Grow Your Own: Grow Your Own: How to Create a How to Create a

Pipeline of Health Pipeline of Health Care ProfessionalsCare Professionals

April L. Vestal, MPHApril L. Vestal, MPHRural Maryland CouncilRural Maryland Council

Annapolis, MarylandAnnapolis, MarylandOctober 2, 2008October 2, 2008

The MessageThe Message State Policy and Education leaders make State Policy and Education leaders make

a differencea difference

Strategic partnerships of local Strategic partnerships of local communities and higher education can communities and higher education can impact recruitment and retentionimpact recruitment and retention

Outcomes should be directly linked to Outcomes should be directly linked to health status, program elements, and health status, program elements, and best practices.best practices.

Experience and Evidence supportsExperience and Evidence supports

• Pipeline programs with rural focus and Pipeline programs with rural focus and contentcontent

• Training in rural communities Training in rural communities • Recruiting rural people into programsRecruiting rural people into programs• Financial incentives and Community Financial incentives and Community

support support • Strategies that improve community’s ability Strategies that improve community’s ability

to recruit and retain healthcare providers.to recruit and retain healthcare providers.

The West Virginia Experience in Training Recruiting, and Retaining Rural Health Providers

Unique Elements of this Unique Elements of this PartnershipPartnership

Degree-required rural rotations of all state Degree-required rural rotations of all state supported health sciences students since 1996supported health sciences students since 1996

Tuition and fee waivers for successful Tuition and fee waivers for successful completers of middle and high school health completers of middle and high school health careers programscareers programs

Unique collaboration of health sciences schools, Unique collaboration of health sciences schools, private schools and local communitiesprivate schools and local communities

Recruitment of health professionals contributes Recruitment of health professionals contributes to economic development through the creation to economic development through the creation of jobs (in rural WV 1 doc= 4.3 jobs)of jobs (in rural WV 1 doc= 4.3 jobs)

What Our WV Experience Has What Our WV Experience Has Taught Us…Taught Us…

When community in put is valued When community in put is valued community members can have a community members can have a highly effective role in traininghighly effective role in training

Schools improve mission deliverySchools improve mission delivery

Health promotion services are Health promotion services are increased at community levelincreased at community level

Organizations and SystemsOrganizations and Systems

Local Rural Health ProvidersLocal Rural Health Providers• CHCs, rural hospitals, private CHCs, rural hospitals, private

practitioners, pharmacists, etc.practitioners, pharmacists, etc.• Serve as fiscal agents, employ site Serve as fiscal agents, employ site

personnel, provide office spacepersonnel, provide office space• Serve as preceptorsServe as preceptors• Serve as local board membersServe as local board members• Provide student meals, housingProvide student meals, housing• Provide learning resource centersProvide learning resource centers• Send one rep to state level Rural Health Send one rep to state level Rural Health

Advisory Panel appointed by GovernorAdvisory Panel appointed by Governor

Organizations and SystemsOrganizations and Systems

WV Higher Education Policy WV Higher Education Policy CommissionCommission• Carries legislative authority for Carries legislative authority for

implementationimplementation• Transfers and oversees funds from state Transfers and oversees funds from state

treasury to schools and communitiestreasury to schools and communities• Administers state funded scholarship Administers state funded scholarship

programprogram• Oversees annual legislative reporting Oversees annual legislative reporting

requirementsrequirements• Maintains link with Governor’s officeMaintains link with Governor’s office• Maintains state level budgetMaintains state level budget

Organizations and SystemsOrganizations and Systems

Schools (all state funded Health Schools (all state funded Health Sciences programs)Sciences programs)• Devote faculty time to coordinate rural Devote faculty time to coordinate rural

health curriculum and rotations health curriculum and rotations (generally 20% FTE)(generally 20% FTE)

• Provide orientation to rural rotations to Provide orientation to rural rotations to students on campusstudents on campus

• Host Rural Health Fairs for studentsHost Rural Health Fairs for students• Provide rural health courses and/or Provide rural health courses and/or

specific rural health content in other specific rural health content in other coursescourses

• Receives state funds allocated to schools Receives state funds allocated to schools under RHI Actunder RHI Act

Organizations and SystemsOrganizations and Systems State AgenciesState Agencies

• Bureau for Public Health: RCP, SLRP, Bureau for Public Health: RCP, SLRP, SEARCH scholarships, technical SEARCH scholarships, technical assistance to communities on R&R issuesassistance to communities on R&R issues

Economic DevelopmentEconomic Development• Local partners on Workforce Investment Local partners on Workforce Investment

Board, do joint projectsBoard, do joint projects Public SchoolsPublic Schools

• Joint childhood health projects, CARDIAC, Joint childhood health projects, CARDIAC, etc.etc.

Legislature Legislature • Core funding and federal matchCore funding and federal match• AdviseAdvise

K-12 Programs

Rural Scholars

Rural Preceptors & Academic AffiliationsWVRHEP

WVAHECRural Rotations

West Virginia

EDUCATIONAL PIPELINEPublic School

7-12 GradeCollege Postgraduate Community

PracticeProfessional

Education

HCOP

Recruit-able Project Community

Financial Incentive and

Assistance Programs

SLRPRRCP

HSSP, MSLFSEARCH

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

Health Education Centers (AHEC) Health Education Centers (AHEC)

Interdisciplinary training in rural Interdisciplinary training in rural underserved areasunderserved areas

Blend strategies of training and Blend strategies of training and financial incentives with community financial incentives with community recruitment and retentionrecruitment and retention

WVRHEP/AHEC InfrastructureWVRHEP/AHEC Infrastructure

100 student rotations per month100 student rotations per month State level Rural Health Advisory State level Rural Health Advisory

Panel specified in legislation Panel specified in legislation serves both state and federal serves both state and federal functionsfunctions

$2.5 million per year to $2.5 million per year to communities, $4.5 million to communities, $4.5 million to schools for rural health trainingschools for rural health training

$200K per AHEC center in federal $200K per AHEC center in federal fundingfunding

2007 WVRHEP/AHEC Infrastructure2007 WVRHEP/AHEC Infrastructure

498 training sites in 55 counties498 training sites in 55 counties

750 clinical field faculty750 clinical field faculty

8 regional consortia with local boards 8 regional consortia with local boards and 4 AHEC Centers with local/campus and 4 AHEC Centers with local/campus boardsboards

15 site coordinators, 5 AHEC center 15 site coordinators, 5 AHEC center directors, program and support staff directors, program and support staff

17 Learning Resource Centers17 Learning Resource Centers

Partnership Training SitesPartnership Training Sites

Of the these 498 partnership training sites:

•374 in HPSAs or MUAs

•148 sites are both

Types of Training SitesTypes of Training Sites

•45 CHCs45 CHCs•47 FQHCs 47 FQHCs •8 RHCs8 RHCs•28 small rural hospitals28 small rural hospitals•25 dental offices25 dental offices•37 pharmacies37 pharmacies

Training Sites, con’t.Training Sites, con’t.

•14 county health departments, 14 county health departments, •40 physical therapy agencies or 40 physical therapy agencies or

rehabilitation center sites, rehabilitation center sites, •15 healthcare for the homeless 15 healthcare for the homeless

facilities, facilities, •13 school based health centers, 13 school based health centers, •3 free clinics, and 3 free clinics, and •1 migrant health center1 migrant health center

Recruit-able Community ProjectRecruit-able Community Project

Initiated in FM Dept with private Initiated in FM Dept with private foundation fundsfoundation funds

Is now Bureau for Public Health Is now Bureau for Public Health resourcesresources

Helps communities map assets Helps communities map assets and recommends improvementsand recommends improvements

First Impressions and First Impressions and Community Design Teams Community Design Teams Cooperative ExtensionCooperative Extension

Recruit-able Community ProjectRecruit-able Community Project

Communities apply and pay Communities apply and pay $3,000 to $5,000 on average for $3,000 to $5,000 on average for Teams assessmentTeams assessment

Rural Scholars (FM residents) Rural Scholars (FM residents) complete rotations in or near complete rotations in or near communitiescommunities

TA continues to develop long TA continues to develop long range R&R plan for communityrange R&R plan for community

RCP Community Process RCP Community Process “Cycle”“Cycle”

Community Development

Health CareAvailability

IncreasedEconomicStability

Background - Community Decision-Background - Community Decision-Making ModelMaking Model

Community approach to strengthening Community approach to strengthening the community health systemthe community health system

Often, “community encourager” Often, “community encourager” provided leadershipprovided leadership• identifying community health needs and identifying community health needs and

resourcesresources• strategic planningstrategic planning• decision-makingdecision-making

RCP Community “Tools”RCP Community “Tools”

Recruitment manualRecruitment manual

Video on recruitment and Video on recruitment and retentionretention

NewslettersNewsletters

Board game on rural practiceBoard game on rural practice

Outcomes of WV’s Outcomes of WV’s

Pipeline Partnership Pipeline Partnership Programs Programs

Health Sciences & Technology Health Sciences & Technology AcademyAcademy

Targets under represented Targets under represented minority and disadvantaged minority and disadvantaged students and communitiesstudents and communities

Over 2,500 students served by Over 2,500 students served by HSTA since 1994HSTA since 1994

982 HSTA High School Graduates 982 HSTA High School Graduates (98-07) (98-07)

HSTA OutcomesHSTA Outcomes 95% enter college vs. 56% for 95% enter college vs. 56% for

all WVall WV

59% in health career majors VS 59% in health career majors VS 17% for all WV17% for all WV

786 (80%) of the 982 HSTA 786 (80%) of the 982 HSTA graduates are still in collegegraduates are still in college

HSTA OutcomesHSTA Outcomes

  55 HSTA Scholars in 55 HSTA Scholars in graduate/prof schoolgraduate/prof school

27 HSTA Scholars in health 27 HSTA Scholars in health sciencessciences

10 HSTA graduates currently in 10 HSTA graduates currently in medical schoolmedical school

WV RHEP/AHECWV RHEP/AHECService to the StateService to the State

Over 50,000 weeks of student training Over 50,000 weeks of student training since 1992since 1992

$15 million in uncompensated dental $15 million in uncompensated dental care to 60,000 patients since 1995care to 60,000 patients since 1995

967 RHEP/AHEC grads confirmed to be 967 RHEP/AHEC grads confirmed to be practicing in rural areas of the state in practicing in rural areas of the state in 20072007

WV Trained Rural Providers who completed WV Trained Rural Providers who completed

Degree Required Rural Health Rotations 2007Degree Required Rural Health Rotations 2007

PhysiciansPhysicians 264 264

(91-04 graduates)(91-04 graduates)

NPs/Nurse Educators NPs/Nurse Educators 104 104

NursesNurses 80 80

Physician AssistantsPhysician Assistants 152 152

DentistsDentists 89 89

Dental HygienistsDental Hygienists 22 22

PharmacistsPharmacists 183183

Physical TherapistsPhysical Therapists 60 60

Occupational Therapist 2 Occupational Therapist 2

Medical TechnologistsMedical Technologists 8 8

MPHMPH 1 1

Social WorkersSocial Workers 1 1

Nurse MidwivesNurse Midwives 1 1

TotalTotal 967 967

Number of physicians completing RHEP/AHEC rotations practicing in rural areas of West Virginia

264

213

187

165

142124

1039288

0

50

100

150

200

250

300

1999 2000 2001 2002 2003 2004 2005 2006 2007

Physicians

Retention OutcomesRetention Outcomes

38.6% medical school 38.6% medical school

graduates stay in the state graduates stay in the state following residencyfollowing residency

25% medical school 25% medical school graduates stay in state in graduates stay in state in primary careprimary care

Retention OutcomesRetention Outcomes Retention of WV SoM graduates Retention of WV SoM graduates

AND residency grads in FM is 79%AND residency grads in FM is 79%

In past 11 years retention in In past 11 years retention in primary care has increased by primary care has increased by 67% 67%

Dentistry is 58%Dentistry is 58%

Pharmacy is 64%Pharmacy is 64%

Oct 2006 HRSA Health Workforce Oct 2006 HRSA Health Workforce study (2004 data)study (2004 data)

31% of WV’s physician workforce 31% of WV’s physician workforce are graduates of instate medical are graduates of instate medical schools while national average is schools while national average is 29%. 29%.

38% of the WV physician 38% of the WV physician workforce are international workforce are international graduates, compared to a graduates, compared to a national average of 26.07%national average of 26.07%

OutcomesOutcomes

State has eliminated 8 HPSA State has eliminated 8 HPSA counties in 10 years; all 91 health counties in 10 years; all 91 health professionals in these counties professionals in these counties completed rural rotations completed rural rotations

In 9 years rural physicians who In 9 years rural physicians who completed this training increased completed this training increased by 200%, annual rate of 14.7%by 200%, annual rate of 14.7%

Precepting students may impact Precepting students may impact retentionretention

58% (61) of the physician respondents to 58% (61) of the physician respondents to the 2005 survey reported that they are the 2005 survey reported that they are currently RHEP/AHEC field professors currently RHEP/AHEC field professors

Of these 61:Of these 61:• 85% said that they find teaching to be 85% said that they find teaching to be

personally rewarding personally rewarding • 73% said that teaching helps them stay 73% said that teaching helps them stay

current in their professioncurrent in their profession

Lessons LearnedLessons Learned

Involve communities in program Involve communities in program implementation – ownershipimplementation – ownership

Develop a “champion” for your causeDevelop a “champion” for your cause Bring key stakeholders together early Bring key stakeholders together early

to establish cooperationto establish cooperation Sustainability options involving your Sustainability options involving your

partnerspartners

Visit us on the Visit us on the WebWeb

www.wv-hsta.org

www.wvrhep.org www.wvahec.org

www.wvochs.org/dr