Rural Health Workforce Trends: A National Perspective

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Rural Health Workforce Trends A National
Perspective

• J. H. Fonkert, MN ORHPC
• July 14, 2008

Thanks to Pam Smith, Massachusetts SORH
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A Rural Health Workforce Partnership
Thanks to Pam Smith, Massachusetts SORH
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10.5 Million Healthcare Employees
JHF, MN ORHPC
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Health Careers not just for doctors and nurses
anymore!
JHF, MN ORHPC
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551,000 Physicians
JHF, MN ORHPC
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A NOSORH Workforce Conference conclusion
Policies based on urban practices need to be
modified to reflect rural realities.
But, what are the rural realities?
JHF, MN ORHPC
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Whats different about Rural?

• low population small market size
• remoteness distance from larger markets
• unique population ethnicity, income, insurance
  coverage.

How do these things affect health care delivery,
and what practical things can we do about it?
JHF, MN ORHPC
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The Many kinds of Rural

• Non-metro trade centers
• Agricultural towns
• High amenity and tourist areas
• Remote small cities and towns
• Frontier areas

Health workforce challenges are different in each.
JHF, MN ORHPC
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3RNet

• REcruTENTION!
• Tom Skinner recruit to retain.

JHF, MN ORHPC
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Rural Health Works

• Show the impact of medical practices and
  healthcare facilities on local economies.
• Know the impact of a medical school on a states
  economy.

Thanks to Pam Smith, Massachusetts SORH
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Keynote - Jack Dillenberg, DDSDean, Arizona
School of Dentistry and Oral Health

• Letter from community health center guarantees
  admissions interview.
• Admissions emphasize volunteer work and
  community commitment.
• Paradigm shift from primary care to
  comprehensive care to interdisciplinary care.

Thanks to Pam Smith, Massachusetts SORH
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Workgroup Questions

• Where are the gaps in our data?
• What obstacles hamper rural workforce
  development?
• Where are the greatest opportunities?
• What things can we impact most?
• Who are our partners?
• What do we recommend?

JHF, MN ORHPC
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Allied Health

• poor national data unclear occupational
  definitions.
• lack of rural critical mass to employ some
  occupations.
• Need distance learning, practicum sites.
• Need mid-career training and career paths.
• Beware of degree creep.
• Licensing and scope of practice issues.

JHF, MN ORHPC
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Emergency Medical Services

• Problems with pay and turnover.
• Lack of state support (dependent on local
  resources).
• Should support EMS as a public service like
  other public safety.

John Becknell Regionalize EMS and fund
readiness. (MN Rural Health Conference, June 2008)
JHF, MN ORHPC
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Health information technology

• Turnover competing with other industries for
  staff.
• Need for health IT curriculum.
• Small facilities need help with implementation
  cost.
• Interoperability issues.

JHF, MN ORHPC
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Mental Health

• Gaps in care for less than chronically ill.
• Too much reliance on part-time providers.
• Returning veterans.
• Role for tele-psychiatry?
• Reimbursement issues.
• Rural-Urban earnings gap.

JHF, MN ORHPC
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Oral Health

• Small, remote communities not viable for
  traditional practices.
• High incidence of public program patients in
  rural areas.
• Need for mid-level practitioners.
• Need more rural rotations.
• Make state schools accountable for serving rural
  and underserved.

JHF, MN ORHPC
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Recommendations

• Identify models of articulation agreements that
  could be replicated for allied health
  professions.
• More k-12 programs for allied health
  professionals utilizing AHECs with a rural focus.
• Cross credentialing of health care specialist
  (WA) proposed legislation.
• Improve dissemination of working models and best
  practices

Thanks to Pam Smith, Massachusetts SORH
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NOSORH Workforce Committee

• To develop SORH expertise and understanding of
  workforce issues in order to provide the State
  Office of Rural Health perspective on workforce
  policy issues and serve as a link between State
  Offices of Rural Health, national partner
  organizations, the Federal Office of Rural Health
  Policy and other federal agencies.

Thanks to Pam Smith, Massachusetts SORH
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Actions/Next Steps

• Survey of SORHs for workforce activities
• Provided input for Workforce Summit
• Creating a model for cross-credentialing of
  Allied Health Professional
• Survey of SORHs about knowledge of Allied Health
  programs in state.

Thanks to Pam Smith, Massachusetts SORH
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Allied Health Workforce

• What professions would you include under Allied
  Health?
• Is Allied Health work part of your SORH work?
• What type of work does that include?
• Do you work with the Community Colleges on any
  workforce development?
• Does the SORH have a role in developing allied
  health workforce?
• Where does it fall on your list of priorities?
• What health workforce issue ranks higher?
• What should be the focus of the Workforce
  Committee?

Thanks to Pam Smith, Massachusetts SORH
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Questions?

• Jay Fonkert, Sr. Workforce Analyst, Minnesota
  Office of Rural Health and Primary Care
• 651-201-3846
• Jay.fonkert_at_state.mn.us

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Presentation Overview

• Rural Health Workforce Summit
• Recruitment, Retention, Collaboration Model
  programs
• Key note Highlights
• Breakout Highlights and recommendations
• NOSORH Workforce Committee
• Next Steps

Thanks to Pam Smith, Massachusetts SORH
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Recruitment, Retention, Collaboration Program
models

• Oregon - If you recruit without keeping your eye
  on retention, you are going to fail in the long
  run.
• Recruitention
• Tim Skinner
• Colorado CoRRRN, CROP and CPR
• Statewide Initiative

Thanks to Pam Smith, Massachusetts SORH
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Recruitment, Retention, Collaboration Program
models

• South Dakota - Healthcare Workforce Center
• South Carolina
• Noon conferences with resident physicians.

Thanks to Pam Smith, Massachusetts SORH
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Oral Health Challenges,

• Gaps
• - Less dentists per capita than 10 years ago.
• - Some rural communities cannot support a
  dental practice due to low population.
• - Definitions/scope of practice for dental
  hygienists vary greatly.

Thanks to Pam Smith, Massachusetts SORH
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Oral Health Challenges,

• Obstacles
• - lack of a rural pipeline for dentists
• - 3rd party payers
• - Licensing boards
• - Facilities/equipment that are inadequate
• - Integration of dental and primary care and
  subsequent issues.
• - All dental graduates are not created equally

Thanks to Pam Smith, Massachusetts SORH
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Allied Health Training the Health Workforce

• Gaps
• Allied Health to big and becomes a catch all
• Lack of data
• Obstacles
• Few distance learning opportunities
• Salaries are too low
• Lack of structured education for some of these
  professions

Thanks to Pam Smith, Massachusetts SORH
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Recommendations

• Federal loan forgiveness increase
• Graduate Medical Education money and how it
  relates to dental residencies
• NHSC lower dental professions shortage area 18
  for scholars
• Incentives to practice in rural areas (loans)

Thanks to Pam Smith, Massachusetts SORH
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Health Information Technologies

• HIT Workforce Crisis
• Health care industry lags all other major
  industries in IT adoption even with advances.
• Need for HIT management is increasing.
• Health care facilities are struggling to staff
  HIT needs and also turnover.
• Lack of interoperability because systems are
  different.

Thanks to Pam Smith, Massachusetts SORH
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Recommendations

• Loan repayment program recruitment and
  retention incentives
• Job Corp
• Signing bonus
• State of the art technology
• Pay for standardization of skill set/degree
• Support for distance education
• Technical assistance for HIT
• Catalog of models
• Grants for HIT network development

Thanks to Pam Smith, Massachusetts SORH
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EMSA unique approach to addressing rural health
needs

• Gaps
• - Turn over Money not there move on to RN or
  go to urban communities for bigger salaries
• - Paying for credentialing
• Obstacles
• - Lack of hospital support
• - Equipment - get hand me downs
• - Liability insurance

Thanks to Pam Smith, Massachusetts SORH
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Recommendations

• Need for distance learning opportunities for EMTs
  and Paramedics due to limited training
  facilities.
• EMS is a local public service and needs to be
  supported and funded

Thanks to Pam Smith, Massachusetts SORH
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Behavioral Health Workforce Trends

• Gaps
• - Licensure lists dont reflect who can practice
  and provide mental health care
• - Impact of returning vets, supply of mental
  health providers employed by the VA
• Obstacles
• - Lack of rural training
• - Lack of funding
• - Territorialism of existing providers

Thanks to Pam Smith, Massachusetts SORH
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Policy issues that impede workforce development

• Policies need to reflect reality. Policies that
  allow mid levels, telemedicine, loan repayment
  policies etc. that allow providers to be
  reimbursed for offering rural care.
• Recommendations
• Policies need to be changed to reflect rural
  realities

Thanks to Pam Smith, Massachusetts SORH