Needs and Opportunities for Implementing a Stronger Grow Your

Own Model

Michelle Green Clark, SORH DirectorSusan K. Stewart, Western Maryland AHEC Director

Overview

Healthcare Pipeline Today in Maryland Pieces that Exist (AHEC program) Pieces Missing - Needs Barriers Opportunity Call to Action

Review of Work Groups – Common Themes

Expand Workforce – Why we are here Expansion of opportunities to learn in rural

areas Expansion of Loan Assistance Repayment

Program (LARP) Strengthening Grow Your Own Model Telehealth Expansions Compensation for providers in rural areas

Maryland AHEC Program

Cecil

Kent

QueenAnne’s

Talbot

Dorchester

Wicomico

Somerset

Worcester

Car -oline

Garrett

Allegany Washington

Garrett

Allegany Washington

GarrettAllegany Washington Cecil

Kent

Talbot

Dorchester

Wicomico

Worcester

Car -oline

Cecil

Kent

QueenAnne’s

Talbot

DorchesterWicomico

SomersetWorcester

Caroline

Carroll

Howard

Baltimore

Balt. City

AnneArundel

St. Mary’s

Harford

Prince George’s

CharlesCal -vert

Frederick

Carroll

Howard

Baltimore

AnneArundel

St. Mary’s

Harford

Prince George’s

Charles Calvert

Montgomery

AHEC Center Locations

Maryland AHEC Program Office

University of Maryland School of Medicine Office of Policy and Planning Claudia Baquet, M.D., M.PH. Program Director

Expansion of AHEC Clinical Education Activities

Health Professions Education Pipeline

K-12 Initiatives College & Health Professions Education

Continuing Education & Training

InspireMotivateEncourageSupportAssistMentor Inform PrepareExperience

Academic Support and Enrichment

Financial Incentives

Guarantee Placement

Clinical Rotations that connect or Return Students to Communities

Retention in Shortage, isolated, or Underserved Areas

Partnerships and funding to build a sustainable pipeline also means high level collaboration between stakeholders, with legislative support.

Eastern Shore AHEC Mission

To recruit and retain health care professionals and build healthy communities

through educational opportunities and collaborative partnerships.

Jacob F. FregoExecutive Director

410-221-2600814 Chesapeake Drive.   PO Box 795   Cambridge, MD 21613

ESAHEC Pipeline Programs

Elementary, middle, and high school programs in the 9 Eastern Shore counties

“The Great Hospital Adventure” puppet video show

Job shadowing; career mentoring by healthcare professionals

Hospital tours & work-based learning experiences

To improve access to and promote quality in health care through educational partnerships.

Western Maryland AHEC Mission

GARRETT ALLEGANY WASHINGTON

FREDERICK

11 Columbia StreetCumberland, MD 21502301-777-9150

Susan K. Stewart Executive Director sstewart@allconet.org

STEM: Promoting Careers in Science Technology Engineering and Mathematics

Links K-12 schools with community professionals Western MD STEM Task Force to address STEM initiatives on a regional Western MD STEM Task Force to address STEM initiatives on a regional

levellevel Governor’s STEM and Economic Development Task ForceGovernor’s STEM and Economic Development Task Force

Exploring Careers in Health Occupations (ECHO)

Residential summer health careers program Trips to healthcare facilities, higher education

institutions, Baltimore, New York, DC Job shadowing, mentoringJob shadowing, mentoring College entrance advice and prepCollege entrance advice and prep

Youth Health Service Corps (YHSC)

The Youth health Service Corps’ mission is to recruit The Youth health Service Corps’ mission is to recruit diverse high school students into health care careers.diverse high school students into health care careers.

Program components Program components Training CurriculumTraining CurriculumVolunteer ServiceVolunteer ServiceReward and RecognitionReward and RecognitionService learning Projects (Wii)Service learning Projects (Wii)

WMAHEC Clinical Education Outcomes

449 health professionals who participated in Clinical Education subsequently practiced in the Western MD Region.

2 of the 11 Family Practice physicians in Garrett County (or 18%) are AHEC alumni; 90% of these physicians serve as preceptors for medical students.

WMAHEC Clin Ed Outcomes Continued

The only Primary Care internist in Garrett County is an AHEC alumnus. This internist has precepted more than 50 students since 1985, including two who subsequently returned to Western Maryland to practice.

1 of the 3 General Surgeons in Garrett county is an AHEC alumnus (or 33%).

WMAHEC Clin Ed Outcomes Continued

1 of the 5 orthopedic surgeons in Allegany County is and AHEC alumnus (or 20%).

At least 16 medical students or residents have practiced or still practice in the region.

ESAHEC Clinical Education Outcomes

330 health care professionals (includes physicians, nurses, pharmacists and social workers) who participated through AHEC as part of their training are now practicing or have practiced on the Eastern Shore.

At least one-third of the medical preceptors are former Clinical Education participants.

ESAHEC Clin Ed Outcomes Continued

According to UMES, 14 clinical education students over the past 3 years have chosen to relocate to or remain on the Shore. (33% of all students participating from UMES)

At least 9 pharmacy students served by the Center have returned to practice in the region.

“Grow Your Own” in Maryland: Public Schools

STEM Certificate Programs (CNA)

- Dual enrollment with 2 & 4 Year Colleges Health Occupations Students of America, Medical

Academy, Gear Up, Project Yes, & others Maryland Department of Education (MSDE)

– Enrichment and Summer Opportunities Maryland Rural Health Association

– Planning state’s first Med Bee– Scholarship for winners who go into health careers

“Grow Your Own” in Maryland: Community Colleges and Universities

Discipline specific collaborations with public schools

Degree collaborations with each other Cecil County Dental School Expansion Summer and other programs

– Upward Bound, Regional Science Center– Robotics camps at Garrett College and Frostburg

State University

“Grow Your Own” in Maryland:Local Hospitals

Medical Explorers, teen volunteer programs Career Ladders that encourage and pave the

way for employees to move from administrative positions into clinical positions

Scholarships for nursing education In-house training for careers not requiring

licensure

Not Another Committee on the Healthcare Workforce – But Action

New Zealand, Tony Myall MP – March 26, 2008, National Party Health Spokesman

“With its many army of bureaucrats, Labour has produced at least 43 reports on the health workforce since 2000. No one seriously believes this will all be fixed by yet another report!”

Rural Student = Rural Health Professionals

Rural Student more likely to return to rural areas to practice (Wiener, 1993)

Patterns show rural go back to rural and those from underserved areas go back to underserved areas (Bowman, 2008)

Rural training gives broader responsibility and competency skills (Hunsaker et al., 2006)

Rural Training = Rural Provider

Jeffererson Medical College – Physician Shortage Area Program (PSAP) (Rabinowitz, 1991)– 4 times as likely to practice family medicine and in

a rural area– 2.5 times more likely if had a senior rural

preceptorship (Rabinowitz, 2001)– Other predictor if not in PSAP to return to a rural

area is growing up there (Rabinowitz, 1999)

Key components to a successful Grow Your Own Model

Strong AHEC through rural areas Strong Training sites in Maryland

– Federal and State Funded– K-12 Pipeline programs (ECHO)– Clinical rotation opportunities for students– Youth Health Service Corps– Expanding– Housing and Preceptors

Commitment to Economic Development in Rural Areas Some support to rural facilities in recruiting physicians

Missing components to a successful Grow Your Own Model

FORMAL Consortium of Partners Integration of University and Community College K-

12 Programs Large Osteopathic School Private funding Support for rural students while in medical

professional school (connections back to home) Scholarships/incentives for students to return to

rural community Mandatory rotations in rural/underserved areas for

clinicians Rural Residency program

Key Components of R&R

Foundation of Workforce Programs

Task Force on HCAR Task Force on Rural

Primary Care Rural AHECs CMS EHR project

Financing and Staffing of recruitment programs

Rural attention and focus of programs

Community/local involvement

Data that retention of health providers is essential to rural quality of life

Key Components of Telemedicine

Rural Broadband Cooperative

Health Information Exchange (HIE) efforts

U of M Statewide Health Network

Telemedicine – Use and Reimbursement - Study 2006

Innovative Pilots

Little reimbursement Liability not tested Telehealth

network/consortium FEDERAL FUNDING

– FCC money left on table– USDA money left on

table

Barriers

Tough fiscal times- no new money coming in Stakeholders Need to Engage (Quantify and

Quality) Workforce is one of many rural public health

problems Existing factors that negatively impact

reimbursement and insurance High cost of medical and health professional

education

Opportunities

Focus Here Today – Continue the Work Tough Fiscal Times – Attention to most

important work SB 459 – Task Force on Rural Primary Care Medical Home Concept Telehealth – Innovation happening

Response to Workforce Issues

Addressing these issues will require the collaborative efforts of providers, community based organizations, businesses, and policy makers

Stakeholders in rural health care systems must be as vigilant in protecting and building upon the resources currently available as in addressing the challenges that remain

New England Roundtable (2008)

Other State Solutions

Alabama, New Mexico, and Oregon – Tax incentives

Washington, New Mexico – Waive licensure fee

Grow Your Own Models (AL, WV, TN, TX…) Workforce Centers – South Dakota, South

Carolina Local community solutions

Requirements to Change Workforce Policy

1. Shared perception of the problem- Public agreement, communication, frame issue,

raise priority

2. Political Support- Broad base support

3. Viable policy solution- Workable, timely, affordable, proven

(Skinner, 2008)

Time to Work!