Developing Creative Health Care Workforce Solutions:

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Developing Creative Health Care Workforce
Solutions

• Statewide Health Careers Pipeline Partnerships

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• Presented to the
• New Hampshires
• Workforce Development
• Policymakers and Leaders
• May 8, 2007
• Concord, NH

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The Message

• The challenges and rewards of providing health
  care in Rural America
• WVs approach to addressing the challenges and
  celebrating the rewards and outcomes
• Discuss what might be applicable to rural New
  Hampshire

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The Take Aways

• Rural states/regions have to take bold steps to
  develop creative solutions to their workforce
  crises.
• Community based partnerships can provide
  flexibility and resources for this innovation.
• If WV can do it, NH can too.

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Rural is.

• both an objective quantitative measure
• and a subjective state of mind

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Rural is.

• Defined by tradition and history
• Defined by geography and politics
• Defined by legend, myth, and stereotype
• Defined by culture and values

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• Rural America is home to
• Almost 60 million people
• Who live on 85 of Americas
• land
• 75 of all the Health
• Professions Shortages Areas

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Commonalities of Definitions of Rural

• Rural is defined by what it is noturban
• Rural is defined by geography and population
  density (census blocks not in urban areas or
  urban clusters 1,000 per square mile is urban 6
  per square mile is frontierrural is just about
  everything else)

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Rural as legend and myth

• Reinforced Stereotypes
• Poverty always breeds fatalism
• Rural people do not value education
• Rustic, quaint, charming
• Fatalism and ignorance are rural values
• Rural lifestyle results in health problems

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Creative Workforce Solutions
Require more than addressing policy issues They
require the grace of understanding.
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Just Different?
or Special
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Rural Beatitudes
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Blessed are the rural for they are collaborators
and are self-reliant
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Blessed are the rural for they value their
families
and are friendly folks
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Blessed are the rural for they value
individualism, are personable, independent, and
modest
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Blessed are the rural for they are
patriotic, and they go to war
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Blessed are the rural for they serve others
without being asked
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Blessed are the rural for they work the earth
And they make stuff for everyone else
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• Blessed are the rural for they have a deep
  faith,
• a sense beauty, and a sense
• of humor

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• Blessed are the rural for they ALL
• deserve high quality health care!

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Barriers and Opportunities in Recruitment and
Retention

• Reimbursement policy disparities
• Limited knowledge of rural culture and values
• Too much Myth and not enough Real McCoy
• Limited education and opportunities
• Limited income and resources

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Opportunities

• To truly make a difference
• To be respected and a leader
• A home for mavericks and missionaries
• Raise families or retire in a nurturing
  environment
• Wide open opportunities to practice the health
  care arts

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How To Talk Rural Issues and Policy

• Publication by W.K. Kellogg Foundation prepared
  by FrameWorks Institute (Food Systems and Rural
  Development)
• CD for Rural Advocates
• How to create messages based on how people
  currently think about Rural America

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To Talk Rural Issues and Policy First Dispel the
Stereotypes and Myths

• Rural Utopia
• Poverty is ennobling
• Life is simple and chosen to be this way
• Rural will take care of themselves

• Rural Dystopia
• Rural people are backward
• They are Others
• They need to catch up with the rest of us

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Rural Policy influence in Health Professions
Education

• Tax Credits for doctors in HPSAs, 1000 monthly
  for up to 5 years. (S. 824).
• Tax credits for doctors in frontier areas (S.
  2789).
• Increase VA training of medical residents and
  health professionals in rural areas (H.R. 5524)
• Integrated Rural Training Tracks

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Urban-Rural Policy Disparities in Health Care

• Medicare reimbursement policy discriminates
  against rural providers
• Based on historically erroneous fiscal
  assumptions
• Based on greater political power of urban
  providers and trade organizations
• Health care access policies that do not consider
  rural challenges

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Our mission is to fulfill our social contract
with WVs people

• Increased rural physicians by 142 in eight years
  (annual rate 13.5)
• Degree required rural rotations
• Full pipeline programs over seen by partnerships
• Increased and maintained jobs in rural WV at a
  rate of 4.3 FTEs per doc

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Our experience shows and the Literature supports

• Several strategies should be used to fix the
  problem
• Training in rural communities
• Financial incentives
• Community support for RR
• Policy and advocacy
• Effective strategies have to address the
  communitys ability to recruit and retain
  healthcare providers.

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• Pipeline training programs that recruit trainees
  from rural areas and have rural specific content
  make a substantial difference.
• Improvements must be made in reimbursement for
  all rural providers.
• Long term economic development in rural areas can
  improve the problem over time.

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• The contribution and uniqueness of this
  Partnership
• Unique collaboration of health sciences schools,
  private schools and local communities
• Recruitment of health professionals contributes
  to economic development through the creation of
  auxiliary jobs,
• And stabilizes the economy for attracting and
  sustaining other industries and business.

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The West Virginia Rural Health Education
Partnership (WVRHEP)/Area Health Education
Centers (AHEC)

• Interdisciplinary training in rural underserved
  areas
• Blend strategies of training and financial
  incentives with community recruitment and
  retention

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HSTA and HCOP Mission

• Increase the number of underrepresented students
  in post-secondary education in the health
  sciences
• Increase the number of health practitioners in
  MUA and HPSA communities

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• Profile of Students Served by HSTA
• 34 Black
• 49 Financially Disadvantaged
• 60 First To College
• 70 Female
• 803 total students currently in the program
• 78 high school teachers currently in the program

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HSTA Infrastructure

• 63 joint governing board members with community
  as majority
• 125 local governing board members from 14 regions
• 26 Counties chosen by need and under represented
  minorities
• Updated 5/3/2006

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HSTA Infrastructure

• Annual budget 1.4 million state, federal,
  foundation and private sources
• Receives substantial state support
• Tuition and fee waivers for successful students

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2006 WVRHEP/AHEC Infrastructure

• 476 training sites in all 55 counties
• 682 clinical field faculty
• 8 regional consortia with local boards and 4 AHEC
  Centers with local/campus boards
• 17 site coordinators, 4 AHEC center directors,
  program and support staff
• 17 Learning Resource Centers

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WVRHEP/AHEC supports

• 100 student rotations per month average 75,000
  community service contacts per year
• State level Rural Health Advisory Panel specified
  in legislation serves both state and federal
  functions
• 2.5 million per year to communities, 4.5
  million to schools for rural health training in
  state funding and 200K per AHEC center in
  federal funding

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WV Rural Health Education Partnerships
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• Outcomes of WVs
• Pipeline Partnership Programs

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HSTA Outcomes

• 95 enter college VS 56 for all WV
• 80 of the HSTA students are retained in college
  to graduation
• 2,526 students served by HSTA since 1994
• 713 HSTA High School Graduates (98-06)

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HSTA Outcomes

• 10 currently in medical school with more accepted
  for next year.
•  May 2006 HSTA graduates 3 Doctorates (MD,
  PharmD, DVM), 10 Masters, and 68 Bachelors. 
• 15.6 are in graduate or professional school
  within 6 years of college
• 59 in health career majors VS 17 for all WV

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WV RHEP/AHECService to the State

• Over 50,000 weeks of student training since 1992
• More than 1M community members participating in a
  variety of community service activities provided
  by students since 1997
• 15 million in uncompensated dental care to
  60,000 patients since 1995
• 820 RHEP/AHEC grads confirmed to be practicing in
  rural areas of the state in 2006

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2006 RR of Health Providers

• Type of Professional in rural WV who
  received financial incentives
• Physicians 213 90 (42)
• (99-03 graduates)
• NPs/Nurse Educators 92 39 (42)
• Nurses 56
• Physician Assistants 131 43 (33)
• Dentists 80 1 (1)
• Dental Hygienists 24
• Pharmacists 157
• Physical Therapists 57 2 (4)
• Occupational Therapist 2
• Medical Technologists 6
• Masters in Public Health 1
• Total 820 175 (21)

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Outcomes

• 39 medical school graduates stay in the state
  following residency
• 79 primary care residents who complete WV
  residency stay in the state
• In past 9 years retention in primary care has
  increase by 74

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Outcomes

• State has eliminated 8 HPSA counties in 10 years
  all 91 health professionals (including 19
  physicians) in these counties completed rural
  rotations in communities
• In 8 years rural physician who complete this
  training increased by 142, annual rate of 13.7

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2005 Rural WV Physician Placements By County
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New Federal Workforce Legislation

• Tax Credits for doctors in HPSAs, 1000 monthly
  for up to 5 years. (S. 824).
• Tax credits for doctors in frontier areas (S.
  2789).
• Increase VA training of medical residents and
  health professionals in rural areas (H.R. 5524)
• Integrated Rural Training Tracks