Restoring and Reforming Ambulatory Services and Internal Medicine Training in the Aftermath of Hurricane Katrina

The health system in New Orleans before Hurricane Katrina, in which 70% of all Louisiana physicians trained, was generally provider-centric, not supported by interoperable information technology or by health policies that financially supported primary care. This created a health culture rooted in the fragmented, centralized, provider-centered model of care in which patients experienced fragmented care, delivered in clinics located inconveniently downtown and open during hours convenient to the physicians and trainees. The destruction of the training environment by the flooding from the storm opened an opportunity for rapid innovation and improvement of this training environment for the internal medicine residency at Tulane School of Medicine. The post-storm events we describe in this piece are an example of the kind of collaborative spirit and efforts that embody our program and the new health care sector in New Orleans. It is this spirit that has helped the ambulatory training component of our internal medicine program survive and thrive in the aftermath of Hurricane Katrina.