1. Nebraska’s Rural Health Opportunities Program: 20 Years of Educating Health Professionals for Rural Communities Ann Kraft, Program Coordinator University of Nebraska Medical Center Rural Health Education Network Nebraska AHEC Program Office NAO Conference June 24, 2010

2. UNMC Develops the Rural Health Education Network (RHEN) Form partnerships among rural communities Develop a network of volunteer faculty Change how and where health science students are educated Develop programs to encourage students from rural communities to consider health care careers Established in the early 1990’s to address the shortage of health professionals in rural Nebraska

3. R H E N Student/Resident Education And Rotation in Community Health Student Association for Rural Health Student Rotations Rural Health Opportunities Program Science Education Partnership Award Area Health Education Center Regional and State Science Meets for 8 th graders Career Days Science Teacher Connections Science Teacher Retreat Weeklong Workshops for College Students Cultural Competency Geriatric Careers AgroMedicine Behavioral Health Careers

4. Rural Health Opportunities Program (RHOP) “ Grow Our Own” To recruit rural Nebraska students into the health professions Support programs to recruit them back to rural Nebraska communities RHOP spans 9 health professions

5. Rural Health Opportunities Program (RHOP) 1989 - Discussions between UNMC’s College of Medicine and Chadron State representatives. Wayne State joins a year later. Chadron State College University of Nebraska Medical Center Wayne State College

6. Three Nebraska State Colleges Chadron Omaha ▼ ▼ ▼ Wayne Peru

7. Rural Health Opportunities Program (RHOP) Students who are accepted into RHOP are pre-admitted to UNMC’s academic programs when they begin their undergraduate education Medicine Pharmacy Dentistry Dental Hygiene Clinical Laboratory Science Physician Assistant Physical Therapy Radiography * Nursing (at Chadron only) Negotiations are underway to add nursing at Wayne State *

8. Rural Health Opportunities Program (RHOP) Which programs? How long? How many positions? Length of Education# of Positions ProgramDegreeCollegeUNMCCSCWSC MedicineMD4 years 55 PharmacyPharmD3 years4 years33 DentistryDDS4 years 33 Dental HygieneBSDH2 years 12 Clinical Laboratory Science BSCLS3 years1 year43

9. Rural Health Opportunities Program (RHOP) Length of Education# of Positions Program DegreeCollegeUNMCCSCWSC Physician AssistantMPA4 years28 months44 Physical TherapyDPT4 years3 years32 RadiographyBSRST3 years1 year21 NursingBSN1 ½ years2 ½ years6n/a Which programs? How long? How many positions?

10. How do students apply? Apply on-line to RHOP at the same time they apply for admission to WSC or CSC May apply ONLY to one program and ONLY to one college Applications due December 1

11. Criteria used for selection From a rural Nebraska community Well rounded student ACT/SAT scores Grade point averages (especially science) Essay – Interest in rural; connecting to rural Experience/Knowledge of health care – Shadowing – Volunteer work

12. How many are interviewed? About 2-3 times the number of positions available Who interviews Students notified before March 1 Alternate status – must enroll at selected undergrad institution Alternates have a high acceptance rate to UNMC because of the RHOP experiences

13. What’s the commitment? A “commitment of the heart” to return to rural Nebraska Applicants are too young to sign a contract We want the graduates to set up practice in a small community and make it their home. Not leave once the “commitment” is completed

14. Early Financial Incentives 1993 RHOP Loan Program $400,000 from legislature All RHOP students eligible

15. Early Financial Incentives 1998 RHOP Loan Program Discontinued High penalties for default Faculty discouraged use Funds returned to State of Nebraska’s loan / loan forgiveness programs for those who practice in underserved areas

16. Financial Incentives Tuition waiver for all programs at the undergraduate level Eligible for waiver through the State College Board of Trustees Many RHOP students qualify for Rural Health Advisory Commission Loan or Loan Forgiveness Strict definitions of underserved to qualify for loan repayment regulations

17. RHOP Odds –n- Ends RHOP Bachelor of Science in Nursing program offered at UNMC’s College of Nursing, West Nebraska Division (500 miles from Omaha) “Rural Issues” is a distance education course from UNMC to the undergraduate students Annual visit to UNMC

18. RHOP Pipeline MedPharmDental Dent al HygieneNurse Phys Asst Phys Thpy Clinic Lab ScienceRad Total CSC1579367122468 WSC197104--- 3 43 UNMC331816365112296 Grads81564225751443614356 TOTAL1518877351963674320563

19. RHOP Graduates by Year Graduated Practicing in Rural Nebraska PRACTICING RHOP GraduatesTotal Rural Nebr Urban Nebr Rural Out of State Urban Out of State % Grad Rural Nebr % Grad Rural (NE and OS) % Grads Staying in Nebraska Medicine 67361451254%61%75% Dentistry 412345956%68%66% Dental Hygiene 251063640%52%64% Pharmacy 532217-0-1442% 74% Nursing 752-0- 71% 100% Physician Assistant 493445669%80%78% Clinical Lab Science 291624755%69%62% Physical Therapy 412197451%68%73% Radiography 1135-0-327% 73% 323170632961 Percentage Totals 53%20%9%19%53%62%73% Fall 2009

20. 2009 RHOP Hometowns 563 RHOP students and graduates from 227 hometowns

21. 384 are from 201 towns with populations of < 5,000 108 are from 16 towns with populations 5,000–10,000 71 are from 10 towns with populations > 10,000

22. RHOP Practice Sites

23. 323 practicing graduates who have completed residency 170 working in rural Nebraska 63 working in urban Nebraska 233 providers in 60 Nebraska communities (73%)

24. What we learned along the way Market, market, market Clarify requirements i.e. Ralston, NE Communicate expectations Define the advantages – early admission

25. What we learned along the way RHOP Acceptance Decision seniors in high school vs. end of freshman year in college Benefits to State Colleges Increased applications Increased tuition to fund science curriculum Stronger faculty

26. RHOP Success Number of graduates who have completed residency: 323 53% in rural Nebraska 9% in rural across the U.S. 62% currently rural! Since RHOP began, 71% of all graduates have practiced in a rural community at some point.

27. RHOP Success Drs. Kate & Jason Hesser 2006 College of Medicine RHOP graduates 3 year family practice residencies through UNMC’s Rural Training Track Program in Grand Island Joined the medical staff at Crete Medical Center (July 2009 )

28. RHOP RESULTS Niki and Aaron Salomon, live in Gothenburg She’s a pharmacist in Cozad He’s a physician assistant in North Platte

29. RHOP Success Kyle Klammer (left) 2004 State Science Meet (8 th grade) 2008 freshman Chadron State College (freshman) 2007 Alumni Science Meet (junior in high school)

30. Questions? Ann Kraft Phone: (402) 559-3398 E-mail: akraft@unmc.edu www.unmc.edu/rhen