Presented to the

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• Presented to the
• 24th Annual Oregon
• Rural Health
• Conference
• Hilda R. Heady, MSW
• Associate Vice President for Rural Health
• West Virginia University
• Ex. Director WVRHEP/AHEC

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The Message

• The need for innovation and creativity in
  workforce development and RR
• Partnerships can provide the synergy for success
  when you set no limits
• The grace of understanding the rural culture is
  the foundation for achieving positive results

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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.
• Oregon has a strong track recorduse it!

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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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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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Synergy and Success require

• Vision
• Leadership
• The social and political will to do the right
  thing

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Creative Workforce Solutions
Require more than addressing policy issues They
require the grace of understanding.
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Creative Workforce Solutions

• Require boldness
• Require advocacy and strategic thinking
• Require skills, research, and provider networking
• Dedicated community based training in rural
  practice skills
• A focused rural health curriculum

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Creative Workforce Solutions

• Financial Incentives for training and practice
  placement
• Technical Assistance at all levels
• Support for practitioners to retain them
• Mechanisms to bring existing practitioners into
  training networks
• Rewards for their efforts

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Well Positioned Leadership

• Oregon Office of Rural Health
• Oregon Rural Health Association
• Oregon Rural Practice-based Research Network
• Oregon Area Health Education Centers

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Our experience shows and the Literature supports

• Several strategies should be used to fix the
  problem
• 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 or retire in a nurturing
  environment
• Wide open opportunities to practice the health
  care arts

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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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Partnership
State Federal Governments
Healthy WV Citizens
Community
Campus/Higher Education
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Train, Work, and Give back

• Community service-learning is an essential part
  of the curriculum
• 820 Health Professionals in rural underserved
  areas of the state
• Increased rural physicians by 142 in 8 years

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Our mission is to fulfill our social contract
with WVs people

• 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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The Partnership Mission and Vision is
fulfilling our social contract

• West Virginias Pipeline Programs are designed to
  educate, recruit, and retain quality health care
  professionals for service to rural communities to
  improve the health of the people.

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• The contribution and uniqueness of this
  Partnership
• Degree-required rural rotations of all state
  supported health sciences students
• 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)
• Stable economy for attracting and sustaining
  other industries and business.

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Our social responsibility expressed through our
social contract

• Social contract State governments mission
• Social contract Strengthens higher educations
  core mission
• Social contract Constituencies in Local
  Communities

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Rural Health Curriculum

• Discipline specific clinical objectives
• 20 in community service-learning, community
  based research, and/or interdisciplinary
  activities
• Mentoring by rural providers and rural community
  members
• Competency, outcome and evidenced based

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Our History Teaches Us

• Community based training makes a difference
• 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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Outcomes

• State has eliminated 8 HPSA counties in 10 years
  20 physicians in these counties completed rural
  rotations in communities
• In 8 years rural physician who complete this
  training increased by 142, annual rate of 13.5

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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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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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2006 RR of WV Trained 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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AHEC The Glue That Holds It Together
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Putting the pieces together

• The big picture includes blessings and
  challengesall result in growth