1. RURAL TRACK PIPELINE PROGRAM
MU SCHOOL OF MEDICINE
RURAL TRACK PIPELINE PROGRAM
MU for YOU
March 28, 2019
Kathleen Quinn, PhD Associate Dean for Rural Health

2. Disparities in the U.S
By the year 2030, all baby boomers will be over age 65.
For first time in US Census history, people over 65 (78 million) will outnumber people under 18 (76.4 million).
The US will be short between 42,600 and 121,300 physicians.
Of that number, between 14,800 and 49,300 Primary Care Physicians will be needed.
An estimated 13,800 Primary Care Physicians are needed to remove the Primary Care Shortage designation from all designated shortage areas.
Becker, M. (2018) Primary Care Physicians – Missouri Workforce Update

3. Disparities in Missouri
Missouri fell from 37th to 40th in National ranking for health—ranked 40th or below among all states in 13 out of 35 measures documented by United Health Foundations American Health Rankings.
Ranked 42nd for Senior Health and 35th for Women and Children Health.
Missouri has almost 6 million residents, 38% live in rural communities (2.23 million)
99/101 rural counties are Primary Medical Health Professions Shortage Areas (HPSA)
69/143 licensed MO hospitals are in rural counties – 4 rural hospitals have closed since 2010.
32 rural counties without a hospital
36/69 rural hospitals are Critical Access with 25 or less beds
Becker, M. (2018) Primary Care Physicians – Missouri Workforce Update

4. Disparities in Missouri
Today, the average age of Primary Care Physicians in Rural Missouri is 60, compared to that of Urban Missouri Primary Care Physicians’ average age of 54.
61% of Rural Primary Care Physicians are over age 50, versus 52.7% of Urban Primary Care Physicians.
19.4% of the rural population is over age 65, while only 14.7% are over age 65 in urban areas.
There are 55.9 Primary Care Physicians for every 100,000 residents in rural Missouri compared to 139 PCPs per 100,000 residents in urban areas.
(National average is 68 PCPs/100,000 rural residents and 84 PCPs/100,000 urban residents)
Becker, M. (2018) Primary Care Physicians – Missouri Workforce Update KQ

5. MO Rural vs. Urban Disparities
Rural MO
Urban MO
Smoking Rate
24.9%
21.6%
Obesity Rate
31.1%
29.9%
Percent of Population with No High School Diploma
14.2%
9.04%
Life Expectancy
76.5 years
77.9 years
Heart Disease Death Rate per 100,000 ( )
225.4
193.5
Cancer Death Rate per 100,000 ( )
190.3
180.3
Total Number of Primary Care Physicians
1,246
5,379
Average Age of Primary Care Physicians (2018) 60 54
Percent & (number) of PCPs over age 50 (2018)
60.6%(755)
52.7%(2,835)
Percent & (number) of PCPs over age 70 (2018)
8.7%(108)
6.3%(338)
Percent & (number) of PCPs age 40 & younger (2018)
15.8%(197)
19.6%(1,052)
MO Rural vs. Urban Disparities
Rural MO
Urban MO
Smoking Rate
24.9%
21.6%
Obesity Rate
31.1%
29.9%
Percent of Population with No High School Diploma
14.2%
9.04%
Life Expectancy
76.5 years
77.9 years
Heart Disease Death Rate per 100,000 ( )
225.4
193.5
Cancer Death Rate per 100,000 ( )
190.3
180.3
Total Number of Primary Care Physicians
1,246
5,379
Average Age of Primary Care Physicians (2018) 60 54
Percent & (number) of PCPs over age 50 (2018)
60.6%(755)
52.7%(2,835)
Percent & (number) of PCPs over age 70 (2018)
8.7%(108)
6.3%(338)
Percent & (number) of PCPs age 40 & younger (2018)
15.8%(197)
19.6%(1,052)

6. The Challenge

7. Program Beginnings
The MU Rural Track Pipeline Program began in 1995 as a cooperative effort between the MU Area Health Education Center and MU School of Medicine to address the rural health workforce shortages in the state.

8. Leadership
Dr. Michael Hosokawa- Senior Associate Dean of Medical Education Rural Track Management Group: Dr. James Stevermer- MUAHEC Medical Director Dr. Kathleen Quinn –Associate Dean of Rural Health Dr. Laine Young Walker– Associate Dean of Student Affairs Dr. Kevin Kane – Associate Dean for Curricular Improvement Clerkship Directors (for 7 clerkships) Regional AHECS (Missouri Area Health Education Centers) Rural Track Medical Directors (at rural training sites)

9. Bryant Scholars Program

10. Program Design Based on three premises from the literature:
Students who come from rural areas are more likely to return to rural areas & MO students are more likely to stay in MO
Multiple, longitudinal experiences living and working in a rural community increase the likelihood of eventual rural practice
Living and working in a rural community helps to better prepare students for eventual rural practice

11. Bryant Scholars Pre-Admissions Program
Students are offered acceptance into a particular entering class, conditional upon:
Maintaining certain academic standards
Demonstrating ongoing professional conduct; and
Participating in required activities (leadership, shadowing, retreats)
Students who matriculate are required to participate in the 3 components of the Rural Track Program during medical school

12. Eligibility Requirements
Undergraduate graduation date two academic years from the time of application
High academic achievement during high school
Minimum 3.3 cumulative GPA and minimum 3.3 Math/Science GPA
A or B grades in required lecture/lab courses already taken at the time of application
Missouri resident
Graduated from a rural Missouri high school as defined by the National Center for Education Statistics
Enrolled full-time at an institution of higher education in Missouri or contiguous state
Students currently enrolled at a two-year public or independent college are eligible to apply but must provide proof of acceptance at a Missouri (or contiguous state) four-year public or independent college or university.
College English, two semesters or one year
College-level mathematics (college algebra or above), one semester
Biologic Sciences (e.g. biology, genetics, cell biology, animal physiology, molecular biology, histology), two semesters or one year
General chemistry, two semesters or one year
Organic chemistry, two semesters or one year
General physics, two semesters or one year

13. Student Selection Total SOM class size = 112
Dedicated rural pre-admission slots (up to 20)
Sample interview questions and evaluation score sheet addressing two main areas are provided to committee members:
Is the applicant someone who will excel as a patient-centered physician?
Is the applicant someone who is likely to practice in a rural setting?

14. Student Requirements
Maintain a cumulative and math/science GPA of 3.30 and earn A or B grades in the required course work
Receive the minimum MCAT set by the SOM
Current: 503 with no sub-score lower than 124
Attend 3 of 4 Winter and Summer Retreats
Winter Retreats are online and focus on a variety of topics (MCAT, Financial Aid/Scholarships, connecting with older students)
Summer Retreats are in person on campus and are mandatory
Complete 20 hrs. of rural physician shadowing, 20 hrs. of other health related activities, and 8 hrs. of community service per academic year
Submit 4 mentor shadowing reflection papers

15. Bryant Scholars Outcomes
54.9% entered a residency program in Missouri
41.8% entered a residency program at MU
59.6% practice in a rural location
50% practice in rural Missouri
70.2% practice in Missouri
Data as of 03/12/19
Total N for residency=122
Total N for practice=94

16. How Extension Can Help
Identify high school youth in your programs and/or community interested in medicine
Refer students to your regional AHEC and MU-SOM

17. Rural Scholars Program

18. Student Eligibility All first year medical students
Number of students accepted will depend on number of incoming Bryant Scholars (max of 25 students)
Rural and urban background students
-Students do not need to be from a rural area to apply. They can apply if they have an interested in learning about rural health disparities and quality of life concerns or are interested in serving and underserved population
-many parallels between rural and urban underserved

19. Student and Community Engagement
Continuity Community/Region
Rural Scholars will be assigned to a community/region where they will complete all their clinical training during the three clinical Rural Track programs (Summer, Clerkship, Elective)
Allows the Scholar to develop a more in-depth connection with an understanding of the community/region, culture, health disparities, and health care resources in the area
Continuity Community/Region Fair will be held to increase engagement of communities and familiarity with potential Scholars
Idea from TRUST.

20. Summer Community Program
Paid opportunity following 1st year of medical school ($1,000 or $1,500)
Students work with a rural physician for 4 or 6 weeks in their continuity community/region to gain insight into rural practice
Housing provided free of charge or student may stay with family or friends in the area
Opportunity for students to gain history-taking and physical exam skills
•Rockport
•Canton
•Quincy, IL
•North Kansas City
•Lexington
•Holt’s Summit
•Westphalia
•Versailles
•Mack’s Creek
•Richland
•St. James
•Aurora
Monett•
•Hayti

21. Goals for the Summer Community Program
Increase knowledge of rural practice by working with an experienced preceptor.
Learn about the different specialties commonly available in rural communities.
Improve clinical skills in history-taking, physical examination, assessment and medical management.
Explore common acute and chronic clinical problems.
Compare medical practice in a community setting to practice in an academic health center.

22. Clerkship Program Occurs during the 3rd year of medical school
Rural Scholars must complete 3 rotations in their assigned continuity community/region:
Family Medicine
Child Health
Internal Medicine
Obstetrics and Gynecology
Neurology
Psychiatry
Surgery
Housing is provided free of charge to students

23. Goals for the Rural Track Clerkship Program
Explore and discover issues relevant to practicing medicine in a rural community.
Provide students with core clinical experiences by working with a qualified preceptor.
Afford students the unique opportunity to live and work in a rural community.
Provide opportunities for service learning through community integration activities.

24. Participating Hospitals & Health Systems

25. Student Housing Hannibal Sikeston Branson St. Joseph Sedalia
Osage Beach
West Plains

26. Rural Immersion Program
Paid opportunity following 1st year of medical.
Four-day experience for health professions students who are interested in living and working in a rural area.
Non-clinical experience hosted in a rural community designed to highlight the social and communal aspects of rural life.
Housing and meals provided.
Rural Scholars must also complete at least 4 weeks of the Summer Community Program.
Chillicothe 2017
Through group activities and meetings with community leaders participants will get a preview of life as a rural healthcare professional. This project emulates one we learned about from Mark and Melanie in CO.
Hannibal 2018
Sedalia 2019

27. Community Integration Project
Students research community health needs in a region of the state and develop and evaluate a community research project to address the identified needs. An academic poster and paper are submitted to reflect on the project.
Idea from WONCA

28. Elective Program Occurs during the 4th year of medical school
Rural Scholars must complete one 4 week elective in their assigned continuity community/region
Sample Elective Offerings:
Dermatology
Emergency Medicine
Family Medicine
Cardiology
Immunology/Rheumatology
Obstetrics and Gynecology
Radiology
Urology
Psychiatry
Legislative Advocacy and Rural Health Policy

29. Student Benefits and Requirements
Rural Missouri Experience
Experience the rewards and challenges of working and living in a rural community
Examine rural health disparities and quality of life concerns within a specific region of Missouri
Develop an ongoing relationship with hospital systems and health care providers in rural Missouri
Explore potential future practice locations
Mention R.I. Program

30. Student Benefits and Requirements
Lasting Benefits
Prepare for rural practice through ongoing clinical exposure
Develop strong, supportive relationships with other students interested in rural care
Receive personal mentoring from a rural community-based faculty member
Participate in the annual rural lecture series for ongoing exposure to topics in rural health
Receive a program completion scholarship during the fourth year of medical school
Receive personalized assistance and support from Rural Track Pipeline Program faculty and staff
Receive potential scholarships from participating hospitals and/or health systems

31. How Extension Can Help Welcome students to your region/community
Provide students with a community tour
Involve students in Extension events
Suggest/Supervise Community Integration Projects
Participate in Rural Immersion to highlight Extension in your region

32. Statewide solutions to address rural healthcare workforce

33. MU Rural Track Collaborative Projects
Health Network of Missouri
A collaborative network formed in June 2014 to improve access and better coordinate health care for patients in the communities they serve. The six health systems will work together to share best practices in business, clinical and operational practices.
Collaboration with member hospitals to develop training sites for medical students and residents
Department of Health and Senior Services
Rural Lecture Series
Rural Training Site Development with HNM members
Rural Immersion
Rural Residency Development
RME Conclave Support
Missouri Hospital Association Health Institute
Implementation of Rural Scholars Program
Summer Program Collaboration with Rural member hospitals
Rural Training Site Support for Rural member hospitals
MU develops and opens the sites with the intention the systems can host all students, but they do prioritize MU students due to the partnership. This funding and these partnerships helps to ensure MU students receive training despite competition.

34. Missouri Healthcare Workforce Coalition
Bring together key stakeholders in Missouri who are committed to growing a strong primary care workforce across our state
Increase the number of primary care providers practicing in Missouri
Retain primary care providers educated and/or trained in Missouri to continue practice in our state
Increase the number and improve the distribution of primary care training sites and preceptors in Missouri
Promote a statewide infrastructure by which to measure and evaluate healthcare workforce trends, assess critical needs, and inform long term, evidence-based strategies for Missouri
Develop responsive policy proposals and engage in coordinated advocacy efforts that support a strong primary care workforce across our state
S’s of M, AHEC, DHSS, MPCA, MHA, Professional Registration and State Boards. Started meeting in April of 2016.

35. Missouri Healthcare Workforce Coalition
MO Healthcare Workforce Data System – The system is based of the Cecil G. Sheps Center for Health Workforce Analysis. Statute passed in August 2016 to allow Professional Registration Boards to contract with OSEDA to analyze Missouri healthcare workforce data. To date, MO State Board of Nursing and the Board of Healing Arts has signed on.
Rural Training Track: October 2017 – MHA sent a survey to Missouri hospitals
March-April 2018 – Accreditation and Funding webinars
Summer 2018 – Hospital meetings/interviews
September 2018 – 3 HNM hospitals selected and Randy Longenecker secured as RTT Consultant
1. The project will provide analysis of healthcare workforce issues utilizing the data collected within the application as well as published relevant research and policy analysis of Missouri’s workforce by other researchers.

36. Rural Training Track Development
October 2018 – MU Task Force members and Dr. Longenecker made site visits to make final determinations of viability and interest in establishing an RTT
November 2018 – Dr. Longenecker’s report received
January 2019 – MU Task Force determined first of three sites to proceed with FM RTT
February 2019 – Working on HRSA grant
June 2022 – Admit residents to RTT
We are recruiting more physicians, but schools are competitive and aren’t necessarily collaborating regarding placements for all

37. QUESTIONS?

38. THANK YOU!