Healthcare Workforce Issues in Montana Cindra K. Stahl, MS, MBA Montana Office of Rural Health/ Area Health Education Center

Presentation overview Brief overview of Montana’s healthcare workforce Oral health workforce in Montana How do we assure a well-trained healthcare workforce to meet the needs of all regions of the state?

Healthcare Workforce in MT Healthcare sector is a robust component of Montana’s economy, and represents roughly 15% of total workforce. Continued to add jobs through the recession and recovery (over 8,000 jobs added since 2007). Offers above average salaries and safe, stable work environment. Projected to add about 2,100 jobs per year through 2021 with a need for new workers (increasing demand) as well as replacements (aging/ retirement).

Department of Labor and Industry Two categories of workers that provide healthcare services: Healthcare Practitioners and Technical occupations Healthcare Support Occupations Most jobs require post-secondary training (ties to MT HealthCARE grant) Non-health care occupations working within the health care industry (45% of healthcare workers): Accountants, HR specialists, billing

Community Benefits Typical Critical Access Hospital Employs 141 employees, generates $6.8 million in wages, salaries and benefits Generates a total annual impact of 248 jobs and $10.3 million in wages, salaries and benefits from operations and construction (National Center for Rural Health Works) One practicing physician (in Montana) Supports 9.8 jobs (including his/her own), generates an average $740,979 per physician in wages and benefits, and generates $51,887 per physician in local and state taxes All Montana practicing physicians (2140 total) Support 20,988 jobs, $1.6 billion total wages and benefits, and $111 million total local and state tax revenue (The Economic Impact of Physicians in Montana, IMS Health Report, March 2014)

Do we have enough supply? Concerns…. Aging workforce across all professions, retirement Increased demand Affordable Care Act Aging population utilizes increased healthcare Maldistribution of professionals Frontier/rural areas are challenged to recruit and retain their healthcare workforce

Oral Health professionals around the state Maldistribution: 14 counties with no active dentist licensees 80 % dentists in just nine counties. Those nine counties compose 60% of population Health Professions Shortage Areas (Dental HPSAs are based on a dentist to population ratio of 1:5,000). 10 counties are not considered HPSAs Community Health Needs Assessments (MT Office of Rural Health) 23% of CAH implementation plans prioritized a need for local dental services. From survey responses: 45.7% adults say they have seen a dentists within the past three years (Reason? cost, distance to provider, no insurance) Education: No dental education options in-state, few supported options out-of-state (WICHE and U of MN) Dental Hygiene through Great Falls College, accept 16 students into new class each year

Other Considerations… Lack consistent and reliable data about the healthcare workforce. Practice models are changing—moving away from sole practitioner toward corporate, multi-office, employee dentists. Dental students have greater debt. Utilization trends—Children are increasing their dental visits but adults are decreasing (why?). Several new dental schools have been built in the last five years—where do these students practice? National Health Service Corps—Pay off debt, then enter sole practice.

How do we supply healthcare professionals, especially in Rural and Frontier communities? Grow our own — with support from regional Area Health Education Centers around the state.

Area Health Education Centers The AHEC (Area Health Education Centers) program was developed by Congress in 1971 to recruit, train and retain a health professions workforce committed to underserved populations. Montana regional AHECs were implemented in 2007 with four planned centers. The North East regional center was just added in September.

AHEC regions

AHEC overview The purpose of the Montana AHEC is to expand and retain the number of health professionals, particularly those in primary care, who are practicing in rural and underserved areas of Montana. The Montana AHEC: supports medical, nursing, and allied health students; provides education and outreach to K-12 students in rural and underserved areas; coordinates workforce development with the State Workforce Investment Board and its one-stop centers; and provides continuing education and training to health professions throughout rural and underserved Montana.

Dental/Oral Health Example, Pipeline programs Through grant funding from DPHHS (Improving Oral Health in Montana), AHECs are sponsoring an Oral Health Careers presentation designed for high school students. The goal is to increase student awareness and interest in oral healthcare professions. Since September, presentations have been given at 11 high schools for 579 students (including Noxon, Augusta, Cut Bank and Fort Benton).

Pipeline activities continued AHEC sponsored REACH (Research and Explore Awesome Careers in Health) camps: a one-day program, taking place at the local healthcare facility that provides high school students the opportunity to explore the healthcare field through a variety of hands-on stations and activities. Professionals from the sponsoring healthcare facility lead the stations, volunteering their time and talent to mentor students and share their expertise. Four REACH camps including oral health professions: 69 students (including Red Lodge and Lewistown).

Pipeline activities continued The MedStart Summer Camp (sponsored by MT AHEC) is a week- long residential summer program for sophomores and juniors. The camp offers: Hands-On Activities (oral health included) Job Shadowing (oral health included) Health Science Symposiums Financial Aid Information Recreational-Social Activities Residential Life Experience Medical Facility Tours Career Personality Screening

Additional Activities Career Fairs Anaconda—included middle school students (600 students) Jobs for Montana’s Grads (500 students) Pathways to Oral Health Careers—brochure distributed to all high school guidance counselors, also offer general health professions education brochure HOSA—Future Health Professionals, 24 chapters in the state

Support for Dental Student Rotations 1 st and 3 rd year students from University of Washington Dental School Coordinate placement and housing in rural Montana, and ensure a welcoming and supportive experience in the community.

Oral Health professionals recruitment North and South Central AHECs specialize in recruitment of oral health professionals to rural/underserved Montana. AHECs participate in 3RNet—specific recruitment tools for rural healthcare professionals.

Thank You… For additional information: Cindra Stahl