1. Denise Denton - D2, Inc.1 Presentation to the State Agricultural and Rural Leaders San Diego, California January 24, 2008 by Creating a Rural Healthcare Workforce Denise Denton ddenton@d2inc.biz 303/941-0181

2. Denise Denton - D2, Inc.2 A National Rural Health Snapshot RuralUrban Percentage of USA Population** nearly 25%75% + Percentage of USA Physicians** 10%90% Num. of Specialists per 100,000 population** 40.1134.1 Population aged 65 and older 18%15% Population below the poverty level 14%11% Average per capita income $19K$26K Population who are non-Hispanic Whites 83%69% Adults who describe health status as fair/poor 28%21% Adolescents (Aged 12-17) who smoke 19%11% Male death rate per 100,000 (Ages 1-24) 8060 Female death rate per 100,000 (Ages 1-24) 4030 Population covered by private insurance 64%69% Population who are Medicare beneficiaries 23%20% Medicare beneficiaries without drug coverage 45%31% Medicare spends per capita compared to USA average 85%106% Medicare hospital payment-to-cost ratio 90%100% Percentage of poor covered by Medicaid 45%49% Statistics used with permission from "Eye on Health" by the Rural Wisconsin Health Cooperative, from an article entitled "Rural Health Can Lead the Way," by former NRHA President, Tim Size; Executive Director of the Rural Wisconsin Health Cooperative

3. Denise Denton - D2, Inc.3 Rural Health Disparities Rural residents are less likely to have employer-provided health care coverage or prescription drug coverage Rural poor are less likely to be covered by Medicaid benefits One-third of all motor vehicle accidents occur in rural areas however two-thirds of the deaths attributed to these accidents occur on rural roads The majority of EMS first responders are volunteers Rural residents are poorer than their rural counterparts Alcohol abuse is a significant problem among rural youth Methamphetamine use and admission treatment rates are higher in rural, non-metro areas Rural residents are nearly twice as likely to die from unintentional injuries other than motor vehicle accidents Suicide rates among rural males are significantly higher than in urban areas and the suicide rates among rural women are rapidly catching up to that of men Rural communities represent about 20% of America’s population however less than ten percent of physicians practice in those communities

4. Denise Denton - D2, Inc.4 We already know what works - Pipeline programs with rural focus and content Training in rural communities Recruiting rural people into training and education programs Financial incentives and reimbursement improvements Strategies that improve community’s ability to recruit and retain healthcare providers

5. Denise Denton - D2, Inc.5 How to make a rural family physician. Rural student graduates from high school.

6. Denise Denton - D2, Inc.6 How to make a rural family physician. Rural student graduates from high school with strong college-prep course work.

7. Denise Denton - D2, Inc.7 How to make a rural family physician. They have an interest in a health career because of exposure to health fairs, shadowing, and other experiences in their community.

8. Denise Denton - D2, Inc.8 How to make a rural family physician. The student goes to college and does well because of the strong high school preparation. They aren’t too preoccupied with money because they have a local scholarship.

9. Denise Denton - D2, Inc.9 How to make a rural family physician. They get into a medical school with a rural medicine track - - seeks qualified rural students; - primary care instructors; - required rural and ambulatory care rotations; - rural health mentor; - training in skills needed for rural practice.

10. Denise Denton - D2, Inc.10 How to make a rural family physician Apply to residencies with strong rural program. -training in rural sites or rural rotations; -ample training in OB, behavioral health, etc. -rural, ambulatory care instructors.

11. Denise Denton - D2, Inc.11 How to make a rural family physician. Have National Health Service Corps (NHSC) scholarship or know about NHSC loan repayment. And/or support from local community.

12. Denise Denton - D2, Inc.12 How to make a rural family physician. State programs – Data that tracks, identifies, predicts need Scholarship and loan repayment programs Incentives for rural practice – tax credits, sign-on bonuses, community support Expect (require?) medical schools and training programs to meet State needs

13. Denise Denton - D2, Inc.13 How to get a rural family physician. Recruited to a community with a vibrant local recruitment committee. Returns “home” to practice.

14. Denise Denton - D2, Inc.14 How to keep a rural family physician. In her practice she has- -a personal and family support -Se knows the community needs and appreciates her.

15. Denise Denton - D2, Inc.15 How to keep a rural family physician. In his practice he has- -a realistic call schedule with time for vacation, CME -a fair salary (with loan repayment, tax incentives, etc.) -professional support

16. Denise Denton - D2, Inc.16 How to keep a rural family physician. When he retires, his state has a program where healthcare professionals who donate their time have their malpractice insurance covered, so he helps out in another rural underserved community.

17. Denise Denton - D2, Inc.17 How to really keep a rural family physician. Upon her death, her body is donated to science - and to a medical school with strong rural program.

18. Denise Denton - D2, Inc.18 Solving the Chronic Shortage of Healthcare Providers in Rural America MEDICAL SCHOOLS AND TRAINING PROGRAMS STATE GOVERNMENT FEDERAL GOVERNMENT INDIVIDUALS RURAL COMMUNITIES RESIDENCY PROGRAMS

19. Denise Denton - D2, Inc.19 States’ Roles Take full advantage of relevant federal health workforce programs – Primary Care Office, National Health Service Corps, etc. Implement statewide policies and processes to identify, track, and address health provider needs. Develop rural scholarship and loan repayment programs. Develop reimbursement incentives for rural practice such as tax credits or sign-on bonuses. Encourage medical schools and other state-funded training programs to adhere to needs-based training through the use of incentives and requirements. Encourage/reward/require participation and investment of other sectors.

20. Denise Denton - D2, Inc.20 Colorado’s Full Spectrum Healthcare Career Program

21. Denise Denton - D2, Inc.21 How to make a rural family physician. Starting really early – invitro health career sensitization tapes.

22. Denise Denton - D2, Inc.22 Colorado Mating Approval Board For healthcare students on the rural track, when dating, before the third date, both parties must appear before the CoMAB for determination of “rural lifestyle compatibility.