1. New York State AHEC System Community partnerships placing health professionals where they are needed most. Thomas Rosenthal:

2. Mission “…to enhance the quality of and access to health care, improve health care outcomes and address health workforce needs of medically underserved communities and populations by establishing partnerships between the institutions that train health professionals and the communities that need them the most.” New York = 42nd State AHEC system in US. The new model for community driven health service planning through participation in education.

3. Goals 1) Create a dynamic statewide needs-based Area Health Education Center system. 2) Improve the training, recruitment and distribution of health professionals working in New York’s medically underserved communities. 3) Strengthen the professional environment to increase retention and improve the effectiveness of health professionals in New York’s medically underserved areas.

4. Strategies 1) Developing opportunities and arranging placements for future health professionals to receive their clinical training 2) Encouraging local youth, especially those from underrepresented and disadvantaged backgrounds, to pursue health careers 3) Providing continuing education and professional support to health practitioners enhancing their skills in those communities

5. New York State AHEC System n Time line: –Organizational development 1998-99 Federal Funding –Building statewide capacity 2000-04 Federal and State Funding –Refinement, improvement 2004-10 –Model Funding 2010 and beyond. Federal, State, Local, Service Funding

6. New York State AHEC System 2004 Covering all of NY.

7. Making All of NYS a Campus n Federal Requirements: –Clinical placements and community faculty development –Continuing education –Recruitment of young people and underrepresented populations to health careers –Workforce/community needs assessment –Evidence of impact, tracking

8. To Make AHEC Work in NYS n Statewide network of health profession schools committed to AHEC concepts n Community empowerment –Each AHEC is a 501 (c) (3) corporation –Community Board of Directors n New resources to impact state’s health disparities

9. Health Career Needs in NYS n 11% of NY’s total workforce ( 490,000 jobs ). –Health Jobs will grow by 29% over 10 years. Twice the rate of non-health jobs. Greatest growth in outpatient settings and SNFs. n Shortage professions: –Registered nurses, pharmacists, radiologic technicians, respiratory therapists, LPNs. –Distribution continues to be a problem. »Center for Health Workforce Studies, School of Public Health, University at Albany, http://chws.albany.edu.3/03

10. Diversity of NYS Health Workforce.

11. Distribution of Health Workforce. n 102 primary care health professional shortage areas (HPSAs) in NYS. (2002) n 48 our of 62 NYS counties contain a primary care HPSA community. n 841 primary care physicians needed to eliminate NYS HPSAs. n Physicians serving urban HPSAs has increased but number serving rural NY have declined. (Calman, 2002)

12. Specialty Distribution n Specialists in oversupply –Reduce hours slightly, –Practice outside traditional specialty domain, –Increase the rate at which they perform investigations (BMJ, 2002) –Do not move to HPSA communities. In England and India physicians have taken non-physician jobs rather than populate rural communities. (Rosenthal, 2002)

13. Source of Workforce n Medical School Applicants (National Numbers) –Under represented minorities Dropped by 20% (From 4,500 to 4,000) between 1997 and 2001. Comprise 12% of the applicant pool –50% of all applicants get admitted –46% of URM students get admitted. –22% of Americans live in rural areas. Comprise 14% of applicant pool. n Other professions are similar but less well documented.

14. Impact of HPSAs -> Campus Rosenthal TC, Danzo A. Rural-based graduate medical education: An issue whose time has come. Journal of Rural Health. 2000;16:196-7. Impact of Family Medicine Residency Training Location on Eventual Practice Location.

15. Workforce Supply Continuum Supply SupportNeed Students need to have experience with career and employment options, an appreciation for their own interests and aptitudes, and a feeling they can make a difference in the best matched setting. They get this during training.

16. Research Agenda

17. Pipeline Questions: n When are career decisions made in life? n How does goal setting impact educational performance? n Are health career decisions similar to other career decisions? n When do role models have the greatest impact on career decisions?

18. Pipeline Questions: n Is nurture or nature more important? –Family values. –Socio-economic factors. –Empowerment. –Caregiver gene. n Influence of job availability/security? n Influence of job income?

19. Educational experiences: n What length of time is the minimum to influence location decisions? n What components of a community based experience are essential? n How to best integrate training in underserved communities with educational objectives? n How to develop and prepare community based faculty?

20. Educational experiences: n Are student community oriented projects important to location decisions? n What is the role of diversity training? n How does distance learning technology impact training?

21. Retention: n What factors influence retention of providers in underserved communities? –Family, schools, income. –Living in community vs commuting. n Does teaching in AHEC sponsored programs enhance retention? n If communities participate in curriculum development of training programs affect location choice?