhan attending a conference in FY24

JHCP added its third recruiter in October 2022 when Kathy Gallagher joined a team that includes Eileen Walters for primary and specialty care as well as Geralyn Azizkhan for hospital-based medicine hires at Johns Hopkins Howard County Medical Center, Sibley Memorial Hospital and Suburban Hospital.

Recruiters look for talented clinicians at conferences for organizations including the American Academy of Family Physicians, the American College of Physicians and the American College of Osteopathic Internists. The goal is to forge connections, even with those not immediately job-hunting.

“We have an attractive booth and we have our physician recruiters there, shaking hands and engaging with people,” says Rohde. “Often, current JHCP physicians will spend time at the booth, making personal connections and sharing firsthand experience.”

Those connections, she says, “may not yield a hire for next week, but they can pay off over time.”

Visitors to these booths can learn about some of the benefits of working for Johns Hopkins, including a focus on wellness and a schedule that gives up to eight hours of administrative time per a full-time position, a welcome shift in fiscal year 2023 from four hours of administrative time.

“The organizational leaders recognized that additional administrative time accurately recognizes work that’s not face to face,” says Rohde. “That’s a big selling point and a differentiator in the market, which helps us recruit and retain the best candidates to serve our patients in the communities we support.” 

Johns Hopkins Community Physicians Grows Cardiology in National Capital Region

The Johns Hopkins Community Physicians (JHCP) cardiology division is growing in the National Capital Region, giving patients more opportunities to access care while improving the flow of existing exam rooms and workspaces. A $2 million renovation recently completed at the main office in Bethesda, Maryland, modernized the space and increased capacity to see patients. In Northern Virginia, JHCP opened an office in Arlington that includes cardiology, and is planning another site with cardiology in Northern Virginia. The number of nurse practitioners in cardiology increased from one to four across the locations.

Virginia Colliver, M.D., regional medical director, cardiology

The Bethesda space, which dated back to when physicians used paper charts, was in need of a refresh, says Virginia Colliver, JHCP regional medical director of cardiology. It now has 25 exam rooms, up from 20, a renovated nuclear laboratory, and larger offices for physicians to share. It also has flexibility for future expansion, she says. “The exam rooms now are more patient- and clinician-friendly,” Colliver says. “Clinicians are forward-facing their patients, as opposed to the past, when computers were stuck up against a wall and patients were behind them when they were entering information. To leverage the technology, we needed a better flow in the rooms.”

The redesign also updated workspace for medical assistants. Instead of sitting together in an open space subject to frequent interruptions, they now have small alcoves that allow them to be easily accessible but able to better concentrate on tasks.

Cardiologists with JHCP offer a full complement of services including stress testing, echocardiograms, cardiac ambulatory monitoring, vascular studies and remote device interrogation for pacemakers and defibrillators.

“We plan to hire multiple cardiologists to help improve patient access to our practice,” Colliver says. 

JHCP Training Exercises Prepare Clinicians for Violent Situations

A patient grows frustrated in the waiting room and starts yelling at the front desk staff. As tensions escalate, threats are made.

It’s a scene no health care professional wants to face, but with the reality of increased patient disruptions in recent years, especially after the COVID-19 pandemic, preparation is key.

A recent series of training exercises at Johns Hopkins Community Physicians (JHCP) locations has equipped staff members with skills to respond to such high-stress moments. Throughout 2024, the three-part training series reached all 51 JHCP sites, with more than 700 employees participating in workshops alongside actors who simulated realistic scenarios. Employees learned to recognize concerning behavior, de-escalate tensions and follow the U.S. Department of Homeland Security’s “Run, Hide, Fight” protocol for active-shooter situations.

Lou Brungard, director of regulatory affairs

“The goal is to gain confidence and practical techniques for diffusing tense situations,” says Lou Brungard, director of regulatory affairs for JHCP’s Health, Safety, and Environment Department, which created the program with JHCP senior leadership and Johns Hopkins Public Safety. Local law enforcement was also involved in implementing the program as well as observing and participating in scenarios.

Each exercise started with safety training and ended with a debrief to capture feedback and process emotions. “In some cases, people respond personally or sensitively to the scenario because it does resemble real life,” Brungard says. On hand was the RISE (Resilience in Stressful Events) team to offer confidential peer-to-peer support for any employee who needed it.

Already, feedback from the exercises has led to enhanced safety measures, such as adding portable radios to each site for quicker communication among staff members. Looking ahead, JHCP plans to add web-based safety training for new employees and larger regional drills across the Baltimore and Washington, D.C., areas over the next two years.

JHCP Clinics Support Health Intervention Study to Reduce High Blood Pressure

Leaders with Johns Hopkins Community Physicians (JHCP) have long been focused on patient-centered research studies that have high potential to improve patient outcomes and can be scaled across its clinics.

“Projects focused on chronic disease management or prevention are perfect for our primary care clinics and our providers to really dig in because of their relevance to our practices and patient needs,” says Wendy Bennett, research director for JHCP. “Our JHCP research department gets involved with all types of research — everything from surveys related to our patients or providers and their perspectives, all the way up to large cluster randomized controlled trials that test questions that are very relevant to primary care.” 

Wendy Bennett, M.D., research director

Clinicians were excited to participate in a study to determine whether dedicated education and counseling from a community health worker can help patients with elevated blood pressure manage their condition. The Home Blood Pressure Telemonitoring Linked with Community Health Workers to Improve Blood Pressure study, or LINKED-BP for short, gives home blood pressure monitoring devices and instructions on how to use them to all patients who enroll. Yvonne Commodore-Mensah, of the Johns Hopkins University School of Nursing, is the principal investigator.  

Patients are assigned through their JHCP clinic into one of two groups: intervention or enhanced usual care. The intervention group will receive education and counseling on lifestyle management from a community health worker at the clinic or at home, along with follow-up telehealth visits with that community health worker and a free mobile app to record blood pressure readings. The community health worker, who will have access to their patients’ blood pressure measurements, also will link participants to community resources to address any health-related social needs. Participants will still receive care from their primary care physicians.

Participants in the enhanced usual care group will receive care from their primary care physician per usual. However, they also will receive a blood pressure monitor and can share their readings with their doctor. Eight JHCP locations (Remington, Bowie, Brandywine, Charles County, Fulton, I Street, Greater Dundalk and White Marsh) have enrolled study participants, with the goal of including 24 individuals from each site. All but two sites have met or exceeded their enrollment targets. 

Investigators will look at how the interventions compare with usual care in helping reduce blood pressure six and 12 months into the program, and whether any reduction is maintained at 18 months. The project is part of the RESTORE (AddREssing Social Determinants TO pRevent hypErtension) Network, a health equity research network funded by the American Heart Association that focuses on hypertension prevention. 

Some 45%–50% of adults have high blood pressure, Bennett says, so it’s a prime area of focus. “As soon as somebody has poorly controlled pressure, it can confer a higher risk of stroke, heart attack or kidney disease,” she says. Having a new resource in the community health workers provides an additional strategy to help physicians and patients tackle the issue. “Providers are very happy to have their patients receive additional support to manage their blood pressure.”

JHCP practices also participated in the nursing school’s LINKED-HEARTS study, a similar program for adults with high blood pressure and either diabetes or kidney disease.  

JHCP Helps Staff Members, Clinicians Navigate Tough Times with META, RISE

Two programs designed to support employees, clinicians and patients during and after adverse events made major strides in fiscal year 2024.

META (Major Event Triage and Action) formalized its processes, and RISE (Resilience in Stressful Events) expanded into Johns Hopkins Community Physicians.

For years, the risk management and patient safety teams have responded to unexpected events involving patients, visitors and/or staff members that resulted in harm by analyzing what happened and figuring out what actions to take to reduce the risk of a similar event happening again.

In March, the process was formalized at JHCP with META, a subcommittee of the Executive Risk Committee. META regularly meets to review events, and includes representatives from the risk management, patient safety, patient experience, legal and quality improvement teams, as well as physician and nursing leadership and operations leadership. The group’s conversations are peer-review privileged and confidential.

META looks at issues such as improving care team and patient communication; making sure practices have the supplies and appropriate equipment they need for optimal patient care, from assistive devices to examination beds; and identifying areas where more education and training is needed for staff members and clinicians.

RISE, which delivers peer support to health-care workers coping with stressful patient- and work-related events, launched across JHCP in April 2023 with the help of the Armstrong Institute for Patient Safety and Quality and a U.S. Health Resources and Services Administration (HRSA) grant — the first instance of RISE expanding to the ambulatory setting.

“We have different experiences in a hospital versus outpatient care, but we all need support,” says Amanda Cullison, the patient safety program administrator for JHCP. “No matter what we deal with in our work, we can all have experiences that cause stress. We want to make sure all of our members are supported when dealing with these tough situations.”

JHCP now has 20 RISE responders who can provide phone, virtual and in-person support at all JHCP locations, nonhospital school of medicine clinics, ambulatory surgery centers and Johns Hopkins Regional Physicians clinics.

During fiscal year 2024, the team completed 23 peer-support encounters, supporting 84 staff members (some encounters are in groups). Although the HRSA grant was completed in December, JHCP’s RISE program continues with support from the main RISE program, which was founded in 2011 at The Johns Hopkins Hospital.

Changes in Panel Metric Collection and Review Yield Success 

Quality metrics, which measure rates of preventive care, are important. For example, regular cancer screenings and consistent monitoring of chronic conditions like high blood pressure and diabetes find problems before they get serious, minimizing treatment and saving lives. 

Sujay Pathak, M.D., physician quality champion and internal medicine physician

In 2021, primary care physician Sujay Pathak began looking into the metrics and how they’re compiled, finding opportunities for improvement.

For starters, he says, the patient screening data was compiled on a software system that did not live within the electronic medical record system, so patient outreach had to be handled separately.

What’s more, for many Johns Hopkins Community Physicians (JHCP) metrics, the dashboard only measured patients seen in the previous calendar year, and there was a lag in reporting time because the system pulled data a month at a time, and released it a couple of weeks after that. That meant clinicians were looking at information that could be six weeks old, not particularly useful when figuring out which patients to contact to schedule screening appointments. “It’s suboptimal to not have real-time information when you’re actually trying to use that data,” Pathak says.

The solution was two-pronged: Improve an existing quality reporting mechanism, called My Panel Metrics, which is part of the Epic electronic medical record system, and foster wider adoption of its use to close quality gaps.

Pathak brought together about 35 people, including front-line clinicians, division chiefs, medical office assistants, Epic representatives and Raymond Zollinger, JHCP vice president of medical affairs.

One resulting change allowed for more accurate and efficient outreach within the Epic system in the form of MyChart messages to prompt patients to complete screening tests. Another removed the time lag by showing, in near-real time, which patients had already completed the screenings.

“You can build a filter and bulk-outreach patients,” says Pathak — for example, send a note to all patients who are due for mammograms. “We’re now seeing more non-providers running and using panel metric reports to close quality gaps and save lives,” Pathak says.

In 2023, JHCP saw its highest levels of achievement in reaching or exceeding national benchmarks. Though 2024 data is not yet complete, it shows continued improvements.

For example, wellness visits for patients 65 and older have gone from 79.42% in October 2023 to 82.16% in October 2024. Over the same time period, statin therapy for patients with diabetes and without cardiovascular disease has increased from 81.42% to 85.98%, and depression screening and follow-up has grown from 84.34% to 90.63%.