Innovative

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Innovative Strategies for Developing the
Pipeline
Preparing for the Next Generation of Health
Providers
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• Presented to the
• HRSA Bureau of Health Professions
• All Programs Meeting
• February 25, 2008
• Hilton Washington Hotel
• Washington, D.C.
• Hilda R. Heady, MSW
• Executive Director WV Rural Health Education
• Partnerships/AHEC
• Associate Vice President for Rural Health
• West Virginia University

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The Message

• The impact of culture and socioeconomic status on
  career choice gives rise to strategic
  opportunities
• The spirit of collaboration and partnership
  defines and encourages the mission when nurtured
  within the context of culture and values
• Outcomes should be directly linked to program
  elements, and best practices will result

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Rural Is

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

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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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Our experience shows and the Literature supports

• Several strategies should be used to fix the
  problem
• Training in rural communities through a pipeline
  of health professions programs
• Financial incentives and Community support for
  RR
• 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 RR over time.

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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, spend a lifetime, and/or retire
  in a nurturing environment
• Wide open opportunities to practice the health
  care arts

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Creative Workforce Solutions
Require more than addressing policy issues They
require the grace of understanding.
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To define or re-define Social Responsibility

• The social and political will
• must exist to do so

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The grace of understanding The social and
political will The passion to drive us. All
come from the same place.
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Our Strategies and Our Theories are informed

• By the People and Places in our lives and the
  lessons they teach
• By whether or not we take Lifes lessons to
  direct our policies and guide our passions
• By the wisdom we learned in childhood.

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From grandmothers front porch I learned
Some Front Porch Wisdom
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Welcome the People and Problems that Show up
at Your door, for They may have Gifts and Lessons
to be Learned
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• Resilience is the key to how people respond to
  lifes challenges and opportunities

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Resilience is tempered by attitude or adversity
and mostly ones attitude about ones adversity
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• If you are privileged to a have higher education
  and
• you come from a humble background,
• it is
• your responsibility to give back. Period.

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• Giving back starts at home first then goes into
  the community

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There is nothing noble about poverty,
however, people who are poor and embrace
life fully are noble indeed.
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• If you are lucky enough to be blessed in life
  with
• special gifts, you are to share these gifts,
• and remember that you are no better than
• anyone else because of these gifts

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• Family and Children and

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Old people always come first
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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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• The contribution and uniqueness 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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Our social responsibility expressed through
our social contract
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Our Experiences Teach Us

• When community 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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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
• 17 site coordinators, 5 AHEC center directors,
  program and support staff
• 17 Learning Resource Centers

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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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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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• 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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2007 RR of WV Trained Health Providers

• Type of Professional in rural WV who
  received financial incentives
• Physicians 264 97 (37)
• (99-04 graduates)
• NPs/Nurse Educators 104 42 (40)
• Nurses 80
• Physician Assistants 152 49 (32)
• Dentists 89 2 (2)
• Dental Hygienists 22
• Pharmacists 183
• Physical Therapists 60 3 (5)
• Occupational Therapist 2
• Medical Technologists 8
• Masters in Public Health 1
• Social Workers 1
• Nurse Midwives 1
• Total 967 193 (20)

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Outcomes

• 39 medical school graduates stay in the state
  following residency
• 25 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 9 years rural physician who complete this
  training increased by 200, annual rate of 14.7

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HCOP Outcomes

• WVU HCOP graduates since 1984
• 49 physicians,
• 15 dentists,
• 40 pharmacists
• 10 nurses
• WVU HCOP graduates since 1996
• 3 dental hygienists
• 7 exercise physiologists
• 6 medical technologists
• 7 occupational therapists
• 6 physical therapists

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HCOP Outcomes

• Retention of HCOP graduates in practice in WV
• 22 of HCOP physicians
• 30 of HCOP dentists
• 35 of HCOP pharmacists

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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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An adequately trained somebodyis better than a
splendid vacancy anytime
Dr. Marcia Brand November 16. 2007
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Keep you eyes on the whys
We do what we do!
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Visit us on the Web
www.wvrhep.org www.wvahec.org
www.wvrhep.org
www.wv-hsta.org