reemerging health workforce...

A Publication of the National AHEC OrganizationVOLUME XXIII, NUMBER 2Spring/Summer 2007

Reemerging HealthWorkforce Concerns

In This Issue

Renewed Support for Title VII Programs Is Needed to Address Health Workforce Concerns ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 1Sen. Jack Reed (D-Rhode Island)

Reemerging Health Workforce Concerns ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 3Heather Anderson, MPH; Ken Oakley, PhD, FACHE; and Kelley Withy, MD, PhD

The Adequacy of Health Workforce Supply ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 5Tim Dall, MS, and Atul Grover, MD, PhD

State Workforce AssessmentAHECs, Health Workforce Planning and Analysis

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○10

Thomas C. Ricketts, PhD, MPH; Erin Fraher, MPP; and Jennifer King, BA

New York State AHEC System: Partner in Coalition to Reshape Primary Care ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 13Mary J. Sienkiewicz, MBA

History of AHEC and University Collaboration for Workforce Assessment ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 15Jennifer King, BA; Erin Fraher, MPP; and Thomas C. Ricketts, PhD, MPH

Health Workforce Needs in Arkansas ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 18Ann B. Bynum, EdD; Charles O. Cranford, DDS, MPA; and Cathy A. Irwin, PhD, RN

Expanded Role for AHECs: Providing Technical Assistance for a Health Professions Workforce Initiative ○ ○ ○ ○ ○ 21Sally Henry, RN, MA, FHCE

Recruitment ActivitiesThe Miami Comprehensive Model for Health Professions Education: Pathway to Diversity ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 24

Astrid K. Mack, PhD, and Asma S. Aftab, MD, MPH

“Day in the Life” Shadowing Program for High School Students in Rural Oklahoma ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○30

Stephanie J. Payne, BA, MS

Health Career TrainingPreparing Advanced Practice Nurses for Meeting Rural Healthcare Needs ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 32

Susan K. Rice, PhD, RN, CPNP, NCSN, and Sally Royston, RN, BSN, SANE-A, MSN

Arkansas AHECs: Supplying the State with Radiologic Imaging Sciences Professionals ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 34Joseph R. Bittengle, MEd, RT(R)(ARRT); Stanley R. Olejniczak, MS, RT(R)(ARRT); and William M. Pedigo, MPA,

RT(R)(ARRT), RDMS

North Carolina’s Pharmacy Partnership Program ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 37Huyla G. Coker, PharmD; Pamela U. Joyner, EdD, MSPharm; and Jennifer L. Robertson, PharmD

LEP Students Gain Skills, Join Workforce ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 40Kathleen D. Watson, MS

Preparing Future Dentists in Kentucky: Something to Smile About ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○42

Sherry C. Babbage, DMD; Lee S. Mayer, DMD; and Margaret Mahaffey, MEd

Residency FellowshipMinnesota AHEC and the Rural Physician Associate Program: Building on a Model of Success

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○44

Gwen Wagstrom Halaas, MD, MBA, and Angela Bowlus, MA

A “Win” All Around: New Women’s Health Fellowship Benefits Many ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○47

Lenny Salzberg, MD

Spirit of AHECCollaboration for Nontraditional Nursing Training in Central Nebraska ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ 49

Sally Husen, MAEd

Reemerging Heath Workforce Concerns

Volume XXIII, Number 2

Spring/Summer 2007

A Publication of the National AHEC Organization

The National Area Health Education Centers Bulletin

The National AHEC Organization supports and advances the Area Health Education Centers/Health Education and TrainingCenters (AHEC/HETC) network in improving the health of individuals and communities by transforming health care through

education. The National AHEC Bulletin is published semi annually by NAO.

Renewed Support for Title VIIPrograms Is Needed to Address HealthWorkforce ConcernsSen. Jack Reed (D-Rhode Island)

Sen. Jack Reed is a senior member ofthe Health, Education, Labor andPensions Committee (HELP).

One of my top priorities since coming to Congress in 1990 hasbeen to improve access to quality, affordable health care for ournation’s families. I believe we have made significant strides inrecent years through increased funding for community healthcenters, through the creation of the children’s health insuranceprogram, and in protecting funding for Medicare and Medicaid.

While all of these initiatives are essential for better healthcareaccess, they are increasingly threatened by the growingshortages of healthcare professionals throughout the nation.For several years we have documented the need for morenurses, and recent reports now tell us that we will be facingsignificant shortages of doctors, dentists, pharmacists and manyallied health professionals in the coming years. These short-ages will greatly impact our ability to offer preventive andprimary care services to all of our citizens.

While these shortages will affect all Americans, they will createa particular burden for our most vulnerable citizens. Peopleliving in poverty, in rural communities, and in otherunderserved areas will be most acutely affected by the lack ofaccess to well-trained health professionals to meet their needs.I have been one of the strongest supporters of communityhealth centers in the U.S. Senate, but I am now told that theCHCs face a shortage of more than 4,000 physicians over thenext 10 years, with comparable shortages in other health

professional groups as well. Without an adequate supply ofmedical personnel, the community health centers will beunable to meet the needs of the populations they weredesigned to serve.

A Vital Role for Title VII ProgramsFor over 35 years our federal government has funded a broadarray of programs under Title VII of the Public Health ServiceAct designed to prepare a health workforce to meet the needsof our nation’s communities. For a very modest level of federalfunding, these Title VII programs have had a major impact in anumber of areas, including:

• Primary care medicine programs that have expanded thenumber of family physicians, general internists, andpediatricians.

• Area Health Education Centers that have successfullyrecruited tens of thousands of young people into healthcareers and given health science students experiences atthe community setting to better prepare them to work forunderserved populations.

• Health Education and Training Centers to address thespecial needs of vulnerable populations, particularly alongthe U.S./Mexico border.

• Geriatric Education Centers to prepare health profession-als in a multidisciplinary setting to provide high-qualitycompassionate health care for our nation’s older citizens.

• Programs to increase the diversity of the healthcareworkforce, so that it can more effectively address theproblems of health disparities and create greater opportu-nities for underrepresented minority young people to enterhealth careers.

These are but a few of the programs included in Title VII thathave had a major impact in improving access to care for our

The National AHEC Bulletin � Volume XXIII, Number 2 � Spring/Summer 20072

most vulnerable populations. In my own stateof Rhode Island, our AHEC Program, whichwas founded in 2004, already is having asignificant impact through its health careersprograms, the placement of students inunderserved communities, and in a variety ofspecial initiatives designed to meet the needsof our citizens.

The RI AHEC Program, housed at theWarren Alpert Medical School of BrownUniversity, has established three independentAHEC centers throughout Rhode Island, eachof which works effectively with the RhodeIsland’s only medical school and the fourcolleges and universities that offer allied healthprograms. Additionally, given RhodeIsland’s small size, each AHEC center has astatewide approach to programming whilefocusing on a particular healthcare or healtheducation niche.

The Central RI AHEC, located in Cranston,which is considered a medically underservedcommunity, has taken the lead on developinginnovative programs designed to exposemiddle and high school students to a variety ofhealthcare careers. Through the REACTProgram, a program of the Youth ServiceCorps, many minority students have anopportunity to experience firsthand thequalities required to be successful in ahealthcare career and are regularly exposedthrough shadowing experiences to emergencyrooms, operating rooms, and intensive careunits, as well as exposed to primary carepractices and subspecialty practices.

The Northern RI AHEC, located inWoonsocket, also a medically underservedarea, is presently focusing on community-based needs assessments, the support of

health professions students’ community-basedinitiatives, and data collection and the state-wide GIS mapping of the primary care system.

Finally, the Southern Rhode Island AHEC,located in Newport, which in fact is also amedically underserved area, is focusing onidentifying and creating community-basedinitiatives towards the amelioration of environ-mental health risks, such as lead poisoning,asthma, mold in public housing and childhoodobesity.

While the RI AHEC is one of the newerAHEC programs in the country, I am veryproud of the work they have done in their twoshort years of existence, and am very pleasedthat they have contributed much towardsmeeting the healthcare needs of RhodeIsland’s most vulnerable citizens.

Revitalization of Support for Title VIIProgramsBecause of the value of these programs, I amprepared to work with my colleagues in theU.S. Senate in order to revitalize the supportfor Title VII programs and other efforts at thefederal level to strengthen the healthcareworkforce. If we are to improve the availabilityof preventive and primary care services to all ofour citizens, it is critical that we maintain astrong pipeline of programs to prepare futuredoctors, nurses, and other health professionals.The programs in Title VII, including AHECs,HETCs, Geriatric Education Centers, and theother programs, are uniquely positioned toprovide leadership in our nation’s efforts toaddress this important issue. I welcome theopportunity to work with my colleagues inRhode Island and beyond to assure that wehave adequate numbers of health profession-als to serve our country in the coming decades.

Renewed Support for Title VII Programs Is Needed toAddress Health Workforce Concerns

The National AHEC Bulletin � Volume XXIII, Number 2 � Spring/Summer 2007 3

Editorial Overview

Kelley Withy, MD, PhD,is Program Director of theHawaii Pacific BasinAHEC, Honolulu, HI.

Reemerging HealthWorkforce ConcernsHeather Anderson, MPH; Ken Oakley, PhD, FACHE; and Kelley Withy, MD, PhD

Is the United States facing a health workforceshortage in the near future?

Area Health Education Centers are in thehealth workforce business, partnering witheducational and service organizations to trainhealth professionals to be the “right people inthe right place at the right time.” Although wefeel that we know where health workforceneeds are the greatest, many of us would behard-pressed to show supporting research toquantify needs for legislators or policy makers.The United States has no accurate federalassessment of the supply of healthcare workers.At the state level there is great variation. Somestates do this very well and some don’t assesstheir workforce at all. In order to get a handleon what the future holds and appropriatelydirect healthcare decisions, it is essential thatthere be accurate information locally andnationally. Nationally, if we are to plan forfuture healthcare needs, we must first beginwith accurate assessments of current resourcesand then build realistic models for futuredemands.

This issue of the Bulletin includes articlesdescribing national and statewide datacollection and projection methods, individualstate initiatives where AHECs are influencinghealth workforce policy, and training programsthat are making a positive difference withregard to the local and regional quantity anddistribution of health professionals. A fewstates have very effective healthcare assess-ment programs, and some of these are closelyassociated with AHEC. Other states haveuniversity-based programs or private nonprofithospital organizations that focus on workforceissues. You will read about many successfulprograms. In addition, Sen. Jack Reed (D-RI)provides a broader perspective through hiscompelling and comprehensive discussion ofthe overall importance of revitalizing Title VIIPrograms in order to ensure an adequatehealth professions workforce for the future.

Since health workforce forecasting is not anexact science, and few of us are trained in the

methods needed to conduct this type ofresearch, the editors hope that this issue of theBulletin will stimulate interest in the methodol-ogy. We anticipate that it will help AHECboard members, program directors, centerdirectors, staff, partners, policy makers, andaffiliates better understand how estimates andprojections are developed and how they can beeffectively utilized. Ultimately, we want thisissue of the Bulletin to spur dialogue aboutwhat we can all do to assess and improve thehealthcare workforce and to identify newpartnerships that should be developed toaccomplish our goals.

Current national projections demonstrategrowing needs in numerous health professions.Considering several disciplines specifically, ifwe continue our current rate of educatingphysicians, we will have a shortfall of almost150,000 physicians by 2030. In order to avoidthis situation, the American Association ofMedical Colleges has recommended a 30%increase in medical school class size, a veryexpensive proposition.

The future looks even bleaker for nursing, withestimates of the shortage of nurses in themillions. Similarly, allied health professionsare also being assessed and we expect similarpatterns of need, with the greatest shortagesbeing in rural and urban underserved areas ofparticular interest to AHECs.

What Can AHECs Do?As a national program, regional and statewideAHEC systems can be instrumental in collectingaccurate local data that can be used to createprojections and thereby impact health policy.The act of tracking health workforce supply alsoserves as one of the most effective forms ofAHEC program evaluation by demonstratingdirect impact of AHEC activities. Thus, healthworkforce assessment can and should be viewedas a significant opportunity for AHEC programsand centers alike.

Although HRSA has identified healthworkforce assessment as vital to future

Heather Anderson, MPH,is Associate Director of theCalifornia AHECProgram, Fresno, CA.

Kenneth Oakley, PhD,FACHE, is CEO of theWestern New York RuralAHEC, Inc., Warsaw, NY,


planning, the fundingpreviously provided forregional health workforcecenters to assess andforecast needs waseliminated in the nationalbudget along with HETCfunding. However, statesthat are successful in thisarena have leveraged fundsfrom private and stateinstitutions with researchdollars, and therefore, havesuccessfully incorporatedassessment activities intothe healthcare system ofthe state. AHEC does nothave to act alone in this,but can be a leadingpartner. With our networkof providers and educators,we can access knowledge otherwise hidden.Since AHEC is a partnership organization, itwould be both logical and prudent for us tocooperatively partner with other organizationsto accomplish this important task.

We believe that AHEC holds one of the mostimportant keys to the solutions that will beneeded to help this country meet our futureworkforce needs. Through diverse partner-

Reemerging Health Workforce Concerns

Figure 1: Growth in Primary Care Supply and Demand Figure 2: Growth in Non-Primary Care Supply and Demand

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration. PhysicianSupply and Demand: Projections to 2020. Assessing the Adequacy of Current and Future Supply. Retrieved June 12,2007 at http://bhpr.hrsa.gov/healthworkforce/reports/physiciansupplydemand/assessingadequacyofsupply.htm

ships, we can and are making a true difference.Yet we need to challenge ourselves to gofurther. We need to assess our skills, augmentthem as need be, and share our knowledge andskills to develop a unified strategy to assureaccurate and timely workforce planning. In thisway, AHEC can help create a truly integrateddelivery system that spans all specialties andhealthcare environments to maximize access toand quality of care.

Figure 3. Projected U.S. FTE RN Shortages, 2000 to 2020

Source: U.S. Department of Health and Human Services,Health Resources and Services Administration. What IsBehind HRSA’s Projected Supply, Demand, and Shortageof Registered Nurses? Retrieved June 12, 2007 at http://bhpr.hrsa.gov/healthworkforce/reports/nursing/rnbehindprojections/4.htm


The Adequacy of HealthWorkforce SupplyTim Dall, MS, and Atul Grover, MD, PhD

National headlines have drawn attention tocurrent and looming supply inadequacies inmany health professions. While there arevoices to the contrary, the general consensusis that at the national level the UnitedStates faces a current and growing shortfallof registered nurses, physicians, pharma-cists, and a host of allied health profession-als.1,2,3 In addition to projections of futureinadequacies, inequities in the geographicdistribution of health professionals haveresulted in uneven access to health careservices across localities. While problemswith the healthcare system are unlikely to besolved by increasing the supply of healthprofessionals alone, problems with accessand equity are likely to be more severe ifnational shortages increase. Some causes ofthe projected growing shortfall of healthprofessionals are different from factors thathave contributed to past shortfalls. In thisarticle we provide a brief history of healthworkforce modeling, discuss the major trendswith health workforce implications, andsummarize our recent national projections ofthe future adequacy of health workforcesupply for selected healthcare occupations.

History of Health Workforce PlanningThe history of health workforce modeling isone of mixed success and failure. Asillustrated by physician workforce planning,regardless of the accuracy of future supplyand demand projections, forecasts ofshortfalls or surpluses have large conse-quences on government programs andpolicies, the actions of academic medicalcenters and specialty associations, and thedecisions of individuals choosing medicine asan occupation. For example, a 1959Surgeon General’s report that the U.S. faced

a growing shortfall of physicians wasinstrumental in influencing federal initia-tives to subsidize and expand medicalschools during the 1960s and 1970s andallow more foreign-trained physicians topractice in the U.S.4 Efforts to expandphysician supply were so successful that twodecades later the Graduate MedicalEducation National Advisory Committeestudy projected a growing oversupply ofphysicians.5

Congress created the Council on GraduateMedical Education (COGME) in the mid-1980s to make recommendations on theadequacy of supply and distribution ofphysicians in the U.S. One COGME study,based on the work of Weiner (1994) andothers who found that the growth inmanaged care would lead to an oversupplyof specialists, was instrumental in changingfederal policies and specialty choice deci-sions by individual physicians that greatlyincreased the number of primary careproviders and reduced the number ofspecialists being trained. 6,7 One decadelater, after consumer rejection of the moststringent forms of managed care, the U.S.found itself not with a surplus but ratherwith a shortfall in many specialties. A recentfederal study finds that demand for manytypes of specialists will continue to surge,with a growing shortfall projected for manyspecialties.8

Lessons learned from the history of healthworkforce modeling include the following:

• Supply projections tend to be morestable and more accurate than demandprojections. Compared to demand,there are fewer determinants of supply,

Tim Dall, MS, is a HealthEconomist and VicePresident at The LewinGroup, Falls Church, VA.

Atul Grover, MD, PhD, isAssociate Director, Centerfor Workforce Studies at theAmerican Association ofAmerican Medical Colleges(AAMC), Washington,DC.

While history shows that health workforce modeling remains less than anexact science, the current consensus is significant workforce shortages remainon the horizon in numerous areas including nursing, physician specialties,

and allied health.


trends in supply determinants tend totake longer to develop, and there isgreater consensus on what the determi-nants are and the magnitude of theirimpact.

• Demand for health professionals isbased on a complex set of determinants,many of which can change unexpect-edly. Simplifying demand models suchthat projections rely heavily on onemajor determinant (e.g., growth inenrollment in health maintenanceorganizations, or growth in the nation’seconomic well-being) makes theprojections susceptible to gross inaccu-racy if the predicted trend in thatdeterminant fails tomaterialize or if theestimated size ofthe relationship isincorrect.

• Projections need tobe updatedfrequently toreflect changes inthe health operat-ing system.Workforce projec-tion models arestatic in that theyproject future supply and demandbased on current trends. Market forces,as well as projections of shortfalls andsurpluses, tend to producecountervailing trends that help mitigateprojected inadequacies in supply.

• The starting point for making futureprojections should be supply anddemand associated with the existinghealthcare system, despite its imperfec-tions, and the end point should bewhere we think the nation will be ratherthan where we think the nation shouldbe. Alternate projections for hypotheti-cal scenarios reflecting how we think thesystem should look are useful primarilyfor comparison.

Supply: Definitions, Modeling Methods,and Trends in Supply DeterminantsSupply is typically quantified using both thenumber of licensed health professionals andthe number of full-time equivalent (FTE)

The Adequacy of Health Workforce Supply

professionals, where part-time workers arecounted as a partial FTE. FTE supplyestimates can be compared with demandestimates to assess the adequacy of supply.Modeling supply typically involves using aninventory model that starts with the numberof health professionals in a particular year,adds the number of health professionalsthat enter the workforce either as newgraduates or immigrants, and subtracts thenumber of health professionals who sepa-rate from the workforce. The end-of-yearsupply becomes the starting point for thenext year’s supply, with the process repeatedyear after year over the projection horizon.The major supply determinants include the

following:• The age distribu-tion of the workforce.Age is highly corre-lated with the prob-ability of working,average hours worked,and type of workperformed.• Number of newgraduates fromeducation or trainingprograms. Each newgraduate will likely

remain in the workforce for the next twoto four decades, so increases in educa-tional capacity have a cumulative effectover time on supply.

• The percentage of health professionalsthat are women. During the past twodecades an increasing number ofwomen have entered professionshistorically dominated by men. Onaverage, men and women have differ-ent workforce participation patterns andmake different choices regardingspecialty and practice setting (e.g.,choosing primary care over specialistcare in the case of physicians, choosingurban areas over rural areas).

• Lifestyle changes in hours worked.Anecdotal evidence suggests thatyounger health professionals prefer towork fewer hours than earlier cohorts.

• Retirement patterns. Health, satisfac-tion with the work environment,financial considerations (e.g., earnings,

“Making predictions

is risky business,

especially when it

involves the future.”

–Mark Twain


fluctuations in the stock market, medicalliability), and numerous other factorscontribute to a health professional’sdecision to retire.

Our projection models suggest that at thenational level FTE physician supply willincrease by 7-9% between 2007 and 2020(with substantial variation in growth acrossmedical specialties). Even if medical schoolswere to dramatically increase enrollment, itwould take six to ten years for these newphysicians to complete their education andresidency, and even more time before theincrease in new physicians would have asubstantive impact on overall physiciansupply. RN supply will likely increase by 3-6% between 2007 and 2020. Despite therecent sizable increase in graduates fromU.S. schools of nursing, a large number ofRNs are nearing ages typically associatedwith a reduction in hours worked andretirement. Pharmacist supply will likelyincrease by 25-30% between 2007 and2020. The number of graduates from U.S.schools of pharmacy has increased by 25%during the past 5 years and the annualnumber of new graduates is projected tocontinue growing. The current pharmacistworkforce is relatively young, so theproportion of pharmacists nearing retire-ment is smaller than for RNs and physi-cians. Changes in state and local cliniciansupply will vary substantially based on acombination of national factors and localcircumstances.

Demand: Definitions, ModelingMethods, and Trends in DemandDeterminantsRequirements for health professionals canbe broadly categorized as demand-basedestimates or needs-based estimates. De-mand typically is defined as the number ofhealth professionals required to provide thelevel of health services that will be utilizedby a given population, in the absence ofsupply constraints, based on projectedpatterns of health utilization and economicconsiderations. Need is defined based on anassessment of the ideal healthcare usepatterns and the ideal provision of care,usually as determined by a panel of clini-


cians and without regard to the economicconsiderations. While needs-based esti-mates tell us what might be ideal to maxi-mize the health of the population, demand-based estimates are of more practical use forworkforce planning purposes.

Most projection models take into consider-ation changes over time (or across geo-graphic areas) in one or more of the follow-ing: demographics, economic factors, thehealth operating environment, technology,government programs and policies, andother factors (e.g., public expectations,health-related behaviors):

• Growth and aging of the population.The U.S. Census Bureau projects thatthe nation’s population will grow byapproximately 12% between 2007 and2020, from 300 million today to 336million by 2020. The fastest-growingage groups are the 65 to 74 year oldpopulation (64% growth by 2020) andthe 75 and older population (24%growth by 2020).

• Economic factors. National andhousehold financial well-being influ-ence the comprehensiveness of medicalinsurance coverage, the generosity ofplans, and choices regarding the use ofhealth care services.

• The health operating environment.Payers continue to seek ways to makepatients and clinicians more costconscious and to encourage efficiency inthe delivery of services.

• Technology. Advances in science andtechnology have great potential to affectthe demand for healthcare services, buttheir impact is uncertain. Key trendsinclude: (1) emerging forms of commu-nication such as the internet,telemedicine, video conferencing, andtelesurgery; (2) minimally invasivesurgery that makes some proceduresmore accessible, speeds patient recov-ery, and shifts care from inpatient tooutpatient settings; (3) advances indiagnostic equipment that allowclinicians to provide more services butthat can also detect health conditionsearlier; and (4) advances in pharmaceu-ticals, vaccinations, genetic testing and


gene therapy, and transplantation.• Government programs and policies.

States and cities continue to seek waysto provide more effective and efficientmedical services to the uninsured andunderinsured.

• Public expectations. With the in-creased wonders provided by techno-logical advances, public expectationshave changed such that we want allhealth problems fixed.

• Population health-related behaviors.Trends such as reduced smoking andincreased obesity affect prevalence ofchronic conditions.

National projections from our modelssuggest that the demand for physicianservices will increase by 15-20% between2007 and 2020. Growth in demand willvary substantially by specialty, with special-ties predominantly serving the elderlyprojected to grow the fastest (e.g., 25%growth for cardiologists, 9% growth forgeneral pediatricians). Demand for RNs willlikely increase by 25-30% during thisperiod, as will demand for pharmacistservices. Changes in state and local demandfor health professionals will vary substan-tially based on changing demographics,economic growth, and other circumstances.

Conclusion and ImplicationsThe increased publicity given to projectionsof growing shortfalls of health professionalsfueled by changing demographics, economicgrowth, public rejection of the strictest formsof managed care, and other demand andsupply determinants has contributed to arenewed interest in health workforceanalysis. Recent growth in educationalcapacity will help alleviate (though probablynot eliminate) the projected shortfall ofhealth professionals in some occupations.Implications for individual health profes-sions vary, but major changes are in store forall segments of the healthcare workforce:

• National demand for physicians willcontinue to grow substantially fasterthan supply particularly for surgeonsand specialties providing care predomi-nately to the elderly.


• The growth of nurse practitioners hasbeen limited by the relative shortage ofregistered nurses and is unlikely to meetthe needs of a growing elderly popula-tion. The number of physician assis-tants is likely to grow several-fold overthe coming decades and autonomy issignificantly increasing.

• During the past few years wages forRNs have risen faster than wages inother occupations, the nation’s nursingschool capacity has increased, andapplications to nursing programs havesurged. However, a large number ofRNs are nearing retirement age.

• The nation has responded to theincreased attention given to the currentand projected growing shortfall ofpharmacists by raising wages andincreasing the number of graduates fromschools of pharmacy.

• Demand for other health profession-als—and in particular technicians andclinicians that provide services predomi-nantly to the elderly—will continue togrow at rates that exceed growth in theU.S. population.

Over the years, progress has been made inseveral areas with regard to health workforceanalysis. First, the body of literature regard-ing the theory, methods, and estimates ofkey supply and demand determinantscontinues to grow and improve. Second, datapertinent to modeling are more readilyavailable than ever before. Third, thedevelopment of forecasting models that canbe applied to the national and local levelmakes workforce modeling more accessible.Despite this progress, there remains debatewithin the research community regardingwhat could happen with key determinants ofclinician supply and demand, and whatshould happen with the way that health careservices are provided. 9,10,11

Disclaimer: The opinions expressed in thisarticle are those of the authors and do notnecessarily reflect the views of their respectiveinstitutions.



References

1 U.S. Department of Health and Human Services. Council on Graduate Medical Education. (2005).Sixteenth Report. Physician Workforce Policy Guidelines for the U.S. for 2000 -2020. Washington, DC.

2 Biviano, M.B., Dall, T.M., Tise, S., Fritz, M, & Spencer, W. (2006). What is behind HRSA’s projected supply,demand, and shortage of Registered Nurses? Report prepared for the Bureau of Health Professions, HealthResources and Services Administration. http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/index.htm.

3 Goodman, D. C. (2005). The physician workforce crisis: Where is the evidence? Health Affairs, 10.1377.http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.108v2.

4 Bane, F. (1959). Physicians for a growing America: Report of the Surgeon General’s consultant group on medicaleducation. Publication No. R709. Washington DC: US Public Health Service, Department of Health,Education, and Welfare.

5 U.S. Government Printing Office. Graduate Medical Education National Advisory Committee. April 1981.Geographic Distribution Technical Panel, 3. DHHS Publication No. HRA-81-651. Washington D.C.

6 U.S. Department of Health and Human Services. Council on Graduate Medical Education. (1996). EighthReport. Patient Care Physician Supply and Requirements: Testing COGME Recommendations. Washington, DC.

7 Weiner, J.P. (1994). Forecasting the Effects of Health Reform on the U.S. Physician WorkforceRequirements: Evidence from HMO Staffing Patterns. JAMA. 272: 222-230.

8 Dall, T., Grover, A., Roehrig, C., Bannister, M., Eisenstein, S., Fulper, C., & Cultice, J.M. (2006).Physician Supply and Demand: Projections to 2020. Report prepared for the Bureau of Health Professions, HealthResources and Services Administration. http://bhpr.hrsa.gov/healthworkforce/reports/physiciansupplydemand/default.htm.

9 Cooper, R.A., Getzen, T.E., McKee, H.J., & Prakash, L. (2002). Economic and Demographic Trends Signalan Impending Physician Shortage. Health Affairs. 21(1):140-153.

10 Grumbach, K. (2002). The Ramifications of Specialty-dominated Medicine. Health Affairs. 21(1):155-157.

11 Weiner, J.P. (2002). A Shortage of Physicians or a Surplus of Assumptions? Health Affairs. 21(1):160-162.

The National AHEC Bulletin will include advertising startingwith the Autumn/Winter 2007 issue.

Why not promote your product/service?

Advertising guidelines are posted athttp://www.nationalahec.org/Publications/NAOBulletin.asp.


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AHECs, Health WorkforcePlanning and AnalysisThomas C. Ricketts, PhD, MPH; Erin Fraher, MPP; and Jennifer King, BA

The end of the first decade of the twenty-firstcentury will likely see a shortage andmaldistribution of nurses, dentists, andphysicians. Pressure will grow to addresshealth workforce problems as attempts toachieve higher levels of patient safety andclinical quality are thwarted by the lack of realinterdisciplinary preparation.1 Without asignificant about-face by the Congress in itsattitude toward health workforce, the policyresponse to this general situation across thenation will depend on a distributed set ofdecisions made by states and professionalorganizations.

These decisions will likely be ill informedbecause of recent cuts to the capacity for healthworkforce analysis. Helping inform thesedecisions in a way that allows the viewpoints ofmultiple disciplines to converge on efficientand effective policies could become a taskassigned appropriately to Area HealthEducation Centers (AHEC) Programs. Thiswould challenge AHECs but they representthe only national program with an interdiscipli-nary focus and an implied responsibility forunderstanding the workforce needs of theirjurisdictions.2 Furthermore, many AHECsalready support this type of work.

Workforce Analysis in the United StatesThe Bureau of Health Professions (formerlythe Bureau of Health Manpower) only openeda section dedicated to workforce analysis in theearly 1990s. Prior to that, various componentsof the Bureau were involved in developingnational models for supply and need ofphysicians, dentists, and nurses. An extramu-ral program supporting regional researchcenters was authorized in 1998 but defundedin 2006. The Bureau also supported other

advisory groups to do supply and need analysis,including the Council on Graduate MedicalEducation (COGME), the National AdvisoryCouncil on Nurse Education and Practice(NACNEP), the Advisory Committee onTraining in Primary Care Medicine andDentistry, and the Advisory Committee onInterdisciplinary Community-Based Linkages.These advisory committees have generally notengaged in workforce analysis (with theexception of COGME) but have stuck to theiradvisory roles.3

Criticism of Title VII programs voiced by theOffice of Management and Budget (OMB) andthe General Accounting Office (GAO) wascombined with a recommendation that workforceanalysis be expanded and made more timely.4

The GAO complained that national estimates ofsupply and need for physicians were slow incoming and that the agency did not have thecapacity to track the impacts of the Title VIIprograms. The GAO recommended that bettersystems be established:

“In 2005, an HHS advisory councilstrongly recommended that the nationdevelop systems to track physicianworkforce supply, demand, anddistribution and undertake a compre-hensive reassessment within thefollowing four years to guide futuredecisions on medical educationcapacity. We are recommending thatHRSA develop a strategy and timeframes to regularly update andpublish national health professionsworkforce projections.”

There is a stated need for more information,but policy makers have rejected that advice.

Thomas C. Ricketts, PhD,MPH, is a Professor ofHealth PolicyAdministration at theUniversity of NorthCarolina Sheps Center forHealth Policy Research,Chapel Hill, NC.

Erin Fraher, MPP, is theDirector of the NorthCarolina HealthProfessions Data System atthe University of NorthCarolina Sheps Center forHealth Policy Research,Chapel Hill, NC.

The authors suggest that health workforce planning depends uponaccurate assessment. AHECs are well positioned to play a central role

in the development of workforce assessment strategies.


There are some state-supported centers andanalysis programs butfew with a truly interdis-ciplinary focus and fewerstill with any degree ofinstitutionalization.Exceptions include theworkforce analysiscenters at the Universityof Washington, the Iowa Center for HealthWorkforce Planning, The North CarolinaHealth Professions Data System, the Califor-nia Center for Health Workforce Studies, andthe New York Center for Health WorkforceStudies.5 Each of these works with itsrespective AHECs to a greater or lesserdegree; the Washington center is institutionallylinked to the Washington, Wyoming, Alaska,Montana, Idaho (WWAMI) AHEC and theNorth Carolina Center is directly funded by itsstate’s AHEC system.There are uniquesystems in place; forexample, in Georgia,the Georgia HealthWorkforce Collabora-tive is linked to itsstatewide AHECsystem but does notinclude physician data.This is a function of thepolitics of licensingboard jurisdiction,which often separatesdata collection and analysis.

Data for health professions policy making is oftenbased on a combination of profession-specificstudies and ad hoc reports in the states. Oneresource for physician studies is the Associationof American Medical Colleges (AAMC) Centerfor Workforce Studies (www.aamc.org/workforce). The AAMC Center has taken thelead estimating trends in national physiciansupply and need. Other groups have alsoadapted national data to support their positionsand proposals.6,7,8 Reports from discipline-specific groups have examined supply ofphysicians in cardiology, dermatology, geriatricmedicine, medical genetics, neurosurgery, andradiology. Many states have commissionedeither universities, agencies, consultants, orconsortia to examine medical, nursing, dentistry,

AHECs, Health Workforce Planning and AnalysisState W

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pharmacy, or otherprofessional supplyconcerns. In the lastthree years, Michigananticipated a physiciansupply problem; Missis-sippi State Universityreported on futureworkforce “challenges” inthat state; the Texas

Higher Education Coordinating Board issued areport warning of shortages; and a “Task Forceon Wisconsin’s Future Physician Workforce”identified a growing physician shortage.

Nursing uses the National Sample Survey ofNursing (NSSN), which is fielded by theBureau of Health Professions, Division ofNursing in HRSA to develop nationalsupply and need estimates. The NSSN isdeveloped by contractors and its methodol-

ogy is complex. Itpredicts growingshortages and allowsfor a range of interpre-tation as to the pre-ferred solutions.9

Beyond national andstate efforts, individualtraining programs havefelt the need to tracktheir graduates andassess their impact viastudies and analyses.

The rural-oriented family medicine program atJefferson Medical School in Philadelphiaassesses the effects of its program on supplyingrural physicians.10 There are multiple survey-and inventory-based studies of programeffects, but relatively few look beyond afive-year horizon or identify a specific policysolution, and most are costly to implement.

This paints a picture of a diffuse system forinformation for workforce policy. The nationaldata that are available are not analyzed at thelevel at which most health workforce policydecisions are being made: states and localities.Nor are the data sets designed for continuousmonitoring of federal programs that focus onthe underserved, specific professions, orregional or local variations in supply and need.3

Jennifer King, BA, is aResearch Associate at theUniversity of NorthCarolina Sheps Center forHealth Policy Research,Chapel Hill, NC.

There is a stated need for

more information, but

policy makers have

rejected that advice.

This situation represents

a large gap in the policy

making process - and

AHECs can fill that gap

by applying current

resources to workforce

analysis needs.


A Role for AHECsThis situation represents a large gap in thepolicy-making process—and AHECs can fillthat gap by applying current resources toworkforce analysis needs. Federal fundsshould be appropriated for this. The federalNational Center for Health WorkforceAnalysis (NCHWA) program of regionalworkforce centers met regional and state-level needs, but the coverage was notcomplete or necessarily appropriate for somestates. A joint effort among AHECs and theU.S. Bureau of Health Professions todevelop a collaborative, nationwide systemwith federal and state funds may providemore locally relevant analysis capacity, moretimely data, and more consistent and highSt

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quality analysis. Such an effort would haveto knit together organizations that have notalways cooperated, but joint funding withrequirements for data sharing and jointproducts and services could be managed.

The goal of such a program would be tocoordinate national data analysis activities withstate or local studies and projects. This wouldrequire the more timely production of nationalprojection models and the sharing of technicalskills, model assumptions, and data sets.However, given that there are multipleseparately funded systems and products, suchcoordination could result in substantial costsavings.

References

1Association of Academic Health Centers. (2006). The Policy Agenda to Expand the Health Workforce,Washington, DC.

2Weiner, B. J., Ricketts, T.C., Fraher, E.P., Hanny, D., & Coccodrilli, L.D. (2005). Area Health EducationCenters: Strengths, challenges, and implications for academic health science center leaders. Health CareManage Rev 30(3):194-202.

3 U.S. Department of Health and Human Services, Bureau of Health Professions. (2004). Effects of the WorkforceInvestment Act of 1998 on Health Workforce Development in the States. Washington, DC.

4Government Accountability Office. (2006). Health Professions Education Programs: Action Still Needed to MeasureImpact. Washington, DC.

5The Center for Health Workforce Studies, University of Albany, State University of New York. (2002). Stateresponse to health worker shortages: Results of a 2002 survey of states. Albany, NY.

6Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing andpatient mortality, nurse burnout, and job dissatisfaction. JAMA 288(16):1987-93.

7Cooper, R.A. & Aiken, L.H. (2001). Human inputs: The health care workforce and medical markets. Journalof Health Politics, Policy & Law 26(5):925-38.

8Cooper, R.A., Getzen, T.E., & Laud, P. (2003). Economic expansion is a major determinant of physiciansupply and utilization. Health Services Research 38(2):675-96.

9Buerhaus, P.I., Donelan, K., Ulrich, B.T., Norman, L., & Dittus, R. (2005). Is the shortage of hospitalregistered nurses getting better or worse? Findings from two recent national surveys of RNs. Nurs Econ23(2):61-71, 96, 55.

10Rabinowitz, H.K. & Paynter, N.P. (2000). The role of the medical school in rural graduate medicaleducation: Pipeline or control valve? Journal of Rural Health 16(3):249-53.


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ssessment

New York State AHEC System:Partner in Coalition to ReshapePrimary CareMary J. Sienkiewicz, MBA

In 2005, New York State established theCommission on Health Care Facilities in the21st Century that was charged with undertak-ing an independent review of acute care andlong-term care facilities. This review addressedthe capacity to assure that hospital and nursinghome facilities were configured to respond tolocal needs while promoting fiscal efficienciesand infrastructure stability.

Concerned that this drive to “right-size”hospitals and nursing homes would not takeinto account the primary care workforce (theCommission was not charged with addressingprimary care healthcare services), the New YorkState AHEC System provided testimony tothe Commission. “Facility closure withoutconcern for underserved communities,healthcare disparities, and care for theuninsured and underinsured, will underminethe goal for access to quality health care.Facility closure will need to take into accountaccess to primary care and ambulatory careservices provided by the health careworkforce in conjunction with long term andacute care facilities. Facility closure withoutconcern for the displaced skilled health careworkforce will also have a deleterious effecton local and regional economies.”

The Community Health Care Association forNew York State (CHCANYS), the statewideassociation of community health centers,testified, “We cannot successfully restructureour health care delivery system…withoutconsidering the central role that primary careplays at the front end of the health care system.Primary care…is key to addressing 1) dispari-ties in health status and access to health care;

2) the epidemic of chronic diseases, allpreventable, in underserved communities; and3) …rising health care costs by preventingexpensive and avoidable emergency room visitsand hospitalizations.”

Testimony was also provided by the PrimaryCare Development Corporation (PCDC), anorganization dedicated to expanding access toprimary care by providing capital and perfor-mance improvement programs in underservedcommunities. “Currently, New York’s primarycare sector is woefully underdeveloped.Primary care is the least expensive and mosteffective form of care.” PCDC recommendedstrategies to build adequate capacity, improvethe model of care, adopt health informationtechnology, and align incentives in the pay-ment system for primary care.

Similarities in the three organizations’testimonies and perspectives about thevalue of primary care resulted in the creationof the Primary Care Coalition in April 2006with a goal to establish primary and preven-tive care as an integral part of the state’shealthcare agenda.

The Primary Care Coalition’s first initiative wasto commission a policy paper, “Laying theFoundation: Health System Reform in NewYork State and the Primary Care Imperative,”prepared by Sara Rosenbaum, JD, andcolleagues from The George WashingtonUniversity School of Public Health and HealthServices. The report, equally funded byCHCANYS, PCDC, and the New York StateAHEC System, used state data to demon-strate the importance of strengthening and

Mary J. Sienkiewicz,MBA, is Associate Directorof the New York StateAHEC Systemand Research Instructor,Department of FamilyMedicine, School ofMedicine and BiomedicalSciences, University atBuffalo, Buffalo, NY.

An effort to consolidate and downsize healthcare facilities turned intoan opportunity to expand primary care capacity and develop the

primary care workforce.


expanding New York State’s primary carefoundation and its impact on reducinghealthcare costs, improving health outcomes,and reducing health disparities.

Over 100 leaders from government, business,health care, and other sectors, signed on to thePrimary Care Coalition’s letter to the Commis-sion requesting that it “make primary care afocal point of your discussions as you take onthe difficult task of determining how toimprove health care facilities in our state.”

The report and letter received media attentionfollowing press conferences in New York Cityand Albany, New York. Opinion editorials,letters to the editors, and meetings witheditorial boards of regional papers calledattention to the message that primary carereduces costs, improves healthcare outcomes,and reduces health disparities. A studycompleted by the New York State AHECSystem provided a ZIP code analysis ofprimary care workforce shortages.

In November 2006, thePrimary Care Coalitionachieved its initial goalwhen the Commission onHealth Care Facilities forthe 21st Century finalreport included the follow-ing recommendations for aprimary care reform agenda:

• Ensuring that all New York residents havea primary care “home.”

• Stemming the erosion of primary carecapacity.

• Investing in primary care infrastructure,including investment in facilities, equip-ment, and information technology.

• Ensuring adequate financial support tothe primary healthcare safety net.

• Gaining participation by all payors tosupport such investments.

• Investing in the development of a primarycare workforce.

New York State AHEC System: Partner in Coalitionto Reshape Primary Care

In his State of the State address, newly electedGovernor Eliot Spitzer noted, “Expandingaccess to health care will reduce state spendingsignificantly in the long run, because seeing aprimary care doctor costs far less than provid-ing charity care for the same patient in anemergency room.”

By 2007, the Primary Care Coalition hasexpanded to five principals, including the NewYork Chapter, American College of Physiciansand New York State Academy of FamilyPhysicians. The Primary Care Coalition’s goalsnow focus on policy agenda recommendationsto 1) reform the primary care payment system,2) retain and expand primary care capacity, 3)transform the model of primary care into aprimary care home, 4) invest in primary careinformation technology, and 5) develop theprimary care workforce.

Strategies have been developed for each of theagenda items. Workforce strategies of particu-lar interest to the New York State AHECSystem include recommendations for increasedfunding for scholarships, loan forgiveness, andrepayment programs; adequate funding ofGraduate Medical Education residencyprograms for training, regardless of practicesetting; and expanded AHEC and othercommunity-based initiatives including trainingof residents and medical students inunderserved areas.

What would have been a move to onlyconsolidate and downsize healthcare facilitiesturned into an opportunity to expand primarycare capacity and develop the primary careworkforce. This successful model can bereplicated throughout the country with state-specific messaging and policy recommenda-tions via networks and collaborations withprimary care associations, professional associa-tions, AHECs, and others. More informationis available at www.nyprimarycarehome.org.

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“In the middle of

difficulty lies

opportunity.”

–Albert Einstein


Oral H

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Concern is growing about whether the supplyof health professionals will be adequate tomeet demand in the near future. Objectivedata on trends in the supply of health profes-sionals can help to determine whether andwhere increased capacity is needed and thekinds of workforce policy options required toaddress workforce shortages.

The North Carolina Health Professions DataSystem (HPDS) is one resource for suchinformation. In partnership with the NorthCarolina Area Health Education Centers(AHEC) Program and 12 state licensingbodies, the HPDS maintains licensure files for19 health professions. The data system hasmany functions. Through consistent annualreports, analysts are able to monitor the supplyof health professionals and detect new trendsas they emerge. Further, state institutionsfrequently call on HPDS data when debatesabout workforce issues surface. Finally,workforce policy experience has enabledHPDS analysts to identify emerging issues inthe supply of unlicensed health professionals.

Program StructureThe HPDS, a research program at the Cecil G.Sheps Center for Health Services Research atthe University of North Carolina at ChapelHill, was initiated in the 1970s through a mixof federal and state funding, including anappropriation by the North Carolina GeneralAssembly to NC AHEC for the developmentof an information system to track the supply oflicensed health personnel (see Table 1). Whilefunding streams have come and gone, NCAHEC has consistently supported the HPDSover the past three decades. Today, many

HPDS projects are completed at the requestof, or in collaboration with, NC AHEC.

The backbone of the HPDS is a rich licensuredatabase that has been updated yearly since1979. Using data files voluntarily provided bythe licensing boards, the HPDS publishes theannual North Carolina Health ProfessionsData Book, a point-in-time snapshot of thesupply of health professionals in the state.This book and other HPDS publications arewidely used by policy makers, educators,researchers, the media, and health profession-als as the official source of health workforcestatistics in NC and are available on theHPDS website http://www.shepscenter.unc.edu/hp/publications.htm.

Monitoring Trends and Informing PolicyDebatesThrough this process, HPDS analysts are ableto identify trends that merit special attention.For example, based on data from 2000 to2004, researchers became concerned that therobust growth inphysician supplyrelative to popula-tion that NorthCarolina hadexperienced in thepast was coming toa halt. Thisrealizationprompted the NorthCarolina Institute ofMedicine toconvene a task forceto examine thestate’s physiciansupply.

Thomas C. Ricketts, PhD,MPH, is a Professor ofHealth PolicyAdministration at theUniversity of NorthCarolina Sheps Center forHealth Policy Research,Chapel Hill, NC.

Jennifer King, BA, is aResearch Associate at theUniversity of NorthCarolina Sheps Center forHealth Policy Research,Chapel Hill, NC.

The long-standing partnership between the North Carolina AHECsystem and the North Carolina Health Professions Data System (HPDS)demonstrates the benefits of workforce analysis and represents a successful

model that could be effective in other states.

Erin Fraher, MPP, is theDirector of the NorthCarolina Health ProfessionsData System at theUniversity of NorthCarolina Sheps Center forHealth Policy Research,Chapel Hill, NC.


Using HPDS data on physicians, physicianassistants, nurse practitioners and certifiednurse midwives, researchers projected thefuture supply of providers relative to theprojected growth in the North Carolinapopulation. The model allowed analysts to“test” the effects that a variety of policyscenarios would have on provider supply. Themodel revealed that, if nothing changes, thestate will face a decreased supply of providersin the near future (see Figure1).

The task force also focused on the need toimprove the geographic distribution of thehealthcare workforce and the need to increasethe number of providers from under-represented racial and ethnic groups. Datafrom the HPDS illuminated these issues.

The HPDS is also frequently called upon byinstitutions or groups when they wish to makethe case for a new policy or educationalprogram or when an issue related to healthprofessionals surfaces in public debate. Datafrom the HPDS are readily available—there isno need to undertake expensive one-timestudies—and equally accessible to stakehold-ers on all sides of issues.

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History of AHEC and University Collaboration forWorkforce Assessment

Highlighting New Areas of WorkforceResearchIn recent years, the HPDS has expanded itsworkforce analysis capacity to a sector of thehealthcare industry that faces pronouncedlabor shortages and opportunities for futuregrowth—allied health. Since the vastmajority of this workforce is not licensed,assessing the supply of these workers can beespecially challenging.

To address this challenge, the HPDS hasbegun an Allied Health Job Vacancy TrackingProject that tracks newspaper and onlineadvertisements to identify professions facingacute shortages and differences in the demandfor allied health professionals among the state’snine AHEC regions.

State policy makers are collaborating withHPDS staff and other leaders to developinnovative ways to transition unemployedindividuals into allied health jobs. The hope isthat these efforts will reduce workforceshortages, increase access to healthcare servicesand improve the economic outlook in the state’sneediest counties.

Table 1. Professions Included in North Carolina Health Professions Data System.

Health Professions Assessed


State Workforce A

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Figure 1: Projected Provider Supply, North Carolina.

Source: North Carolina Health Professions Data System and North Carolina Institute of Medicine.

Table 2. Total, Healthcare and Allied Health Employment, North Carolina.

Source: Bureau of Labor Statistics. Occupational Employment Statistics. State Cross-Industry Estimates: 1999-2005. URL: http://www.bls.gov/oes/. Accessed 06/28/2006.

History of AHEC and University Collaboration forWorkforce Assessment

ConclusionThrough a lasting partnership with NCAHEC and state licensing boards, the HPDShas developed an infrastructure that allows it toobjectively inform state health workforce policydecisions. The HPDS experience has demon-strated the benefits of sustained investments inworkforce analysis capacity and represents amodel that could be adapted by other states.

HPDS allied health workforce research hasdrawn the attention of state policy makerswho are looking for ways to address manu-facturing, textile, and furniture job losses inNorth Carolina. As evidenced by the rapidrate of growth in allied health employment(Table 2), this field represents an engine foreconomic growth.


Table 1. Characteristics of the Sample of Respondents (N = 341) (population size = 774).

Arkansas has significant workforce needs fornursing, medicine, pharmacy, and allied healthprofessions.1,2,3 Health workforce vacancy dataare essential for planning strategies to solvethe complex problems associated withshortages of health professions in hospitalsand other healthcare facilities.4,5 In addition,health workforce vacancy data are needed forcollaborative workforce planning and develop-ment efforts.

The Arkansas Area Health Education Center(AHEC) Program has assumed a majorleadership role in the assessment of current andprojected workforce shortages throughout thestate by administering a paper-based vacancysurvey which they mailed to all hospitals,nursing homes, mental health clinics, mentalhealth hospitals, county health departments,rural health and private clinics, communityhealth centers, and AHEC clinics in the state.The vacancy survey was sent to key informantsincluding human resources personnel, adminis-trators, and office managers between July 2002and October 2002. This study was based onthe reported budgeted current and cumulativeexpected vacancies for the healthcare facilities inthe sample (see UAMS, Rural HospitalProgram web site, http://rhp.uams.edu/

reports_publications/). Follow-up procedures fornonrespondents included three follow-up phonecalls and two mailings of the survey instrumentto nonrespondents. Response rates can be seenin Table 1. Each survey instrument wasassigned a code number to identify respondentswith their healthcare facility location. The codenumbers were used to link the healthcare facilitylocations to ZIP codes. The ZIP codes wereused to obtain the variable for AHEC regions inArkansas and to determine the county in whicheach healthcare facility was located. Data wereanalyzed in the Statistical Package for SocialSciences (SPSS) for summary statistics.

Results for the sample of respondents (N = 341)indicated that there were a total of 3,387 currentvacancies and 8,240 expected vacancies withinthe next five years for 79 health professions inArkansas. Nursing had the highest number ofcurrent vacancies (1,440) and allied healthprofessions had the highest number of expectedvacancies (4,499). The highest current andexpected vacancies found for health professions ineach of the four categories are included in Table 2.

Findings from the study present implications forclinical practice and health professions educationthat address the needs of a rapidly changing

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Ann B. Bynum, EdD, isAssociate Director of ProgramDevelopment of the ArkansasAHEC at the University ofArkansas for Medical Sciences,Little Rock, AR.

Charles O. Cranford, DDS,MPA, is Executive Directorof the Arkansas AHEC, andVice Chancellor of RegionalPrograms at the Universityof Arkansas for the MedicalSciences, Little Rock, AR.

Cathy A. Irwin, PhD, RN,is a Research Associate inthe Rural Hospital Programat the University ofArkansas for the MedicalSciences, Little Rock, AR.

Health Workforce Needs inArkansasAnn B. Bynum, EdD; Charles O. Cranford, DDS, MPA; and Cathy A. Irwin, PhD, RN

The Arkansas AHEC Program played a major role in the assessment ofcurrent and projected workforce shortages by conducting a comprehensive

statewide survey. Findings from the survey present implications forclinical practice and health professions education that may be used for

future workforce planning efforts throughout the state.


Health Workforce Needs in ArkansasState W

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Table 2. The Highest Current Vacancies and Expected Vacancies Within the Next Five Years forHealth Professions in Arkansas (N = 341).

healthcare industry. Inorder to meet thehealthcare challenges inArkansas, strong supportand collaboration fromcommunities, government,business, education, andthe healthcare industry areneeded. Innovativestrategies that take intoconsideration statedemographics, technologi-cal innovations, and thechange to a market-drivenhealth system must bedeveloped. This work provides a baselinedatabase for planning curricula and degreeoptions for the healthcare industry in Arkansas.The survey findings were communicated to thedeans and academicians at the University ofArkansas for Medical Sciences (UAMS), and tohealthcare administrators and key publicpolicymakers within the state. Results may be usedto plan strategies in clinical practice and healthprofessions education for addressing workforceshortages in Arkansas.

Rural healthcare systems face workforce issuesthat are as challenging as urban systems. Specificprograms for rural Arkansas need to be devel-oped with a focus on the strengths of the existingAHECs and the partnerships they haveestablished. Nontraditional delivery of specifictraining programs that are designed to meetexisting vacancies in local healthcare facilitiesshould be made available to rural residents whileallowing them to remain in their own community.

An individualizedhealthcare trainingprogram for ruralArkansans delivered bydistance education couldprovide a workforce tomeet specific healthcarevacancies that exist in agiven communities andmust improve existingprocesses to fit thepresent challenges.Mentoring programs,financial support,academic enrichment,

tutorials for admissions preparations, andmotivational programs can aid all students,particularly those from underserved areas.Professional opportunities such as apprentice-ships can expose students to health careers.Focusing on early and sustained education inhealth careers and flexible pathways thatfacilitate career development will help inpreparing a pipeline of healthcare professionals.

This study may serve as a model for AHECPrograms for the research methods used in theassessment of health workforce vacancies and forproviding a database for planning degree optionsfor academic healthcare institutions. Results fromstudies using this model may be employed todevelop health professions education programsin rural healthcare facilities that focus on theneeds of communities and establishing commu-nity/academic educational partnerships.

The authors thank Jimie Jarry, Research Assistant,from the UAMS Rural Hospital Program in LittleRock, Arkansas, for her assistance with datacollection for this study.

Findings from the study

present implications for

clinical practice and health

professions education that

address the needs of a

rapidly changing

healthcare industry.


Health Workforce Needs in ArkansasSt

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Table 3. Current Vacancies and Expected Vacancies Within theNext Five Years for Health Professions by Type of HealthcareFacility and AHEC Regions in Arkansas (N = 341).

References

1Guyton, R., Bynum, A., Cranford, C., & Irwin, C. (2000). Perceptions of health workforce needs and healthcaresystem trends among hospital administrators in Arkansas. pp. 9-12. Little Rock, AR: University of Arkansas forMedical Sciences, Regional Programs, Arkansas Area Health Education Center (AHEC) Program.

2U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau ofHealth Professions, National Center for Health Workforce Analysis. (2004a). The Arkansas health workforce:Highlights from the health workforce profile. Retrieved January 17, 2007, from http://www.bhpr.hrsa.gov/healthworkforce/reports/profiles/default.htm.

3U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau ofHealth Professions, National Center for Health Workforce Analysis. (2004b). HRSA state health workforceprofiles, Arkansas. Retrieved January 17, 2007, from http://www.bhpr.hrsa.gov/healthworkforce/reports/profiles/default.htm.

4American Hospital Association. (2002). Chartbook: Trends affecting hospitals and health systems, chapter 5,workforce. Retrieved January 17, 2007, from http://www.aha.org/aha/research-and-trends/health-and-hospital-trends/2003-or-earlier.html.

5U.S. Department of Health and Human Services, Health Resources and Services Administration. (2001).Nurse staffing and patient outcomes in hospitals, p. ii, Executive Summary. Rockville, MD.


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Expanded Role for AHECs:Providing Technical Assistancefor a Health ProfessionsWorkforce InitiativeSally Henry, RN, MA, FHCE

According to the Colorado OccupationalEmployment Outlook, significant increases indemand for health professionals are highlylikely throughout the state due to an increasingand aging population and a maldistribution ofhealthcare providers. Some counties have fewor no doctors, dentists, or mental healthproviders to serve their residents—especiallythe uninsured and underinsured and thosewith language or transportation barriers—evenin areas where healthcare providers areavailable. Out of 64 Colorado counties, 51 aredesignated as health professional shortageareas (HPSAs) and 45 are designated asmedically underserved areas (MUAs).

In 2005, the Colorado AHEC System wasselected to provide technical assistance (TA)and consultation services for the 21 granteesof the Colorado Trust’s (The Trust’s) three-year $10.2 million Health ProfessionsInitiative (HPI). The Trust awarded grantsdesigned to increase the number of primary,dental, and mental health professionals, aswell as nurses and pharmacists. Twenty-oneorganizations including hospitals, clinics,universities, and colleges are providingadvancement opportunities especially forindividuals from disadvantaged backgroundsand in rural areas. By stimulating partner-ships among community-based organiza-tions, schools and health professionals, TheTrust aims to help meet the statewidedemand for more health professionals.

As the HPI-designated TA provider, theColorado AHECs were assigned grantees intheir service regions and conducted focusedinterviews to identify needs. After interviews

were complete, AHEC program and centerdirectors met to identify overarching challengesthat affect multiple grantees and develop acoordinated plan of assistance. Uniquegrantee needs were addressed in individual-ized workplans that would be implemented byeach AHEC. This method created opportuni-ties for collaboration even as distinctive needswere honored. In general, needs fell into thefollowing categories: advancement of currentemployees, assistance with clinical placementof students, faculty development and capacitybuilding, student recruitment and retention,and program sustainability (see Table 1).

Selected interventions have included clinicalpreceptor coaching, dissemination of a healthcareer readiness tool for potential students,workshops on fund-raising and communityplanned giving, development of a resourcemanual of over 100 health professionsscholarships, assistance with strategies forrecruiting students, communication training,support for a clinical placement technologyproject, incentive strategists for clinical ladderstudents, identification of best practices for at-risk students, consultation on organizationalreadiness for change, and a workshop onconstructing tests.

Also included in the HPI management team isthe Center for Research Strategies (CRS), anindependent research and evaluation companyin Denver. CRS is focusing its evaluation ontwo program impacts: did the number of healthprofessionals in Colorado increase as a result ofthe initiative and what were the barriers andfacilitators that influenced this increase?Although the answer to these questions will

Sally Henry, RN, MA,FHCE, is Co-Chair of theNAO Editorial Board andExecutive Director ofCentennial AHEC,Greeley, CO.

The Colorado AHEC system provides new technical consultation services toenable communities to address local professional health workforce needs.


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etencynot be known until after the initiative’scompletion next year, many of the prelimi-nary findings of CRS have helped guide theAHECs. Of particular note is a recentsurvey of all grantees that has provided thefoundation for the upcoming Grantee Net-working Conference that focuses on programsustainability. After the conference, AHECtechnical assistance providers will follow upone-on-one with assigned grantees.

Expanded Role for AHECs: Providing TechnicalAssistance for a Health Professions Workforce Initiative

The synergy among the initiative’s manage-ment team members has enriched under-standing of the successes and challengesexperienced by individual grantee programsand is expected to strengthen both short-and long-term successes. Meeting regularlywith The Trust’s HPI program officer,AHEC and CRS staff share information,develop coordinated plans, and make jointsite visits as appropriate. As commonalities

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Table 1. Colorado Trust’s Health Professions Initiative.


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Expanded Role for AHECs: Providing TechnicalAssistance for a Health Professions Workforce Initiative

have been identified, integrated strategieshave been determined and shared amonggrantees, sometimes informally and some-times with a structured approach such as the“career ladder sub-group” series of confer-ence calls led by an AHEC facilitator.

This formalized support network, theInitiative Management Team approach,insures that HPI grantees have the re-sources needed to maximize The ColoradoTrust’s investment in the future of the state’shealthcare professionals. The combinedcapacity of foundation funders, AHECworkforce experts, and formal evaluatorslevels the playing field for small and noviceorganizations, and complements the skills ofthose with experience and deep resources oftheir own.

Finally, a high-powered statewide summit isbeing planned by the Management Team toprepare recommendations for Colorado’s2008 legislative session. Among others,invitees will include key members of the

governor’s office, the state legislature, andthe new Blue Ribbon Commission forHealth Care Reform, health professionsleaders from the state’s provider network,colleges and universities, public health andeconomic development agencies, federalagencies, other healthcare foundations, andconsumers. The resulting White Paper willserve as a guide for planning by policy makers,other organizations, and workforce centers.

While the workforce outcomes of the HealthProfession’s Initiative will not be known forawhile, it is already evident that this “AHECas technical expert” role can be considered apromising practice for others. Community-based centers with their local knowledgeand statewide presence along with programoffices that have access to universityexpertise are uniquely positioned to provideregional asset development in this consulta-tive manner—empowering communities tosolve their own problems and enhance thehealth of their residents.

Program DirectorConstituency Group

Fall Meeting - Nov. 15-16, 2007

Holiday Inn on the HillWashington DC

Agenda & Registration in September


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The Miami ComprehensiveModel for Health ProfessionsEducation: Pathway to DiversityAstrid K. Mack, PhD, and Asma S. Aftab, MD, MPH

For over 20 years, the University of Miami AHEC Program has partneredwith the Office of Minority Affairs at the University of Miami, Miller

School of Medicine to assist individuals from disadvantaged backgrounds insuccessfully applying to and graduating from health professions programs.

Through comprehensive pipeline programs, this collaborative “MiamiModel” has increased the number of disadvantaged individuals in healthprofessions schools, especially medicine, and increased the diversity of the

health workforce in the region.

Astrid K. Mack, PhD, is aResearch AssociateProfessor of Medicine andAssociate Dean forMinority Affairs,University of Miami,Miller School of Medicine,Miami, FL.

The major premise of The Miami Comprehen-sive Model for Health Professions Education(Miami Model) is that the primary cause ofminority underrepresentation in the healthprofessions is the scarcity of academicallywell-prepared disadvantaged applicants.We believe that leadership and collabora-tion are required among educationalinstitutions and community organizations toinsure that many more disadvantagedstudents are exposed to school, home, andcommunity environments in which intellec-tual excitement is fostered, high academicachievement is expected, interest in healthcareers is nurtured, and high career aspira-tions are encouraged. 1, 2

The ethnic and cultural diversity of Floridaand the local region has grown sharply in thelast decade, adding color and vibrancy to thearea, but also offering unique challenges forthe planning and delivery of health care.The 2000 Census figures reveal thatHispanics compose 17% and blacks 20% ofthe state population. In Miami-DadeCounty, Hispanics constitute 57% andblacks 20% of the population. This countyhas among the highest concentration ofHispanic people of any metropolitan area inthe country.3 Findings from a recentevidence-based report by the HealthResources and Services Administration(HRSA) indicate that greater healthprofessions diversity will likely lead to

improved public health by increasing accessto care for underserved populations.4

Racially, economically, and ethnically diversestudents are recruited by AHEC for careersin health care for several reasons. First, mostminority groups provide a relatively un-tapped source of health care personnel.“Healthy People 2010: National HealthPromotion and Disease Prevention Objec-tives,” by the United States Department ofHealth and Human Services, states, “...in-creasing the number of minority healthprofessionals is viewed as a partial solution toimproving access to care.”5 Several studies haveshown that underrepresented minority healthprofessions graduates are more likely to enterprimary care specialties and to voluntarilypractice in or near designated primary carehealth workforce shortage areas.6

The Miami Model was designed to increasethe applicant pool and build diversity in thehealth and allied health professions. The goalof the model is to provide students fromdisadvantaged backgrounds an opportunity todevelop the skills needed to successfullycompete for admission to and graduation fromallied and health professions schools, especiallymedicine. Some of the major barriers confront-ing disadvantaged students include:

• Educational Barriers: The individualcomes from an environment that has

Asma Aftab, MD, MPH,is an Assistant Scientist,Office of CommunityHealth Affairs, Universityof Miami, Miller School ofMedicine, Miami, FL.


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inhibited her/him from obtaining theknowledge, skills, and abilities required toenroll in and graduate from a healthprofession school.

• Economic Barriers: The individual comesfrom a family with an annual income at orbelow low-income thresholds according tofamily size, published by the U.S. CensusBureau.

• Other Barriers: As an outgrowth of theeducational and economic barriers, social,psycho-social, cultural, and geographicbarriers begin to take effect.

Through partnership agreements with thelocal school district, the schools of Arts andSciences and Medicine, the Miami AHEC,and several community-based partners, asequence of programs is offered that enablesdisadvantaged students to progress from onestage of the pipeline to the next.

The student recruitment process is verycomprehensive, targeting educationalinstitutions as early as the middle school andextending to college level. Science teachersand administrators at the high school leveland premedical/health professions advisorsat the undergraduate level are utilized toassist in the identification and selectionprocess. Participants are chosen on the basisof educational, social, and/or economicdisadvantaged status.

Core Program Offerings ContainedWithin the Miami ModelHIGH SCHOOLSummer Science Enrichment Program(SSEP). This program targets 10th gradestudents by improving their knowledge andskills needed to pursue health professions.Students attend P/SAT preparation courses;exploration of public health class, guestlectures, field trips, develop researchinterests, and write a research paper thatincludes a literature review of the topic.

Saturday Science Academy Program (SSAP).SSEP transitions into SSAP during theacademic year. Focus is on time management,classroom listening, note-taking, and strate-

The Miami Comprehensive Model for HealthProfessions Education: Pathway to Diversity

gies for improving reading skills; P/SAT review,and employability skills development.

Students Training in Research (STIR).Twenty 11th grade students engage inhands-on research under the tutelage ofUniversity of Miami mentors. A one-weekLaboratory Skills course is offered thatincludes Histochemistry and SeparationTechniques. The remaining six weeks arespent with the mentor, ending in a posterpresentation by each participant.

High School Careers in Medicine Work-shop. The curriculum for this programdesigned for 12th graders includes selectedtopics in human anatomy and physiology;cellular and molecular biology; languagearts; socio-cultural anthropology, andcomputer informatics. Opportunities areprovided for hands-on learning and in-depth experimental explorations. Parentsare also invited to evening seminars andpreceptor conferences.

FACILITATION OF ENTRY INTOCOLLEGEHealth Careers Motivation Program. Thisseven-week residential program that hasbeen in operation for over 30 years, exposesparticipants to instruction in abbreviatedsegments of representative basic sciencescourses in the medical education curriculum(gross anatomy with cadaver dissection,biochemistry, histology, immunology, along

Figure 1: Status of HCMP Participants1992-2003

(Continued on page 28)


NAO Re

The National AHEC/HETCnetwork lost a supporter from theU.S. House of Representatives withthe death of Charlie Norwood.Congressman Norwood was anAHEC champion in recent years,asking his fellow representatives tosign on to the Norwood-DeGetteletter in support of Title VII pro-grams.

Congressman Norwood was ahealthcare advocate in Congresssupporting patients and individualrights as well as health professions education. Hewas instrumental in healthcare reform for militaryretirees and veterans as well as patients-at-large.The former Army dentist was a co-author of KeepOur Promises to Military Retirees Act in 1999,which provided fully funded health care for life forthe national military retirees. Dr. Norwood was areformer of health care and education, introducingthe Patients’ Bill of Rights legislation andauthoring the Individuals with Disabilities Educa-tion Act Discipline Reform Amendment in 1999.

Dr. Norwood was a decorated Vietnam veteranserving in the U.S. Army Dental Corps, reforming

military dental practices and per-forming some of the first dentalsurgery on military guard dogs. Hewas one of the first participants inthe Army Outreach program thatdelivered dentists to forwardfirebases in lieu of transferringpatients to rear treatment areas andassisted in nondental trauma care inMASH units.

Dr. Norwood began private practicedentistry in Augusta immediately

after his discharge. During his dental career, heserved as President of both the Georgia DentalAssociation and the Eastern District DentalSociety, was a delegate to the American DentalAssociation, and was founder of the AugustaDental Disaster Society.

Dr. Norwood was also an outstanding athlete andplayed against Fran Tarkenton during high school.Congressman Norwood was elected to the Houseof Representatives in 1995 and served seventerms. He succumbed to his ongoing battle withidiopathic pulmonary fibrosis on February 13,2007. He was 65 years old.

U.S. Representative Charlie NorwoodTenth District, Georgia


emembers

Lynette G. JordanCalifornia AHEC ProgramLynette Jordan worked with theCalifornia AHEC Program officefor many years and was a formereditor of the National AHEC Bulle-

tin. She died in an accident at herhome on January 25, 2007.

Many in the AHEC network mayremember Lynette for her work onthe Bulletin. She became the editorin 1991 and remained the editor forthe publication until it transferred tothe Arizona AHEC Program in1995. Lynette worked tirelessly forboth the California AHEC Program and theNational AHEC Program. During her editorialtenure, Lynette worked with a board composed of“assertive, independent thinkers who were inti-mately involved in all aspects of the publication.”As the editor, her responsibilities were to makesure the articles were not simply conceived, butwritten by working with many policy makersaround the country. She had to make sure hercolleagues stayed on task but also had to assure

that their vision for each issue ofthe Bulletin was realized.

Lynette, along with Clark Jones,helped to shape the CaliforniaProgram during the early years ofthe AHEC, which also founded theWestern AIDS Education andTraining Center (now the PacificAIDS ETC) and the HETCprogram. Both programs went on toreceive federal funding separatefrom the AHEC.

Lynette was an avid horseback rider who, alongwith her daughter, competed at a national level -including the intricate dressage maneuvers. In herretirement, Lynette loved to travel with her hus-band, sing in her church choir, and play with hergrandchildren. Those who worked with Lynettewill remember her big smile and her kind heart.She is survived by her husband, Richard, daughtersMaya and Lyneia, and a granddaughter.


with a reading andstudy skills course and abioethics module).Workshops are pre-sented on the medicalschool admissionsprocess and participantsrotate through clinicalservices in all depart-ments at UM/JMHMedical Center.

The Health CareersMotivation Programbegan in 1976. Of the345 graduates of theprogram, 206 (60%) went on to medicalschool; 18 (5%) attended other healthprofessions schools; 49 (14%) were ingraduate school or post-baccalaureateprograms (most of whom were aspiring toattend medical school); and 57 (17%)graduates are working, mostly in some areaof science (see Figure 1). The HealthCareers Motivation Program has success-fully contributed to the entry of more than50% of its participants to medicine and morethan 30% of all others to a health or bio-medical science career.

MEDICAL COLLEGE ADMISSIONTEST (MCAT) PREPARATIONMedical College Admission Test (MCAT)Preparation Program. The MCAT Prep is aseven-week full-time nonresidentialprogram. This comprehensive reviewprogram consists of small classes thatinclude comprehensive science sessions inaddition to verbal reasoning and writing skilldevelopment programs. Students take fivefull-length Medical College AdmissionsTests with detailed diagnostic score reportsand a comprehensive set of course reviewand practice materials.

The comprehensive approach is extended tothe professional school level with theinclusion of academic enrichment activities

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and continuation ofstandardized test-taking strategies, aswell as a SummerInternship Program forrising second-yearmedical students inlocal Health Profes-sions Shortage Areaclinics and facilities.

Approximately 200students per year areselected to participatein structured programsthat strengthen theiracademic backgrounds,such that at least 85%

remain in the career path for one of thebiomedical or health sciences and at least50% apply to and are accepted to medicalschool. Apart from the basic medicalsciences, the curriculum also includesconcepts in cultural competency, bioethics,and community diversity.

Miami AHEC and the Office of MinorityAffairs at the Miller School of Medicineclosely collaborate with the AHEC, provid-ing recruitment and educational sessions forthe middle and high school enrichmentprograms and fully financially supportingthe MCAT Prep Program. The leadershipof the AHEC and Minority Affairs at theUniversity work in close collaboration toensure that program execution and out-comes are in line with the mission of AHECand the University.

Rationally connecting pipeline programs in afocused and disciplined fashion has enabledthe Miami Model to evolve into an effectiveand efficient means to obtain diversity inthe local healthcare workforce. Individually,each of the Model’s elements affordstargeted response and support for theregion’s disadvantaged youth. Integratedtogether however, the Model becomes apowerful and comprehensive pathway to acareer in health care.

Individually, each of the

Model’s elements affords

targeted response and

support for the region’s

disadvantaged

youth. Integrated together,

however, the Model

becomes a powerful and

comprehensive pathway to

a career in health care.

(Continued from page 25)


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References

1Sleeth, B.C., Mishell, R.I. (1977). Black Under-Representation in United States Medical Schools. N.England Journal of Med. 297:1146-8.

2Smedley, B.D., Stith, A.Y., & Nelson, A.R. (2003). Unequal treatment: Confronting racial and ethnicdisparities in health care. Committee on Understanding and Eliminating Racial and Ethnic Disparities inHealth Care, Board of Health Science Policy, Institute of Medicine. Washington, DC.

3U.S. Census Bureau Fact Sheet (2000). Washington, DC: U.S. Government Printing Office.

4U.S Department of Health and Human Services, Health Resources and Services Administration, Bureau ofHealth Professions (October 2006). The rational for diversity in the health professions: A review of theevidence. October 2006. Rockville, MD.

5U.S. Department of Health and Human Services. Healthy People 2010: National Health Promotion andDisease Prevention Objectives. Rockville, MD.

6Cohen, J.J (1995). Generalist in medical education. Academic Medicine, 70, (1, Supplement).


Graduating Class of 2006 Summer Science Enrichment Program.


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Program for High SchoolStudents in Rural OklahomaStephanie J. Payne, BA, MS

Rural HealthProjects, Inc.Northwest AreaHealth EducationCenter (RHP/NwAHEC), of theOklahoma AHECProgram, servesthe 19 northwestrural counties ofthe state. With atotal populationdensity of approxi-mately 20 peopleper square mileand a land mass of21,179 squaremiles, providing recruitment activities to thehigh school and junior high students is achallenge met by RHP/NwAHEC. RHP/NwAHEC partnered with Indianapolis forNursing 2000 and used their model for “ADay in the Life of a Nurse” to create the modelfor DIL in northwest Oklahoma. DIL is a fullday of intensive, one-on-one job shadowing ofa practicing health professional in a hospital orother facility.

In order to participate in this program, areastudents must submit a complete applicationthat inquires about cumulative GPA, allcoursework in science and math classes eithercompleted, currently taking, or plan to take, ashort explanation of interest in the program,and their future plans for education andemployment. Student applications are rankedbased on past and present course work andcumulative GPA. The higher-ranked studentapplications are more likely to be selected and

assigned to theirnumber one choicefor a preceptor.

At the beginningof the scheduledevent, all supervis-ing sponsors andstudents receiveHealth Informa-tion PrivacyProtection Act(HIPPA) training,an orientation tothe facility, and anintroduction totheir preceptor.

The preceptor is an essential determinant inthe experience for the student. As precep-tors are selected, these individuals areencouraged to be cheerleaders for theirprofession and serious mentors to theirassigned student. While students areshadowing their preceptors, they mustanswer a set of questions about thepreceptor’s career. Some of those questionsinclude: “What do you like/dislike aboutyour job?” “Why did you enter this profes-sion?” “What education was required forthis job?” and “How are problem-solvingskills used in this profession?” Within aweek of completing the program, studentsare required to complete a reflection formand submit it to their guidance counselorsfor review and possible discussion. Some ofthose questions on the reflection pageinclude: “What job-related activities did youobserve?” “What did you like best/least aboutthis profession?” “What surprised you most

Stephanie Payne, BA, MS,is the ProgramCoordinator for HealthCareers in NorthwestOklahoma AHEC, Enid,OK.

During orientation, students learned about patientprotection issues, such as HIPPA, and they learned aboutpersonal safety within the hospital.

“Day in the Life” pipeline activities take on several variations for theRural Health Projects, Inc./Northwest Area Health Education Center

partnership, yet each specific session affords students a targeted opportunityto explore a health career of their personal choice.


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about your experience?” and“Would you consider a career inthis field?”

At the conclusion of the DILprogram, students meet with thecareers recruiter for an intensivedebriefing session. Students discusstheir experiences, what theylearned about the job, what theylearned about themselves, highereducation requirements, andpossible preparation students couldbe making now for future careers.The students also complete anevaluation form for the program.Some student comments from arecent DIL include “I have to makesure to concentrate on my scienceclasses” … “Keep the job shadow-ing, it’s a good experience”…“Maybe now I will enjoy HumanAnatomy and Physiology class.” Allthe students who participated inthe DIL experience indicated astrong interest in continuing topursue a health career.

Since the development of DIL atRHP/NwAHEC in 2004, therehave been 13 DIL programs heldat a total of 10 different hospitals.Approximately 95 high school students haveparticipated, for an average of 14.2 hoursper student. Andy Fosmire, ExecutiveDirector of RHP/NWAHEC, stated, “theDay in the Life program is a great tool forour exploration students; it is so much morethan a simple job shadowing opportunity. Ithooks the students up with a mentor. Thegoal of the student after the job shadowingis to remain connected with long-termmentoring so that they can talk about reallife applications of the careers they areconsidering.” The RHP/NwAHEC willshare program information with otherAHECs across the country.

“Day in the Life” Shadowing Program for HighSchool Students in Rural Oklahoma

Two students learned how to use the microscope to look forabnormalities in the cells while they were in the lab.

Lessons learned include the fact that thesuccess of recruiting future healthcareproviders hinges on building relationshipswith both students and teachers. Peoplewant to be known and recognized by name –teachers want to be remembered when theycall in to schedule future events, andstudents want to be remembered as valuableparticipants. Employees of RHP/NwAHECwork diligently to make each interaction withtheir clients a meaningful one.


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ng Preparing Advanced PracticeNurses for Meeting RuralHealthcare NeedsSusan K. Rice, PhD, RN, CPNP, NCSN, and Sally Royston, RN, BSN, SANE-A, MSN

Susan K. Rice, PhD, RN,CPNP, NCSN, is theCoordinator of AdvancedPractice Nursing Programsat the College of Nursing,University of Toledo,Toledo, OH.

Sally Anne Royston, RN,BSN, SANE-A, MSN, is aFamily Nurse PractitionerStudent (at time ofmanuscript, now MSN) ;College of Nursing,University of Toledo,Toledo, OH.

As the need for healthcare professionals inunderserved areas has increased over time,academic programs have responded byproducing an increasing number and variety ofhealth professions students. Unfortunately,this has also resulted in an increasing demandfor clinical sites and preceptors resulting in astrain on available clinical preceptors and sites.The University of Toledo AHEC (UTAHEC) Program, in a cooperative effort withthe Advanced Practice Nursing (APN)Program of the University of Toledo, identifiedthis shared problem. Past attempts tocoordinate efforts of the two programs hadbeen unsuccessful, so a new approach to thechallenge was developed to increase thechances of success for the joint effort.

In August 2005, the UT AHEC and theAPN Programs developed a pilot projectinvolving the placement of adult, family, andpediatric nurse practitioner students into theestablished AHEC regions of northwest Ohio.Prior to establishing any framework for theprogram, guiding principles were set: 1)cooperation, 2) communication, and 3)commitment to success. The two programsagreed at the onset of the program to theseprinciples in order to maximize the chancesfor success.

Early in the development of the project, thedecision was made to build upon the strongfoundation of the UT AHEC Program. Theplacement of medical students is a provenprocess that has been developed and revisedover more than two decades. Each of the UTAHEC regions has an established network ofclinical sites and preceptors, which includes a

number of clinical preceptors who previouslycompleted AHEC rotations as medicalstudents. Established in 1979, UT AHEC hasplaced 6,623 medical students in 1) Bryan(BAHEC): 2,334 students; 2) Lima(LAHEC); 2,023 students; and 3) Sandusky(SAHEC): 2,266 students as part of theirclinical experiences. In the 2005-2006academic year, placements included 1)BAHEC: 125 students; 2) LAHEC: 102students; and 3) SAHEC: 136 students.

The UT AHEC/APN pilot project wasestablished to parallel this successfulmedical student placement process. Theshort-term goal was to provide nursepractitioner students with clinical experi-ences with underserved populations. Thelong-term goals were: 1) to develop thenetwork of AHEC preceptors; 2) to recruitprimary care providers for the AHECregions; and 3) to develop sites for interdisci-plinary placements of students. Following thepilot, the two programs would be able toevaluate its success with the intent of continu-ing and expanding the project into a long-termcommitment.

The project placed 13 APN students in theAHEC regions during the last clinical semester.Placing these students in clinical sites proved tobe challenging and required extensive time andcooperation between the UT AHEC and theAPN Programs. Unlike full-time medicalstudents, APN students were primarilyworking part-time. The efforts of the AHECCenters were essential to finding clinicalplacements and preceptors who could matchthe available schedules of the students. The

The University of Toledo AHEC and the Advanced Practice NursingProgram of the University of Toledo collaborate to assure an adequate

supply of quality interdisciplinary clinical preceptors and training sites.


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nurse practitioner students had limitedavailability due to their need for employment,so the critical need for supplemental fundingwas addressed by AHEC. Students were ableto obtain Student/Resident Experiences andRotations in Community Health (SEARCH)grants from the National Health Service Corps(NHSC) to support their clinical hours, thusdecreasing the need for full-time employment.AHEC-initiated activities proved to be animportant supportive step for the students byproviding them financial support during theirlast clinical semester.

The pilot project of APN students wascompleted in May 2006 with all 13 nursepractitioners completing the clinical require-ments of the AHEC rotation and their courserequirements. Of the pilot APN studentscontacted, 78% are currently working inmedically underserved areas.

The success of this pilot project was not byaccident, but was the result of the joint efforts

Preparing Advanced Practice Nurses for MeetingRural Healthcare Needs

of the two programs. The clinical preceptorsand sites were not specifically chosen to ensurethe success of the project. Rather, they werechosen because of their agreement to theguiding principles of the project. From theonset of the program, issues or concerns wereaddressed immediately though open communi-cation and cooperation. Both programs werecommitted to the success of the project as abuilding block for the expansion of thecollaborative relationship.

The successful pilot project has been ex-panded into the 2006-2007 academic year. Asit continues, efforts are being made to includeinterdisciplinary clinical placements in theAHEC regions. In the next phase, clinicalplacements will be made with medical andnurse practitioner students at the same sitesusing established clinical preceptors. It ishoped that through this expanded placementproject, the programs will be able to furtherwork toward achieving the long-term goals ofrecruiting and obtaining primary care providersfor the medically underserved areas.

L-to-r, BAHEC Preceptor, Dr. Clarence Bell, Jr., listens as UT Nurse Practitioner student,Sally Royston, presents a plan of care, while UT Clinical Advisor, Meredith McCombs,CNP, evaluates her presentation.


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ng Arkansas AHECs: Supplyingthe State with RadiologicImaging Sciences ProfessionalsJoseph R. Bittengle, MEd, RT(R)(ARRT); Stanley R. Olejniczak, MS, RT(R)(ARRT); and WilliamM. Pedigo, MPA, RT(R)(ARRT), RDMS

The University of Arkansas for MedicalSciences (UAMS), Department of RadiologicTechnology (now known as the Division ofRadiologic Imaging Sciences) accepted its firststudents in 1947 and was first accredited in1948, as a one-year training program with asecond year of “invitational experience.” TheUAMS graduated its first Bachelor of Sciencein Radiologic Technology candidates in 1974and its first Associate of Science candidates in1983. In 2005, the names of the degrees werechanged to Associate of Science in MedicalRadiography and Bachelor of Science inRadiologic Imaging Sciences. That same year,the name of the program was also changedfrom Radiologic Technology to RadiologicImaging Sciences.

The AHEC system is the most importantoutreach effort of UAMS to deliverhealthcare services and professional andcontinuing education to residents across thestate. With seven instructional centersacross Arkansas (El Dorado, Fayetteville,Fort Smith, Helena, Jonesboro, Pine Bluff,Texarkana), UAMS is able to provideeducational services to students in thehealth-related, medicine, nursing, pharmacy,and public health professions. Since eachAHEC serves a multicounty region, practiceopportunities among underserved and ruralcommunities are the hallmark of theUniversity’s outreach endeavors.

The UAMS College of Health RelatedProfessions (CHRP) is a statewide leader indeveloping its partnerships with the variousAHEC sites. The CHRP offers certificatesand degrees in 17 different professional

Figure 1. The location of the AHEC-SW and AHEC-NW, along with their respective service regions.

Stanley R. Olejniczak, MS,RT(R)(ARRT), is theProgram Director forRadiologic Imaging Sciencesat the AHEC–Northwest,Fayetteville, Arkansas.

Joseph R. Bittengle, MEd,RT(R)(ARRT), is theDivision Director forRadiologic Imaging Sciencesat the University ofArkansas for MedicalSciences, Little Rock,Arkansas.

William M. Pedigo, MPA,RT(R)(ARRT), RDMS, isthe Program Director forRadiologic Imaging Sciencesat the AHEC– Southwest,Texarkana, Arkansas.

A strong long-standing relationship among the University of Arkansas forMedical Sciences, the Arkansas AHEC system, and regional medical centerscreates a teaching/learning opportunity for Radiologic Imaging students in

rural and underserved areas, yielding consistently impressive results.

areas through 10 different academic depart-ments. The largest and second oldestprogram in CHRP is the Radiologic ImagingSciences program (formerly known asRadiologic Technology) with faculty andstudents housed in Little Rock, the AHEC-Southwest (AHEC-SW) in Texarkana, andthe AHEC-Northwest (AHEC-NW) inFayetteville.

Radiologic Imaging Sciences at theArkansas AHECThe Radiologic Imaging Sciences programsponsored at the AHEC-SW currently hasthree full-time faculty members and accepts15 new students each fall. With supportfrom Christus St. Michael Health Systemand Wadley Regional Medical Center inTexarkana, and Medical Park Hospital inHope, Arkansas, students receive a well-


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Table 1: A Comparison of the Radiologic Imaging Sciences Programs Sponsored by the AHEC-SW and AHEC-NW in Arkansas. Note: * Some graduates received both an AS and a BS degree.

rounded education. In 2002, an extensionof the diagnostic medical sonography(DMS) program was added to the list ofCHRP programs offered at the AHEC-SW.

The Radiologic Imaging Sciences programsponsored at the AHEC-NW currently hastwo full-time faculty members and acceptsnine students each fall. Washington RegionalMedical Center in Fayetteville, NorthwestHealth System in Springdale, and MercyHealth System of Northwest Arkansas inRogers provide significant financial and clinicalsupport to the AHEC-NW staff and students.In 2004, an extension of the DMS programwas added as an educational opportunity forstudents in northwest Arkansas.

Through their strong partnership with localhospitals, both AHEC programs providestudents with clinical experience usingstate-of-the-art imaging equipment inradiography, computed tomography (CT),magnetic resonance imaging (MRI), mam-mography, cardiac, and vascular studies.Since their inceptions, the RadiologicImaging Sciences programs sponsored at theAHEC-SW and AHEC-NW haveamassed some impressive statistics demon-strating a fulfillment of their mission toprovide radiologic science professionals for

Arkansas and their service regions. In fact,students at the AHEC programs outper-form on both the national and state radiog-raphy certification examination administeredby the American Registry of RadiologicTechnologists (ARRT). For the same period,the percent of individuals in the UnitedStates who took the ARRT averaged an89% pass rate (compared to 100% for theAHEC-SW; and 97.3% for the AHEC-NW). Similarly, for this same radiographyexamination, the average score for U.S. testtakers was 83.8 and 84.3 for all Arkansas testtakers (compared to 87.6 for the AHEC-SW;and 84.4 for the AHEC-NW).1

The FutureAccording to the U.S. Bureau of LaborStatistics, the need for more radiologicscience professionals will continue throughthe year 2014. It is estimated that anadditional 18-26% more qualified personnelwill be needed to meet the demand forradiologic imaging services, particularly asthe population of the nation, and Arkansasin particular, continues to grow and age.2

For the same time period, the ArkansasDepartment of Workforce Services projectsa 32.9% increase in the need forradiographers in the state.3

Program Profile


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References

1The American Registry of Radiologic Technologists, Annual Report of Primary Certification Examinations,2001-2006, http://www.arrt.org/index.html?content=examinations/examresults.htm, retrieved February 20,2007.

2Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition,Radiologic Technologists and Technicians, on the Internet at http://www.bls.gov/oco/ocos105.htm, retrievedFebruary 15, 2007.

3Arkansas Government, Department of Workforce Services, Long-Term Occupational EmploymentProjections on the Internet at http://www.arkansas.gov/esd/, retrieved February 15, 2007.

The future looks brightfor the RadiologicImaging Sciencesprograms at theArkansas AHECs.Both programs con-tinue to attract largenumbers of highlyqualified applicants.Through the dedicatedservice of our faculty,students can beassured of receiving aquality education, at an affordable price,and close to home. Graduates can feelcomfortable in the fact that they will be well

prepared to be success-ful on their nationalcertification examina-tions. Through ourstrong partnership withlocal hospitals, a steadyflow of practitioners intoclinical practice willcontinue to assure abountiful workforce.And, the citizens ofArkansas, particularly inthe underserved and

rural areas of the state, can rest assured thatthey will be able to receive the highest level ofradiologic imaging services.

Through our strong

partnership with local

hospitals, a steady flow of

practitioners into clinical

practice will continue to

assure a bountiful

workforce.


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Pam U. Joyner, EdD,MSPharm, is AssociateDean for ProfessionalEducation and ClinicalAssociate Professor for theUniversity of NorthCarolina School ofPharmacy, Chapel Hill,NC.

North Carolina’s PharmacyPartnership ProgramHuyla G. Coker, PharmD; Pamela U. Joyner, EdD, MSPharm; and Jennifer L. Robertson, PharmD

In 2002, a study mandated by the Universityof North Carolina Board of Governors andconducted by the University of North CarolinaSheps Center for Health Services Researchhighlighted an imbalance in the supply anddemand for pharmacists in North Carolina.Over 90% of counties in northeastern NorthCarolina are below the state’s average numberof pharmacists per 10,000 residents. There arecurrently several vacant pharmacy positions incommunity and hospital pharmacies in thearea. In fact, three local rural hospitals, servingmore than eight northeastern North Carolinacounties, currently have long-standingvacancies, some unfilled for more than a year.

The Sheps Center study indicated that theplacement of a pharmacy training program inan area with a known shortage, such as ruralnortheastern North Carolina, could increasethe likelihood of new practitioners remaining inthat region following graduation. The studyconcluded that a partnership program betweenthe University of North Carolina at ChapelHill (UNC-Chapel Hill) School of Pharmacyand Elizabeth City State University (ECSU),an historically black college/university(HBCU), would be an effective and cost-efficient means of addressing this shortage.

During fall 2005, the partnership betweenUNC-Chapel Hill and ECSU was launchedutilizing distance learning to increase thenumber of doctor of pharmacy (PharmD)graduates from the UNC system. Thisincreased the number of pharmacists in NorthCarolina from minority and underservedpopulations, stimulated economic develop-ment, and increased the pharmacy workforce innortheastern North Carolina.

Students on both campuses have the sameadmission requirements and follow the samecurriculum and progression guidelines.Classroom content is delivered throughsynchronous video-teleconferencing withinstruction originating from faculty on bothcampuses. To date, the Partnership Programhas admitted 23 ECSU-based PharmDcandidates. Recruitment efforts currentlytarget students from ECSU’s 21 county servicearea as well as minority students across NorthCarolina and the east coast. A newly estab-lished UNC-Chapel Hill Director of Recruit-ment and Diversity Initiatives will work toincrease PharmD minority recruitment for bothcampuses.

The North Carolina AHEC Program isintegral to the HBCU Program. Studentsenrolled in the PharmD program mustcomplete 10 months of experiential educationthrough the network of nine Area HealthEducation Centers throughout the state.These experiences are coordinated withAHEC faculty and the Professional Experi-ence Program (PEP) based at UNC-ChapelHill. PEP is a system of practice experiencesthat models the delivery of patient-centeredpharmaceutical care. More than 500 precep-tors in 275 sites across the state work withstudents to develop and improve practice skills.

Partnership Program faculty have establishedclose links with Eastern and Area L AHECfaculty and staff to expand pharmacy resourcesand opportunities in the region. Examples ofcollaboration include offering continuingeducation programs, developing strategies torecruit more preceptors and advanced phar-macy practice professional experience programsites for fourth-year students, and establishingan additional AHEC “sub-hub” to handle the

Utilizing state-of-the-art distance education technology and local trainingresources, the University of North Carolina School of Pharmacy, Elizabeth City

State University, and the North Carolina AHEC system partnered to establish aDoctorate of Pharmacy program for minority and underrepresented students.

Huyla G. Coker, PharmD,is Director of the PharmacyPartnership Program andAssistant Professor-ClinicalPharmacy at Elizabeth CityState University andClinical Assistant Professorfor the University of NorthCarolina School of Pharmacy,Chapel Hill, NC.


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increased numberof PharmDstudents filteringthrough the NorthCarolina AHECsystem. In thepast, pharmacists innortheastern NorthCarolina had totravel considerabledistance to attendAHEC-sponsoredcontinuing educa-tion (CE) programs. Eastern AHEC, UNC,and the Partnership Program have sponsoredfour well-received CE programs for licensedpharmacists and certified pharmacy technicianson the campus of ECSU. ECSU-basedpharmacy students are invited to all CEprograms. In addition to being in a moreconvenient location, the programs allowstudents and pharmacists to establish relation-ships that may encourage the students to stayand practice in the region after graduation.

Faculty from both campuses along withEastern and Area L AHEC staff haveevaluated current statewide faculty require-ments for PEP and have anticipated theincreased number of faculty needed due toenrollment expansion from the PartnershipProgram. Several pharmacy faculty positionshave been proposed and evaluation of potentialfunding sources is ongoing. Newly establishedpositions in the area are being developed with

North Carolina’s Pharmacy Partnership Program

special attention tothe needs of ruraland underservedpatients. A varietyof unique collabo-rations are beingpursued to meetpharmacyworkforce andhealthcare needs ofrural communitiesin the area.

Recruitment for two newly established facultypositions in northeastern North Carolina isunderway. Both positions are located in ruralnortheastern North Carolina counties (Bertieand Dare) and are jointly funded by UniversityHealth Systems, Eastern AHEC, and ECSU.Faculty filling these unique positions will serveas preceptors and will provide fourth-yearpharmacy students with a longitudinalpharmacy practice experience. The positionswill focus on continuity of care with roles inboth the inpatient and ambulatory carepharmacy areas. Pharmacists who fill thesepositions will work closely with physicians toprovide medication therapy managementservices with special emphasis on underservedpatients. It is anticipated that faculty will bebased in rural hospitals working with inpatientswith chronic diseases, especially diabetes.These positions will also have responsibilitiesin neighboring clinics to follow these chronicdisease patients both as inpatients and

Figure 1. Elizabeth City State University and UNC-Chapel Hill are located two hundred miles and three and ahalf hours from each other.

University of NC at Chapel Hill

• Second largest UNC systemcampus

• Oldest public university

• First students enrolled in 1795

• Total 2005 enrollment 24,325

• 71 bachelors’ programs

• 110 master’s & 77 doctoral programs

• Four professional degree programs

• 2005-06 PharmD cohort size 140

Figure 2. Campus profile comparison.

Jennifer L. Robertson,PharmD, is AssistantProfessor of ClinicalPharmacy at Elizabeth CityState University andClinical Assistant Professorfor University of NorthCarolina School ofPharmacy, Chapel Hill,NC.

Elizabeth City State University

• Second smallest UNC systemcampus

• Historically black university (HBCU)

• First students enrolled in 1892

• Total 2005 enrollment 2,664

• 34 undergraduate degrees

• Five master’s programs

• 2005-2006 PharmD cohort size 14


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outpatients. One of the goals of these uniquelongitudinal experiences is to have pharmacists“bridge the gap” between hospital andcommunity practice and serve to improve thecontinuity of care in these regions.

All fourth-year pharmacy students participatein a PEP seminar in conjunction with ad-vanced pharmacy practice experiences. Theaddition of 15 students in northeastern NorthCarolina will double the number of thesestudents in the Eastern AHEC as comparedto most other AHEC regions across the state.A proposal has been submitted for thedevelopment of an Eastern AHEC “sub-hub”located on the campus of ECSU. Faculty inthe “sub-hub” will facilitate seminars forstudents in northeastern North Carolina. Bylimiting the seminar size, the program will

North Carolina’s Pharmacy Partnership Program

insure that the value of the smaller, intimateseminar and mentoring environment withAHEC faculty is maintained.

The newly established partnership betweenUNC-Chapel Hill School of Pharmacy andECSU has already had a positive impact innortheastern North Carolina. However, thereis still much work to be accomplished in orderto meet the primary goals of the program.Collaborations between the two universities,the North Carolina AHEC system, and localand regional healthcare partners have startedthe program on a positive track. Furtherdevelopment of these relationships will assistin moving the program forward and lead to animproved supply of pharmacists and ultimatelyimprove the health care of patients in north-eastern North Carolina.


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When the Rappahannock Area HealthEducation Center (RAHEC) accepted a grantfrom the U.S. Department of Labor to giveSpanish-speaking persons access to tutoringwhile pursuing an education in a health-related field, the goal was to enhance thelearning experience of students who mayotherwise shy away from such educationbecause of the language barrier. The projectyielded one Certified Nursing Assistant(CNA), four Dental Assistants, and anAHEC office that better understood thechallenges and triumphs of running anoutreach program across cultural lines.

RAHEC serves the Northern Neck, a ruraland historic region of Virginia known forseafood, agriculture, and vineyards. It is alsohome to many poor, medically underservedminorities who lack medical and educationalresources found in urban areas. As the area’sworkforce begins to retire, farmers and localbusiness owners have begun to depend heavilyon seasonal and migrant workers from Mexicoand other Spanish-speaking countries to stafftheir businesses. The influx of these workersand Mexican-Americans who have perma-nently relocated to the area prompted theRappahannock Area Health Education Center(RAHEC) to reach out to Hispanics with helpfrom a $25,000.00 grant from the U.S.Department of Labor. This grant allowedRAHEC to partner with the Area XIII BayConsortium Workforce Investment Boardthrough the Fredericksburg WorkforceCenter and the Warsaw Virginia EmploymentCommission (VEC) Workforce Center/Northern Neck One-Stop Center to offertuition assistance and tutoring services to fiveSpanish-speaking women who wanted topursue education in a health-related field.

The tutoring project was the second Hispanicoutreach program for RAHEC. The MaryWashington Hospital Foundation fundedVecinos Ayudando a Vecinos (Neighbors HelpingNeighbors) in 2004. This made it possible forthree classes of Spanish-speaking lay healthworkers to join RAHEC’s successful Commu-nity Health Education and Development(CHED) Program. Community HealthPartners (CHPs) complete 25 hours of trainingon chronic disease and are trained to take bloodpressure and blood glucose readings, enablingthem to provide outreach in their neighbor-hoods and communities. RAHEC soondiscovered that trust is a factor when reachingacross cultural lines. The lay health workermodel works especially well in cases whereCHPs speak the same language or are from thesame ethnic background as the clients theyserve. The close-knit nature of the area’sHispanic community helped RAHEC recruitfor both programs as word spread about theseoutreach efforts.

Finding Limited English Proficient (LEP)students seeking healthcare training was achallenge. When the project began, theintention was that the VEC One-Stop Centerwould refer potential students to the program.Four of the five graduates were recruited intothe program as a result of their participation inthe CHP course. The fifth student contactedRAHEC as a result of a press release pub-lished in a local paper. Not everyone who wasinterested in the program qualified for tuitionassistance through VEC, which had stringentrequirements regarding income and legalresident status. The Project Coordinator soondiscovered the cost was a barrier for students,while scheduling was another. Potentialparticipants were concerned that work in somehealth-related fields yield the same pay they

Kathleen D. Watson, MS,is a Community HealthEducator and theCommunity HealthEducation andDevelopment (CHED)Project Coordinator for theRappahannock AHEC,Warsaw, VA.

Rappahannock AHEC expands the underrepresented minority healthprofessions workforce by providing comprehensive training for students

with Limited English Proficiency.


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were alreadyreceiving doingfarm work.Many coursetimes interferedwith potentialstudents’responsibilitytoward family,farm work, orother obligations.The traditionalsemester formatof some programsalso interferedwith extendedtravel to Mexicoover the winterholidays, which is practiced by many localMexican-Americans.

During the first semester of the LEP tutoringproject, Maria Luna Lewis, a graduate of theHispanic Community Health Partners course,was the first recipient of tutoring while shecompleted CNA courses at the local commu-nity college in 2005. She currently works at anarea assisted living facility.

The second group of four students consideredseveral program options and decided to pursuedental assistant training in the spring of 2006.The program that they enrolled in made specialprovisions for them by forming their own classand allowing the tutor to attend. All fourstudents completed the nine-week program.Three of the women came to the United Statesfrom Mexico knowing little or no English. Priorto enrolling in the dental assistant program theyhad studied English with a local volunteer whoadvocates for area Hispanics. One student, IrisChagolla, had taught kindergarten in Mexicobefore coming to the United States. Prior tocompleting the course she began working ina local community health center’s dentalclinic scheduling appointments and assistingwith translation. She became one of twofull-time dental assistants at the clinic uponher graduation. She continues to work at theclinic and hopes to become a dental hygien-ist in the future.

LEP Students Gain Skills, Join Workforce

The tutor is thekey to programsuccess. The jobtitle “tutor” doesnot begin to coverall responsibilitiesthat came withthis position.WendyGonzalez, anative Spanishspeaker fromGuatemala,joined RAHEC’steam as abilingual tutor.She looked foreducation

programs that would accept LEP students andallow a tutor to attend their classes. Wendynot only offered assistance with course workbut also helped students navigate the applica-tion process at both the VEC and the schools.During the dental assistant course, sheattended classes to translate materials andclarify information. This proved very helpfulespecially when terminology did not translatefrom Spanish to English directly, which is acommon problem when working in twolanguages. Ms. Gonzalez also spent time withthe students outside of class, devoting severalhours per week to individual and grouptutoring sessions.

The collaboration between RAHEC, the VECOne-Stop centers, and the schools, madepossible by funding from the Department ofLabor, impacted RAHEC’s service area inseveral ways. First, LEP persons completedtraining preparing them to work in a healthprofession in a region designated as an HPSA.Through their work with a tutor, the studentswere not only able to pass their courses, but italso improved their proficiency in English.Furthermore, RAHEC’s staff memberslearned about the special needs and concernsof their local Hispanic community. Interactingwith this population and hiring Spanishspeakers enabled the organization to betterunderstand facets of the Hispanic culturesuch as their work ethics and values.RAHEC looks forward to putting theselessons learned to use in future projects forthe area’s Hispanic community.

Iris Chagolla and Maria Torres. Back (left to right): InstructorNicole Lewis, Ana Jamison, Instructor Barbara Brierton, VeronicaBanuelos, Cheryl Alderman-Virginia Employment Commission.


Preparing Future Dentists inKentucky: Something to SmileAboutSherry C. Babbage, DMD; Lee S. Mayer, DMD; and Margaret Mahaffey, MEd

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As oral health has become increasinglyimportant as an index of the general health ofthe United States, there has been an increasein demand for dental services. Access-to-careissues related to the maldistribution of dentalproviders, socio-economic and culturalvariables have now become a concern. Thelack of available dental care results in anunnecessary loss of teeth, lost work days,poor job opportunity/advancement, and lowself-esteem.

Research indicates that dental students fromrural/underserved areas are more likely thantheir urban colleagues to return to these areasto practice, helping to alleviate access-to-careissues. In order to increase interest in den-tistry, the University of Louisville School ofDentistry (ULSD) introduced the Preview toDentistry/Biology 396 course in 1999. Thiscourse was modeled after a similar programoffered at Brigham Young University in Utah.The aims of the course were to introducedentistry as a career, connect students to theadmissions process, and introduce the manyfacets of a dental career.

The class was financially supported by theSchool of Dentistry through 2005. However, in2006, a Health Education and TrainingCenter (HETC) grant from the U.S. Depart-ment of Health and Human Services began tofinancially support the course. Prior toelimination of HETC funding, plans were inplace to extend the course to three Kentuckyuniversity satellite sites. Motivation for thiswas the trend in most college-bound studentsfrom rural areas to attend the regional statecolleges. Fortunately, Bellarmine Universityand Indiana University Southeast introduced

Biology 396 in 2006 and Spalding Universityin 2007. This has also led to the establishmentof the Pre-Dental Society at UofL.

The didactic portion of the course includeslectures by ULSD faculty on aestheticdentistry, cariology, dental demography, dentalmaterials, dental research, endodontics, grossanatomy, implantology, oral microbiology,pathology and surgery, orthodontics, pediatricdentistry, periodontics, public health, ruraldental health, and sports dentistry. It reliesheavily on dental educators sharing theirexperience with the Preview to Dentistrystudents. The course content includesinformation on summer study programs atUofL, DAT training programs, culturalcompetency, and counseling for applying todental school. Students also engage in abstract-ing dental articles, volunteering (SmileKentucky), and hands-on experiences, such aswaxing, alginate impressions, and compositeveneers. This adds up to a truly uniquelearning experience.

Students must also complete 10 hours ofclinical observation with a minimum 3 hours incommunity-based AHEC clinics. Coursegrading is based on exams, a community basedexperience, written journal abstracts, class/labparticipation, and clinical observation.

Since 1999, 180 students have enrolled, andonly two have withdrawn. Of these predentalstudents, 41 have graduated ULSD, 10 ofwhom practice in areas consideredunderserved. Fifty-three of the 180 arepresently enrolled in ULSD and 2 at Univer-sity of Kentucky College of Dentistry (UKCD).Two of the predental students who enrolled in

Lee S. Mayer, DMD, isDirector of CommunityDental Health at theUniversity of LouisvilleSchool of Dentistry,Louisville, KY.

Margaret Mahaffey, MEd,is Associate Director of theKentucky AHEC Program,University of LouisvilleSchool of Medicine,Louisville, KY.

Sherry C. Babbage, DMD, isCoordinator of Admissionsand Minority Recruitmentat the University ofLouisville School ofDentistry, Louisville, KY.

The University of Louisville and the University of Louisville School ofDentistry introduced a Preview to Dentistry undergraduate course that

aims to stimulate interest in a career in dentistry.


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ULSD have dropped out and two others havebecome dental hygienists. Overall, greater than55% have confirmed dental careers.

SummaryThe value of such a course might best beexpressed by one of the faculty at the school ofdentistry:

“I believe the course has a tremen-dous impact on a student’s decisionconcerning a career in dentistry. Itseems to confirm for many studentstheir decision for dentistry as aprofession as well as offer otherstudents a better opportunity to makean informed decision.”

Preparing Future Dentists in Kentucky: Something toSmile About

The success of Preview to Dentistry/Biology396 has demonstrated the value of a coursecontaining meaningful and relevant content toprospective dental students. The course hasserved as an important tool at the University ofLouisville in recruiting predental students toenter the School of Dentistry. Over half of thestudents attending this course in the last sevenyears have pursued dental careers. Althoughelimination of federal HETC funding hasprevented the expansion of the coursestatewide, the course is now being offered onseveral other college campuses in the Louisvillemetropolitan area. Hopefully, funds will beidentified to expand the course to othercampuses throughout the state in order tocreate a stronger interest in dentistry amongstudents from rural areas of Kentucky.

AHECs and HETCs...

Connecting students to careers,

professionals to communities,

and communities to better health.


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Rural Physician AssociateProgram: Building on a Modelof SuccessGwen Wagstrom Halaas, MD, MBA, and Angela Bowlus, MA

The American College of Physicians warnsthat primary care may not survive.1 The impactof this shrinking resource will affect rural,American Indian, and other underservedcommunities significantly. This lack of primarycare physicians results in poor health.2 TheRural Physician Associate Program (RPAP) isa rural clinical training program established in1971 through support from the Minnesotastate legislature to address a shortage ofprimary care physicians in rural Minnesota andhas been supported in part by MinnesotaAHEC since 2002. RPAP is an electiveprogram to which third-year medical studentsapply and are accepted for a nine-monthrural clinical experience. Thirty to 40students are placed each year in Minnesotacommunities that range in population sizefrom 1,000 to 30,000. Since 1971, 110Minnesota communities have been RPAPsites, and 1,127 students have completedthe program with at least 892 formerstudents currently in medical practice.3

RPAP students are taught clinical skillsincluding communication, physical examina-tion, differential diagnosis, clinical decision-making and management by physicians ofmany specialties in the RPAP communities.4

The learning experience is coordinated by aprimary preceptor who is most often in familymedicine. They are supervised and monitoredby faculty of the RPAP program and theyreceive additional teaching from specialtyfaculty members from five departments in theUniversity of Minnesota Medical School andby three residency programs in Duluth,Mankato, and St. Cloud. Students gain

experience with electronic medical records anddigital radiography; they participate in qualityimprovement and community health improve-ment projects to better understand healthcaresystems and the business of health care; theyare exposed to innovative care such asrobotic surgery and new applications oflaparoscopic surgery; and they participate indisaster triage and routine transfers of careby helicopter and ambulance.

There are 892 graduates of the RPAP programto date. Sixty percent of these graduates arecurrently practicing in a rural area. Comparedto a national rate of 34%,5 78% of RPAPgraduates practice in primary care as defined asfamily medicine, medicine, pediatrics, andmedicine/pediatrics. Of the 709 who practiceprimary care, 64% are practicing in ruralcommunities. The majority of the remaining22% practicing in specialties are in emergencymedicine, obstetrics and gynecology, or generalsurgery. Thirty-nine percent of these specialistspractice in rural communities. Sixty-fourpercent of the RPAP graduates (575 physi-cians) currently practice in Minnesota and 361physicians (63%) practice in rural Minnesotacommunities.

Many of the existing rural education programswere modeled after the RPAP programincluding programs in Australia and Canada.Frequent contacts are made from existing anddeveloping programs for advice and information.The Carnegie Foundation for the Advancementof Teaching visited the RPAP program in 2006at the suggestion of other programs in thepreparatory work for the upcoming report on

Gwen Wagstrom Halaas,MD, MBA, is Director ofthe Rural PhysicianAssociate Program andAssociate Director of theMinnesota AHEC,Minneapolis, MN.

Angela Bowlus, MA, isProgram Manager of theMinnesota AHEC,Minneapolis, MN.

Minnesota AHEC supports a very successful nine-month ruralinterprofessinal training experience. 60% of graduates are currently

practicing in rural areas and 78% are in primary care.


Residency Fellowship

medical education forthe twenty-firstcentury.6

Since its inception in2002, the MinnesotaArea Health Educa-tion Center (AHEC)has been an importantpartner of the RPAPprogram. Through theMinnesota AHEC,RPAP studentsreceive housingstipends that help thestudents stay in arural community foran extended period oftime. RegionalAHEC office staffprovides RPAPstudents with communityhealth experiences andeducation and also helpsprovide communitypreceptor development.Additionally, MinnesotaAHEC facilitated severalRPAP communitiesreceiving funding throughMinnesota EducationResearch Costs (MERC)to support the develop-ment of interprofessionaleducation teams aroundlocally identified healthissues based on severalRPAP students’ commu-nity health assessmentprojects.

In addition, the Minnesota AHEC partneredwith the University of Minnesota AcademicHealth Center to provide MERC funds toMinnesota communities to developinterprofessional education experiences. Theintent of the Interprofessional Practice andEducation Development Program is tostimulate long–term partnerships betweenUniversity faculty and community-basedhealthcare providers in rural interprofessionalpractice. Four communities received grant

Minnesota AHEC and the Rural Physician AssociateProgram: Building on a Model of Success

Figure 1. Rural Physician Associate Program.

The numbers of former RPAP students currently practicing in Primary Care andNon-Primary Care specialties nationally, in Minnesota and in rural Minnesota.

One of our RPAP communities is Winona, Minnesota, along the mightyMississippi River.

funds in 2004 and 2005. These projects haveinvolved teams of different health professionalsaddressing issues such as obesity, diabetesmanagement, access and cultural issues of carefor immigrant populations, and geriatric riskassessment and falls prevention. The Com-munity Health Assessment Projects done byRPAP students have resulted in six additionalcommunities receiving MERC funds in 2007for the development of interprofessionaleducation.


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References

1American College of Physicians. (October 30, 2006). College warns of looming collapse of nation’s primarycare. ACP Observer. Retrieved February 26, 2007, from http://www.acponline.org/journals/news/oct06/washington.htm.

2Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health.Milbank Quarterly, 83, 457-502.

3Halaas G.W. (2005a). The rural physician associate program: Successful outcomes in primary care and ruralpractice. Rural & Remote Health, 5, 453. Retrieved February 26, 2007, from http://www.rrh.org.au/articles/defaultnew.asp?IssueNo=5x.

4Halaas, G.W. (2005b). The Rural Physician Associate Program: New Directions in Education forCompetency. Education for Health, 18(3), 379-386.

5Green, L.A., Dodoo, M.S., Ruddy, G., Fryer, G.E., Phillips, R.L., McCann, J.L., (2004). The physicianworkforce of the United States: A family medicine perspective. Washington, D.C.: The Robert GrahamCenter. Retrieved February 26, 2007, from http://www.graham-center.org/PreBuilt/physician_workforce.pdf.

6Cooke, M., Irby, D.M., Sullivan, W., & Ludmerer, K.M. (2007). American medical education 100 yearsafter the Flexner report. New England Journal of Medicine, 355(13), 1339-1344.

RPAP students Deborah Hatanpa and Timothy Hindbjorgen try toevaluate a crying baby and counsel a frustrated mother during asimulated encounter.

Minnesota AHEC willcontinue to partner with theRPAP program to supportRPAP students in ruralcommunities and to supportinterprofessional students inexperiential learning opportuni-ties developed in RPAP sitesand other communities. Theselearning experiences willinvolve students as members ofinterprofessional practice teamsaddressing specific healthissues in these communities.The goal is to attract and retainhealth professionals in ruralcommunities by activelyinvolving them in successfulinterprofessional teams thathave a positive impact on thehealth of the community. The success of theRPAP program in providing primary carephysicians for rural Minnesota can be trans-lated into changing practice and healthcareservices for the future to address healthcareneeds of Minnesota.


Residency Fellowship

A “Win” All Around: NewWomen’s Health FellowshipBenefits ManyLenny Salzberg, MD

First the good news: The results of the 2006National Resident Matching Program (NRMP)reflect a currently stable level of studentinterest in family medicine residency training inthe United States.1 A stable level of interest isbetter than the declining level of interest wehave seen for 10 of the last 11 years.

Now the bad news: Only 38.3% of first-yearfamily medicine residency positions were filled in2005 with medical students who graduated fromU.S. medical or osteopathic schools within theprevious year.2 This means that roughly two-thirds of positions were filled with internationalmedical graduates or physicians who were out ofmedical school for at least a year for some reason.This situation has led to competition amongresidency programs for the few American medicalstudents choosing Family Medicine.

There are many reasons it is difficult to fillFamily Medicine residency slots with Americancandidates. Many of these reasons – such aslifestyle issues and educational debt - are out ofour control as educators. One issue that is inthe sphere of influence of educators andAHECs is the desire of students to have theoption of participating in advanced trainingupon completion of their residency. Familymedicine has two accredited fellowship options:Geriatrics and Sports Medicine, both of whichlead to a Certificate of Added Qualification(CAQ). There are several unaccreditedfellowship options available, and these meetdifferent needs in different locations.

Southern Region AHEC (SR AHEC) is themost rural and the most underserved of thenine AHEC regions in North Carolina. Oneglaring area of need in this region is for

providers who can holistically care for women.Graduates of Family Medicine residencyprograms frequently are the first point ofcontact for women patients and in many casesthe only physician who will provide care forthese women, especially in rural orunderserved areas. Although there is formaltraining in all Family Medicine residencyprograms in obstetrical care, there frequently isnot enough patient volume for graduates tofeel confident in these skills. There are ahandful of primary care Women’s HealthFellowships in the country that provide thistraining. Women’s Health Fellowships provideadditional experience and training so thatgraduates can expertly provide these necessaryservices in remote or underserved geographicallocales. The existence of this fellowship at aresidency program site makes the residencymore attractive to U.S. medical students, manyof whom are reluctant to limit their optionswhen choosing a career. They want fellowshipopportunities, and SR AHEC has identified away to provide these opportunities.

The Women’s Health Fellowship at SRAHEC has two components that make itunique. In addition to delivering dozens ofbabies, doing hundreds of colposcopiescryotherapies, each Fellow receives leadershipand faculty development training. Theleadership training is done in conjunction withthe Wildacres Leadership Initiative, based inNorth Carolina, and includes readings,discussions, and interaction with the WilliamC. Friday Fellows for Human Relations. ThisFellowship is awarded to 20-25 outstandingyoung North Carolinians who have demon-strated a commitment to serving their commu-nities. Fellows learn the leadership model

Lenny Salzberg, MD, isAssociate ResidencyDirector of the SouthernRegional AHEC FamilyMedicine Residency,Fayetteville, NC.

Introducing a Women’s Health Fellowship Program into the SouthernRegion AHEC Family Medicine Residency increased residency applications

by 50% and expanded quality services to communities of need.


taught at the John F. Kennedy School ofGovernment at Harvard University and learnto lead in the real world by developing theirskills through real world situations. SRAHEC is preparing these Family MedicineFellows not only to work in rural areas but toteach and lead in these areas as well.During the training, the Fellow is pairedwith a strong woman leader in a mentorshiprelationship. For example, the currentfellow, Lori Haigler, MD, is working with aNorth Carolina State Representative.

Faculty development training includestraining in the preparation/presentation oflectures, small group teaching, conflictresolution, curriculum design, and dealingwith the difficult learning situation. Each ofthe sessions is taught by faculty memberswho completed a one-year faculty develop-

ment fellowship at DukeUniversity. The Fellowapplies what has beenlearned by teaching currentresidents both in thehospital and in the office.When the residents begintheir practice in a rural site,these skills are transferableto teaching patients andadministrators alike. Addthese skills to the many

clinical skills honed during the fellowship andthe result is a confident, competent physicianmeeting a need in a rural community gettingincreased reimbursement and increased jobsatisfaction.

The Women’s Health Fellowship is sup-ported by grant funding from the Kate B.Reynolds Foundation and the DukeEndowment. The missions of these organi-

Resi

denc

y Fe

llow

ship A “Win” All Around: New Women’s Health Fellowship

Benefits Many

zations dovetail nicely with AHEC’s missionof improving the health care of theunderserved. The fellowship is also sup-ported by faculty in Family Medicine fromSR AHEC, by faculty in Ob/Gyn fromCape Fear Valley Hospital System andDuke University, and by faculty from theWildacres Leadership Initiative. There is alarge patient base to support the education,and the faculty provides the clinical andleadership expertise necessary to make thefellowship a valuable experience. This yearthe residency program increased 50% inapplicants, in part attributable to thefellowship. At least in this regard, theFellowship is already a success.

There were several lessons we learned as wecreated this fellowship that would assist otherresidency programs that wish to replicate oursuccess. The first lesson is to do a SWOTanalysis (strengths, weaknesses, opportunities,threats) and determine the unique patientpopulation or skill sets you possess that are notbeing used to their maximum potential. Next,find a faculty member who is passionate aboutthe project. Without a champion, the projectwill never get accomplished as more pressingurgent matters take precedence. Finally, getmarketing and public relations involved early.Things like placing advertisements in journalsabout your position need to be done monthsbefore you even think about them.

The Women’s Health Fellowship at SR-AHEC is improving the care of our communitydirectly by providing an expert in women’shealth who will practice in our region andindirectly by improving the number of qualifiedapplicants to our residency who will also thengo on to practice in the region. This has been a“win” all around.

References

1Pugno, P.A., McGaha A.L., Schmittling, G.T., Fetter, G.T., & Kahn, N.B. (2006). Results of the 2006National Resident Matching Program: Family Medicine. Family Medicine. 38(9): 637-46.

2Pugno, P.A., Schmittling, G.T., McGaha, A.L., Kahn, N.B. (2006). Entry of US Medical School GraduatesInto Family Medicine Residencies: 2005-2006 and a 3-year Summary. Family Medicine. 38(9):626-36.

Without a champion, the

project will never get

accomplished as more

pressing urgent matters

take precedence.


Spirit of AH

ECCollaboration forNontraditional NursingTraining in Central NebraskaSally Husen, MAEd

A simple tele-phone callchanged so manythings. MonaYoung, of Omaha,Nebraska, wasaccepted intonursing school,and called herthree growndaughters to sharethe news. They, inturn, called theirfriends; thesefriends told theirfriends andacquaintances.One particular phone call was to a motherwho happened to be a Central NebraskaArea Health Education (CN-AHEC)employee. This friend of Mona’s daughterexpressed how special Mona’s family was,and how stretched resources were for themat this point. Could CN-AHEC do any-thing for Mona Young while she pursued hernursing degree?

Ms. Young is a Native American, non-traditional student, who felt compelled toenter the nursing field because of herbackground and life experiences. Thoughthere were numerous hurdles and roadblocksin her journey, including her husband’scancer diagnosis and subsequent death, aswell as a cancer diagnosis for one of herdaughters, she has persevered.

She assists with CN-AHEC communityprojects and CN-AHEC assists Mona withexpenses associated with her nursing classes– this turned out to be a “win-win” situation.

The more CN-AHEC learnedabout Mona asshe overcame hershyness, the moreshe brought to theorganization.

Mona learned tomake choices at anearly age. Whenshe was 15, and afreshman in highschool, she metBob, a 26-year-oldVietnam veteran,at her mother’s

restaurant. They were married within a fewmonths. She said, “I chose to marry thisman. I didn’t have to get married. Followingour honeymoon, I went back to school.” Shewent on to say, “I am sure to tell these factsto satisfy curiosity or correct the assumptionpeople make about marrying so young.”Mona had her first daughter at age 17, andby age 22, she and Bob had two moredaughters, and a “wonderful life” — but notfor long.

After Bob was diagnosed with an incurableform of cancer, Mona’s family life becamefilled with oncology appointments, treat-ments, and surgeries that continued foryears. She became certified both as a CNA(Certified Nursing Aide) and a CSM (CareStaff Member) in order to better care for herhusband and learned patient care andworking with medications. It was duringone of Mona’s instructional sessions at theVeterans Hospital with a home health nursethat she acknowledged that her walk in life

Sally Husen, MAEd, is aHealth Science/WellnessConsultant at the CentralNebraska Area HealthEducation Center, GrandIsland, NE.

Mona Young is Central Community College NursingStudent, Grand Island, Nebraska.

Central Nebraska AHEC helps a nontraditional student fulfill herlifelong dream of becoming a nurse.


was meant to be in health care, specificallynursing. She realized that she had takencare of people since she was 12. Monarecalls, “The sacred teaching of my NativeAmerican culture calls upon us to practice away in life that benefits all beings. It wasobvious that my path had always pointed tonursing.”

CN-AHEC personnel have encouragedMona to go beyond receiving her LicensedPractical Nursing (LPN) degree and earnher Registered Nurse (RN) degree atCentral Community College in GrandIsland. Fortunately, CN-AHEC offices andthe nursing school are both located in

Collaboration for Nontraditional Nursing Training inCentral Nebraska

College Park. It has been easy for Mona tostop over to work on cataloging communityresource materials for CN-AHEC duringher spare minutes, or just to share someconversation. The plans are to employMona Young for additional projects whenher course work allows. Now she not onlywears her “Cherokee Woman” t-shirtsproudly, but has added “The Heartbeat ofNebraska – Healthcare Careers” t-shirt toher wardrobe. CN-AHEC is honored tohelp Mona fulfill her lifelong dream andlooks to use this relationship as a spring-board in working with other nontraditionalhealthcare students.

Spiri

t of

AH

EC

The National AHEC Bulletin Editorial Board

Marilyn B. Biviano, PhD, Director, DMDLouis D. Coccodrilli, MPH, Acting Deputy Director, DMD

National AHEC Program ContactsPhone: (301) 443-6950

David D. Hanny, PhD, MPH, Program Officer, AHEC Branch

Norma Hatot, CAPT/USPHS, Program Officer, AHEC Branch

Vanessa F. Saldanha, MPH, ASPH FellowJennifer A. Tsai, MPH, ASPH Fellow

Leo Wermers, Staff Assistant, AHEC Branch

The National AHEC Bulletin is a publication of the National AHEC Organization (NAO).Requests for copies of the Bulletin should be directed to NAO Headquarters, [email protected].

EDITORIAL BOARD

Robert J. Alpino, MIA*Heather Anderson, MPH, Co-ChairThomas J. Bacon, DrPH, Co-ChairJoel Davidson, MA, MPATina Fields, PhD, MPHGretchen Forsell, MPH, RDSally A. Henry, MA, RN, FHCE, Co-ChairShannon KirklandAndrea Novak, MS, RN, BC, FAEN*Kenneth Oakley, PhD, FACHERosemary Orgren, PhDCatherine Russell, EdDStephen Silberman, DMD, MPH, DrPhKathleen Vasquez, MSEd *Kelley Withy, MD, PhD

EX-OFFICIO MEMBERS

Louis D. Coccodrilli, MPHSusan Moreland, CAETeresa M. Hines, MPHNancy SugdenAndy Fosmire, MS, CTRS

STAFF EDITOR

Gay S. Plungas, MPH

*Co-editors

National AHEC Organization Board of Directors

Susan Moreland, CAE – PresidentCynthia S. Selleck, DSN – President-elect

Rose M. Yuhos, RN – TreasurerAndy Fosmire, MS, CTRS – Parliamentarian

Janet Head, RN, MS – Immediate Past PresidentH. John Blossom, MD – PDCG Vice Chair

Linda Cragin – PDCG RepresentativeGretchen Forsell, MPH, RD – CDCG RepresentativeDonald Schoolcraft, MBA – CDCG RepresentativeRobert Trachtenberg, MS – PDCG RepresentativeKelley Withy, MD, PhD – PDCG Representative

National AHEC BulletinAutumn/Winter 2007

Call For Articles“Rural Health in America: The AHEC Role”

Approximately 60 million Americans, or 20% of our total population, live in rural areas. Less than 9% ofU.S. physicians, however, practice in nonmetropolitan counties, and similar shortages exist for nurses,dentists, pharmacists, allied health professionals, and mental health professionals. Numerous reports havenoted the challenges in recruiting and retaining health professionals for rural areas. In addition, the Bu-reau of Primary Care projects severe shortages of primary care providers available to work in federallyfunded community health centers in future years.

A primary mission of the AHEC Program since its founding in 1972 has been to improve the supply, distribu-tion, and retention of primary care practitioners and other health professionals in rural and otherunderserved communities. The National AHEC Bulletin requests articles for the Autumn/Winter 2007 issueon the AHECs/HETCs role in strengthening the healthcare workforce in rural America. The Bulletin seeksarticles that demonstrate how AHECs and HETCs work in collaboration with educational and healthcaredelivery institutions to:

· Strengthen the recruitment of young people from rural areas to enter health professions educationprograms.

· Undergird the support infrastructure to enhance the recruitment and retention of health profession-als in rural communities, in collaboration with other community partners.

· Provide interdisciplinary rural experiences for students and residents from multiple disciplines toprepare them to function as members of the healthcare team.

· Retrain the existing healthcare workforce to address emerging issues affecting rural areas, includingdisaster preparedness, pandemic flu, substance abuse, or other public health issues.

· Develop strategies to improve the availability of primary care providers and other health profession-als to meet the needs of community health centers and other safety net providers.

· Offer programs designed to prepare health professionals to more effectively serve an increasinglydiverse rural population, and to reduce health disparities.

· Conduct needs assessments in order to identify emerging health issues facing rural populations.

Deadline for First Draft of Articles: August 31, 2007

Editorial Guidelines (Bulletin submission guidelines) can be found at the NationalAHEC webpage: www.nationalahec.org under NAO Bulletin or at:

http://www.nationalahec.org/Publications/documents/BULLETIN%20submission%

Please submit drafts, photos, and accompanying materials to:[email protected]

If you have any questions, please contact one of the following:

Thomas J. Bacon, DrPH

Director

NC AHEC Program

[email protected]

Kathy Vasquez, MSEd

Associate VP and Director

Ohio AHEC Program

[email protected]

Steven Silberman, DMD, MPH, DrPH

Director

Mississippi AHEC Program

[email protected]

Contact NAO

NAO Headquarters Address:109 VIP Drive, Suite 220Wexford, PA 15090Phone: (888) 412-7424Fax: (724) [email protected]

NAO Headquarters Contacts:

Judy [email protected]

Annie [email protected]

Barbara [email protected]

The National AHEC Organization MissionNAO is the national organization that supports and advances the AHEC/HETC networkin improving the health of individuals and communities by transforming health carethrough education.

The AHEC MissionTo enhance access to quality health care, particularly primary and preventive care, by improvingthe supply and distribution of healthcare professionals through community/academic educationalpartnerships.

The HETC MissionHETCs provide community health education and health professions training programs in areas ofthe U.S. with severely underserved populations such as communities with diverse cultures andlanguages. Border HETCs target healthcare workforce needs to address the population in closeproximity to the U.S./Mexico border and Florida using a binational approach to border healthissues. Nonborder HETCs are located in other seriously underserved areas of the country.

www.nationalahec.org

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