1. Grow Your Own: How to Create a Pipeline of Health Care Professionals April L. Vestal, MPH Rural Maryland Council Annapolis, Maryland October 2, 2008

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

3. Experience and Evidence supports Pipeline programs with rural focus and content Pipeline programs with rural focus and content Training in rural communities Training in rural communities Recruiting rural people into programs Recruiting rural people into programs Financial incentives and Community support Financial incentives and Community support Strategies that improve community’s ability to recruit and retain healthcare providers. Strategies that improve community’s ability to recruit and retain healthcare providers.

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

5. Unique Elements of this Partnership Degree-required rural rotations of all state supported health sciences students since 1996 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 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 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) Recruitment of health professionals contributes to economic development through the creation of jobs (in rural WV 1 doc= 4.3 jobs)

6. What Our WV Experience Has Taught Us… When community in put is valued community members can have a highly effective role in training When community in put is valued community members can have a highly effective role in training Schools improve mission delivery Schools improve mission delivery Health promotion services are increased at community level Health promotion services are increased at community level

7. Organizations and Systems Local Rural Health Providers Local Rural Health Providers CHCs, rural hospitals, private practitioners, pharmacists, etc.CHCs, rural hospitals, private practitioners, pharmacists, etc. Serve as fiscal agents, employ site personnel, provide office spaceServe as fiscal agents, employ site personnel, 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 Advisory Panel appointed by GovernorSend one rep to state level Rural Health Advisory Panel appointed by Governor

8. Organizations and Systems WV Higher Education Policy Commission WV Higher Education Policy Commission Carries legislative authority for implementationCarries legislative authority for implementation Transfers and oversees funds from state treasury to schools and communitiesTransfers and oversees funds from state treasury to schools and communities Administers state funded scholarship programAdministers state funded scholarship program Oversees annual legislative reporting requirementsOversees annual legislative reporting requirements Maintains link with Governor’s officeMaintains link with Governor’s office Maintains state level budgetMaintains state level budget

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

10. Organizations and Systems State Agencies State Agencies Bureau for Public Health: RCP, SLRP, SEARCH scholarships, technical assistance to communities on R&R issuesBureau for Public Health: RCP, SLRP, SEARCH scholarships, technical assistance to communities on R&R issues Economic Development Economic Development Local partners on Workforce Investment Board, do joint projectsLocal partners on Workforce Investment Board, do joint projects Public Schools Public Schools Joint childhood health projects, CARDIAC, etc.Joint childhood health projects, CARDIAC, etc. Legislature Legislature Core funding and federal matchCore funding and federal match AdviseAdvise

11. K-12 Programs Rural Scholars Rural Preceptors & Academic Affiliations WVRHEP WVAHEC Rural Rotations West Virginia EDUCATIONAL PIPELINE Public School 7-12 Grade College Postgraduate Community Practice Professional Education HCOP Recruit-able Project Community Financial Incentive and Assistance Programs SLRP RRCP HSSP, MSLF SEARCH

12. The West Virginia Rural Health Education Partnership (WVRHEP)/Area Health Education Centers (AHEC) Interdisciplinary training in rural underserved areas Interdisciplinary training in rural underserved areas Blend strategies of training and financial incentives with community recruitment and retention Blend strategies of training and financial incentives with community recruitment and retention

13. WVRHEP/AHEC Infrastructure 100 student rotations per month 100 student rotations per month State level Rural Health Advisory Panel specified in legislation serves both state and federal functions 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 $2.5 million per year to communities, $4.5 million to schools for rural health training $200K per AHEC center in federal funding $200K per AHEC center in federal funding

14. 2007 WVRHEP/AHEC Infrastructure 498 training sites in 55 counties 498 training sites in 55 counties 750 clinical field faculty 750 clinical field faculty 8 regional consortia with local boards and 4 AHEC Centers with local/campus boards 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 15 site coordinators, 5 AHEC center directors, program and support staff 17 Learning Resource Centers 17 Learning Resource Centers

15. Partnership Training Sites Of the these 498 partnership training sites: 374 in HPSAs or MUAs 148 sites are both

16. Types of Training Sites 45 CHCs45 CHCs 47 FQHCs47 FQHCs 8 RHCs8 RHCs 28 small rural hospitals28 small rural hospitals 25 dental offices25 dental offices 37 pharmacies37 pharmacies

17. Training Sites, con’t. 14 county health departments,14 county health departments, 40 physical therapy agencies or rehabilitation center sites,40 physical therapy agencies or rehabilitation center sites, 15 healthcare for the homeless facilities,15 healthcare for the homeless facilities, 13 school based health centers,13 school based health centers, 3 free clinics, and3 free clinics, and 1 migrant health center1 migrant health center

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

19. Recruit-able Community Project Communities apply and pay $3,000 to $5,000 on average for Teams assessment Communities apply and pay $3,000 to $5,000 on average for Teams assessment Rural Scholars (FM residents) complete rotations in or near communities Rural Scholars (FM residents) complete rotations in or near communities TA continues to develop long range R&R plan for community TA continues to develop long range R&R plan for community

20. RCP Community Process “Cycle” Community Development Health Care Availability Increased Economic Stability

21. Background - Community Decision- Making Model Community approach to strengthening the community health system Community approach to strengthening the community health system Often, “community encourager” provided leadership Often, “community encourager” provided leadership identifying community health needs and resourcesidentifying community health needs and resources strategic planningstrategic planning decision-makingdecision-making

22. RCP Community “Tools” Recruitment manual Recruitment manual Video on recruitment and retention Video on recruitment and retention Newsletters Newsletters Board game on rural practice Board game on rural practice

23. Outcomes of WV’s Pipeline Partnership Programs

24. Health Sciences & Technology Academy Targets under represented minority and disadvantaged students and communities Targets under represented minority and disadvantaged students and communities Over 2,500 students served by HSTA since 1994 Over 2,500 students served by HSTA since 1994 982 HSTA High School Graduates (98-07) 982 HSTA High School Graduates (98-07)

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

26. HSTA Outcomes 55 HSTA Scholars in graduate/prof school 55 HSTA Scholars in graduate/prof school 27 HSTA Scholars in health sciences 27 HSTA Scholars in health sciences 10 HSTA graduates currently in medical school 10 HSTA graduates currently in medical school

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

28. WV Trained Rural Providers who completed Degree Required Rural Health Rotations 2007 Physicians 264 (91-04 graduates) NPs/Nurse Educators 104 Nurses 80 Physician Assistants 152 Dentists 89 Dental Hygienists 22 Pharmacists 183 Physical Therapists 60 Occupational Therapist 2 Medical Technologists 8 MPH 1 Social Workers 1 Nurse Midwives 1 Total 967

30. Retention Outcomes 38.6% medical school graduates stay in the state following residency 38.6% medical school graduates stay in the state following residency 25% medical school graduates stay in state in primary care 25% medical school graduates stay in state in primary care

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

32. Oct 2006 HRSA Health Workforce study (2004 data) 31% of WV’s physician workforce are graduates of instate medical schools while national average is 29%. 31% of WV’s 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% 38% of the WV physician workforce are international graduates, compared to a national average of 26.07%

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

34. Precepting students may impact retention 58% (61) of the physician respondents to the 2005 survey reported that they are currently RHEP/AHEC field professors 58% (61) of the physician respondents to the 2005 survey reported that they are currently RHEP/AHEC field professors Of these 61: Of these 61: 85% said that they find teaching to be personally rewarding85% said that they find teaching to be personally rewarding 73% said that teaching helps them stay current in their profession73% said that teaching helps them stay current in their profession

35. Lessons Learned Involve communities in program implementation – ownership Involve communities in program implementation – ownership Develop a “champion” for your cause Develop a “champion” for your cause Bring key stakeholders together early to establish cooperation Bring key stakeholders together early to establish cooperation Sustainability options involving your partners Sustainability options involving your partners

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