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Grow Your Own: Grow Your Own: How to Create a How to Create a
Pipeline of Health Pipeline of Health Care ProfessionalsCare Professionals
April L. Vestal, MPHApril L. Vestal, MPHRural Maryland CouncilRural Maryland Council
Annapolis, MarylandAnnapolis, MarylandOctober 2, 2008October 2, 2008
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The MessageThe Message State Policy and Education leaders make State Policy and Education leaders make
a differencea difference
Strategic partnerships of local Strategic partnerships of local communities and higher education can communities and higher education can impact recruitment and retentionimpact recruitment and retention
Outcomes should be directly linked to Outcomes should be directly linked to health status, program elements, and health status, program elements, and best practices.best practices.
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Experience and Evidence supportsExperience and Evidence supports
• Pipeline programs with rural focus and Pipeline programs with rural focus and contentcontent
• Training in rural communities Training in rural communities • Recruiting rural people into programsRecruiting rural people into programs• Financial incentives and Community Financial incentives and Community
support support • Strategies that improve community’s ability Strategies that improve community’s ability
to recruit and retain healthcare providers.to recruit and retain healthcare providers.
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The West Virginia Experience in Training Recruiting, and Retaining Rural Health Providers
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Unique Elements of this Unique Elements of this PartnershipPartnership
Degree-required rural rotations of all state Degree-required rural rotations of all state supported health sciences students since 1996supported health sciences students since 1996
Tuition and fee waivers for successful Tuition and fee waivers for successful completers of middle and high school health completers of middle and high school health careers programscareers programs
Unique collaboration of health sciences schools, Unique collaboration of health sciences schools, private schools and local communitiesprivate schools and local communities
Recruitment of health professionals contributes Recruitment of health professionals contributes to economic development through the creation to economic development through the creation of jobs (in rural WV 1 doc= 4.3 jobs)of jobs (in rural WV 1 doc= 4.3 jobs)
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What Our WV Experience Has What Our WV Experience Has Taught Us…Taught Us…
When community in put is valued When community in put is valued community members can have a community members can have a highly effective role in traininghighly effective role in training
Schools improve mission deliverySchools improve mission delivery
Health promotion services are Health promotion services are increased at community levelincreased at community level
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Organizations and SystemsOrganizations and Systems
Local Rural Health ProvidersLocal Rural Health Providers• CHCs, rural hospitals, private CHCs, rural hospitals, private
practitioners, pharmacists, etc.practitioners, pharmacists, etc.• Serve as fiscal agents, employ site Serve as fiscal agents, employ site
personnel, provide office spacepersonnel, provide office space• Serve as preceptorsServe as preceptors• Serve as local board membersServe as local board members• Provide student meals, housingProvide student meals, housing• Provide learning resource centersProvide learning resource centers• Send one rep to state level Rural Health Send one rep to state level Rural Health
Advisory Panel appointed by GovernorAdvisory Panel appointed by Governor
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Organizations and SystemsOrganizations and Systems
WV Higher Education Policy WV Higher Education Policy CommissionCommission• Carries legislative authority for Carries legislative authority for
implementationimplementation• Transfers and oversees funds from state Transfers and oversees funds from state
treasury to schools and communitiestreasury to schools and communities• Administers state funded scholarship Administers state funded scholarship
programprogram• Oversees annual legislative reporting Oversees annual legislative reporting
requirementsrequirements• Maintains link with Governor’s officeMaintains link with Governor’s office• Maintains state level budgetMaintains state level budget
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Organizations and SystemsOrganizations and Systems
Schools (all state funded Health Schools (all state funded Health Sciences programs)Sciences programs)• Devote faculty time to coordinate rural Devote faculty time to coordinate rural
health curriculum and rotations health curriculum and rotations (generally 20% FTE)(generally 20% FTE)
• Provide orientation to rural rotations to Provide orientation to rural rotations to students on campusstudents on campus
• Host Rural Health Fairs for studentsHost Rural Health Fairs for students• Provide rural health courses and/or Provide rural health courses and/or
specific rural health content in other specific rural health content in other coursescourses
• Receives state funds allocated to schools Receives state funds allocated to schools under RHI Actunder RHI Act
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Organizations and SystemsOrganizations and Systems State AgenciesState Agencies
• Bureau for Public Health: RCP, SLRP, Bureau for Public Health: RCP, SLRP, SEARCH scholarships, technical SEARCH scholarships, technical assistance to communities on R&R issuesassistance to communities on R&R issues
Economic DevelopmentEconomic Development• Local partners on Workforce Investment Local partners on Workforce Investment
Board, do joint projectsBoard, do joint projects Public SchoolsPublic Schools
• Joint childhood health projects, CARDIAC, Joint childhood health projects, CARDIAC, etc.etc.
Legislature Legislature • Core funding and federal matchCore funding and federal match• AdviseAdvise
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K-12 Programs
Rural Scholars
Rural Preceptors & Academic AffiliationsWVRHEP
WVAHECRural Rotations
West Virginia
EDUCATIONAL PIPELINEPublic School
7-12 GradeCollege Postgraduate Community
PracticeProfessional
Education
HCOP
Recruit-able Project Community
Financial Incentive and
Assistance Programs
SLRPRRCP
HSSP, MSLFSEARCH
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The West Virginia Rural Health The West Virginia Rural Health Education Partnership (WVRHEP)/Area Education Partnership (WVRHEP)/Area
Health Education Centers (AHEC) Health Education Centers (AHEC)
Interdisciplinary training in rural Interdisciplinary training in rural underserved areasunderserved areas
Blend strategies of training and Blend strategies of training and financial incentives with community financial incentives with community recruitment and retentionrecruitment and retention
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WVRHEP/AHEC InfrastructureWVRHEP/AHEC Infrastructure
100 student rotations per month100 student rotations per month State level Rural Health Advisory State level Rural Health Advisory
Panel specified in legislation Panel specified in legislation serves both state and federal serves both state and federal functionsfunctions
$2.5 million per year to $2.5 million per year to communities, $4.5 million to communities, $4.5 million to schools for rural health trainingschools for rural health training
$200K per AHEC center in federal $200K per AHEC center in federal fundingfunding
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2007 WVRHEP/AHEC Infrastructure2007 WVRHEP/AHEC Infrastructure
498 training sites in 55 counties498 training sites in 55 counties
750 clinical field faculty750 clinical field faculty
8 regional consortia with local boards 8 regional consortia with local boards and 4 AHEC Centers with local/campus and 4 AHEC Centers with local/campus boardsboards
15 site coordinators, 5 AHEC center 15 site coordinators, 5 AHEC center directors, program and support staff directors, program and support staff
17 Learning Resource Centers17 Learning Resource Centers
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Partnership Training SitesPartnership Training Sites
Of the these 498 partnership training sites:
•374 in HPSAs or MUAs
•148 sites are both
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Types of Training SitesTypes of Training Sites
•45 CHCs45 CHCs•47 FQHCs 47 FQHCs •8 RHCs8 RHCs•28 small rural hospitals28 small rural hospitals•25 dental offices25 dental offices•37 pharmacies37 pharmacies
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Training Sites, con’t.Training Sites, con’t.
•14 county health departments, 14 county health departments, •40 physical therapy agencies or 40 physical therapy agencies or
rehabilitation center sites, rehabilitation center sites, •15 healthcare for the homeless 15 healthcare for the homeless
facilities, facilities, •13 school based health centers, 13 school based health centers, •3 free clinics, and 3 free clinics, and •1 migrant health center1 migrant health center
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Recruit-able Community ProjectRecruit-able Community Project
Initiated in FM Dept with private Initiated in FM Dept with private foundation fundsfoundation funds
Is now Bureau for Public Health Is now Bureau for Public Health resourcesresources
Helps communities map assets Helps communities map assets and recommends improvementsand recommends improvements
First Impressions and First Impressions and Community Design Teams Community Design Teams Cooperative ExtensionCooperative Extension
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Recruit-able Community ProjectRecruit-able Community Project
Communities apply and pay Communities apply and pay $3,000 to $5,000 on average for $3,000 to $5,000 on average for Teams assessmentTeams assessment
Rural Scholars (FM residents) Rural Scholars (FM residents) complete rotations in or near complete rotations in or near communitiescommunities
TA continues to develop long TA continues to develop long range R&R plan for communityrange R&R plan for community
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RCP Community Process RCP Community Process “Cycle”“Cycle”
Community Development
Health CareAvailability
IncreasedEconomicStability
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Background - Community Decision-Background - Community Decision-Making ModelMaking Model
Community approach to strengthening Community approach to strengthening the community health systemthe community health system
Often, “community encourager” Often, “community encourager” provided leadershipprovided leadership• identifying community health needs and identifying community health needs and
resourcesresources• strategic planningstrategic planning• decision-makingdecision-making
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RCP Community “Tools”RCP Community “Tools”
Recruitment manualRecruitment manual
Video on recruitment and Video on recruitment and retentionretention
NewslettersNewsletters
Board game on rural practiceBoard game on rural practice
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Outcomes of WV’s Outcomes of WV’s
Pipeline Partnership Pipeline Partnership Programs Programs
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Health Sciences & Technology Health Sciences & Technology AcademyAcademy
Targets under represented Targets under represented minority and disadvantaged minority and disadvantaged students and communitiesstudents and communities
Over 2,500 students served by Over 2,500 students served by HSTA since 1994HSTA since 1994
982 HSTA High School Graduates 982 HSTA High School Graduates (98-07) (98-07)
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HSTA OutcomesHSTA Outcomes 95% enter college vs. 56% for 95% enter college vs. 56% for
all WVall WV
59% in health career majors VS 59% in health career majors VS 17% for all WV17% for all WV
786 (80%) of the 982 HSTA 786 (80%) of the 982 HSTA graduates are still in collegegraduates are still in college
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HSTA OutcomesHSTA Outcomes
55 HSTA Scholars in 55 HSTA Scholars in graduate/prof schoolgraduate/prof school
27 HSTA Scholars in health 27 HSTA Scholars in health sciencessciences
10 HSTA graduates currently in 10 HSTA graduates currently in medical schoolmedical school
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WV RHEP/AHECWV RHEP/AHECService to the StateService to the State
Over 50,000 weeks of student training Over 50,000 weeks of student training since 1992since 1992
$15 million in uncompensated dental $15 million in uncompensated dental care to 60,000 patients since 1995care to 60,000 patients since 1995
967 RHEP/AHEC grads confirmed to be 967 RHEP/AHEC grads confirmed to be practicing in rural areas of the state in practicing in rural areas of the state in 20072007
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WV Trained Rural Providers who completed WV Trained Rural Providers who completed
Degree Required Rural Health Rotations 2007Degree Required Rural Health Rotations 2007
PhysiciansPhysicians 264 264
(91-04 graduates)(91-04 graduates)
NPs/Nurse Educators NPs/Nurse Educators 104 104
NursesNurses 80 80
Physician AssistantsPhysician Assistants 152 152
DentistsDentists 89 89
Dental HygienistsDental Hygienists 22 22
PharmacistsPharmacists 183183
Physical TherapistsPhysical Therapists 60 60
Occupational Therapist 2 Occupational Therapist 2
Medical TechnologistsMedical Technologists 8 8
MPHMPH 1 1
Social WorkersSocial Workers 1 1
Nurse MidwivesNurse Midwives 1 1
TotalTotal 967 967
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Number of physicians completing RHEP/AHEC rotations practicing in rural areas of West Virginia
264
213
187
165
142124
1039288
0
50
100
150
200
250
300
1999 2000 2001 2002 2003 2004 2005 2006 2007
Physicians
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Retention OutcomesRetention Outcomes
38.6% medical school 38.6% medical school
graduates stay in the state graduates stay in the state following residencyfollowing residency
25% medical school 25% medical school graduates stay in state in graduates stay in state in primary careprimary care
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Retention OutcomesRetention Outcomes Retention of WV SoM graduates Retention of WV SoM graduates
AND residency grads in FM is 79%AND residency grads in FM is 79%
In past 11 years retention in In past 11 years retention in primary care has increased by primary care has increased by 67% 67%
Dentistry is 58%Dentistry is 58%
Pharmacy is 64%Pharmacy is 64%
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Oct 2006 HRSA Health Workforce Oct 2006 HRSA Health Workforce study (2004 data)study (2004 data)
31% of WV’s physician workforce 31% of WV’s physician workforce are graduates of instate medical are graduates of instate medical schools while national average is schools while national average is 29%. 29%.
38% of the WV physician 38% of the WV physician workforce are international workforce are international graduates, compared to a graduates, compared to a national average of 26.07%national average of 26.07%
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OutcomesOutcomes
State has eliminated 8 HPSA State has eliminated 8 HPSA counties in 10 years; all 91 health counties in 10 years; all 91 health professionals in these counties professionals in these counties completed rural rotations completed rural rotations
In 9 years rural physicians who In 9 years rural physicians who completed this training increased completed this training increased by 200%, annual rate of 14.7%by 200%, annual rate of 14.7%
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Precepting students may impact Precepting students may impact retentionretention
58% (61) of the physician respondents to 58% (61) of the physician respondents to the 2005 survey reported that they are the 2005 survey reported that they are currently RHEP/AHEC field professors currently RHEP/AHEC field professors
Of these 61:Of these 61:• 85% said that they find teaching to be 85% said that they find teaching to be
personally rewarding personally rewarding • 73% said that teaching helps them stay 73% said that teaching helps them stay
current in their professioncurrent in their profession
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Lessons LearnedLessons Learned
Involve communities in program Involve communities in program implementation – ownershipimplementation – ownership
Develop a “champion” for your causeDevelop a “champion” for your cause Bring key stakeholders together early Bring key stakeholders together early
to establish cooperationto establish cooperation Sustainability options involving your Sustainability options involving your
partnerspartners
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Visit us on the Visit us on the WebWeb
www.wv-hsta.org
www.wvrhep.org www.wvahec.org
www.wvochs.org/dr