Grow Your Own: How to Create a Pipeline of Health Care Professionals

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Grow Your Own How to Create a Pipeline of
Health Care Professionals

• April L. Vestal, MPH
• Rural Maryland Council
• Annapolis, Maryland
• October 2, 2008

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The Message

• State Policy and Education leaders make a
  difference
• Strategic partnerships of local communities and
  higher education can impact recruitment and
  retention
• Outcomes should be directly linked to health
  status, program elements, and best practices.

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Experience and Evidence supports

• Pipeline programs with rural focus and content
• Training in rural communities
• Recruiting rural people into programs
• Financial incentives and Community support
• Strategies that improve communitys ability to
  recruit and retain healthcare providers.

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The West Virginia Experience in Training
Recruiting, and Retaining Rural Health Providers
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• Unique Elements of this Partnership
• Degree-required rural rotations of all state
  supported health sciences students since 1996
• Tuition and fee waivers for successful completers
  of middle and high school health careers programs
• Unique collaboration of health sciences schools,
  private schools and local communities
• Recruitment of health professionals contributes
  to economic development through the creation of
  jobs (in rural WV 1 doc 4.3 jobs)

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What Our WV Experience Has Taught Us

• When community in put is valued community members
  can have a highly effective role in training
• Schools improve mission delivery
• Health promotion services are increased at
  community level

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Organizations and Systems

• Local Rural Health Providers
• CHCs, rural hospitals, private practitioners,
  pharmacists, etc.
• Serve as fiscal agents, employ site personnel,
  provide office space
• Serve as preceptors
• Serve as local board members
• Provide student meals, housing
• Provide learning resource centers
• Send one rep to state level Rural Health Advisory
  Panel appointed by Governor

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Organizations and Systems

• WV Higher Education Policy Commission
• Carries legislative authority for implementation
• Transfers and oversees funds from state treasury
  to schools and communities
• Administers state funded scholarship program
• Oversees annual legislative reporting
  requirements
• Maintains link with Governors office
• Maintains state level budget

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Organizations and Systems

• Schools (all state funded Health Sciences
  programs)
• Devote faculty time to coordinate rural health
  curriculum and rotations (generally 20 FTE)
• Provide orientation to rural rotations to
  students on campus
• Host Rural Health Fairs for students
• Provide rural health courses and/or specific
  rural health content in other courses
• Receives state funds allocated to schools under
  RHI Act

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Organizations and Systems

• State Agencies
• Bureau for Public Health RCP, SLRP, SEARCH
  scholarships, technical assistance to communities
  on RR issues
• Economic Development
• Local partners on Workforce Investment Board, do
  joint projects
• Public Schools
• Joint childhood health projects, CARDIAC, etc.
• Legislature
• Core funding and federal match
• Advise

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Financial Incentive and Assistance Programs
HSSP, MSLF SEARCH
SLRP RRCP
Recruit-able Project Community
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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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WVRHEP/AHEC Infrastructure

• 100 student rotations per month
• 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
• 200K per AHEC center in federal funding

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2007 WVRHEP/AHEC Infrastructure

• 498 training sites in 55 counties
• 750 clinical field faculty
• 8 regional consortia with local boards and 4 AHEC
  Centers with local/campus boards
• 15 site coordinators, 5 AHEC center directors,
  program and support staff
• 17 Learning Resource Centers

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Partnership Training Sites

• Of the these 498 partnership training sites
• 374 in HPSAs or MUAs
• 148 sites are both

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Types of Training Sites

• 45 CHCs
• 47 FQHCs
• 8 RHCs
• 28 small rural hospitals
• 25 dental offices
• 37 pharmacies

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Training Sites, cont.

• 14 county health departments,
• 40 physical therapy agencies or rehabilitation
  center sites,
• 15 healthcare for the homeless facilities,
• 13 school based health centers,
• 3 free clinics, and
• 1 migrant health center

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Recruit-able Community Project

• Initiated in FM Dept with private foundation
  funds
• Is now Bureau for Public Health resources
• Helps communities map assets and recommends
  improvements
• First Impressions and Community Design Teams
  Cooperative Extension

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Recruit-able Community Project

• Communities apply and pay 3,000 to 5,000 on
  average for Teams assessment
• Rural Scholars (FM residents) complete rotations
  in or near communities
• TA continues to develop long range RR plan for
  community

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RCP Community Process Cycle
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Background - Community Decision-Making Model

• Community approach to strengthening the community
  health system
• Often, community encourager provided leadership
• identifying community health needs and resources
• strategic planning
• decision-making

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RCP Community Tools

• Recruitment manual
• Video on recruitment and retention
• Newsletters
• Board game on rural practice

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• Outcomes of WVs
• Pipeline Partnership Programs

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Health Sciences Technology Academy

• Targets under represented minority and
  disadvantaged students and communities
• Over 2,500 students served by HSTA since 1994
• 982 HSTA High School Graduates (98-07)

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HSTA Outcomes

• 95 enter college vs. 56 for all WV
• 59 in health career majors VS 17 for all WV
• 786 (80) of the 982 HSTA graduates are still in
  college

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HSTA Outcomes

•  55 HSTA Scholars in graduate/prof school
• 27 HSTA Scholars in health sciences
• 10 HSTA graduates currently in medical school

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WV RHEP/AHECService to the State

• Over 50,000 weeks of student training since 1992
• 15 million in uncompensated dental care to
  60,000 patients since 1995
• 967 RHEP/AHEC grads confirmed to be practicing in
  rural areas of the state in 2007

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WV Trained Rural Providers who completed Degree
Required Rural Health Rotations 2007

• Physical Therapists 60
• Occupational Therapist 2
• Medical Technologists 8
• MPH 1
• Social Workers 1
• Nurse Midwives 1
• Total 967

• Physicians 264
• (91-04 graduates)
• NPs/Nurse Educators 104
• Nurses 80
• Physician Assistants 152
• Dentists 89
• Dental Hygienists 22
• Pharmacists 183

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Retention Outcomes

• 38.6 medical school graduates stay in the state
  following residency
• 25 medical school graduates stay in state in
  primary care

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Retention Outcomes

• Retention of WV SoM graduates AND residency grads
  in FM is 79
• In past 11 years retention in primary care has
  increased by 67
• Dentistry is 58
• Pharmacy is 64

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Oct 2006 HRSA Health Workforce study (2004 data)

• 31 of WVs physician workforce are graduates of
  instate medical schools while national average is
  29.
• 38 of the WV physician workforce are
  international graduates, compared to a national
  average of 26.07

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Outcomes

• State has eliminated 8 HPSA counties in 10 years
  all 91 health professionals in these counties
  completed rural rotations
• In 9 years rural physicians who completed this
  training increased by 200, annual rate of 14.7

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Precepting students may impact retention

• 58 (61) of the physician respondents to the 2005
  survey reported that they are currently RHEP/AHEC
  field professors
• Of these 61
• 85 said that they find teaching to be personally
  rewarding
• 73 said that teaching helps them stay current in
  their profession

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Lessons Learned

• Involve communities in program implementation
  ownership
• Develop a champion for your cause
• Bring key stakeholders together early to
  establish cooperation
• Sustainability options involving your partners

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Visit us on the Web
www.wvrhep.org www.wvahec.org
www.wvochs.org/dr
www.wv-hsta.org