strategies for recruitment and retention of a rural healthcare workforce texas rural health forum
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Strategies for Recruitment and Retention of a Rural Healthcare Workforce Texas Rural Health Forum Austin, Texas November 2010 John R. Bowling, DO, FACOFP dist. Professor, Family Medicine Professor, Medical Education Assistant Dean of Rural Medical Education UNTHSC-TCOM. - PowerPoint PPT PresentationTRANSCRIPT
Strategies for Recruitment and Retention of a Rural Healthcare Workforce
Texas Rural Health Forum Austin, Texas November 2010
John R. Bowling, DO, FACOFP dist.Professor, Family MedicineProfessor, Medical EducationAssistant Dean of Rural Medical EducationUNTHSC-TCOM
Learning Objectives
• Discuss proven strategies• Define the commitments necessary to implement
these strategies.
Proven StrategiesPhysician Workforce
• Preparation for medical school• Recruitment by medical schools• Experiences during medical school• Experiences during residency• Recruitment by communities• Retention by communities
Recruitment by Communities• Correlation with geographical areas
• Where lived during pre-adulthood• Where attended medical school• Where did residency
• Contact• Indentify early and stay in contact
Retention
• Training• 3 or more clerkships/rotations in rural location
• Self-preparedness for rural life• Those reported feeling more prepared or prepared for rural life
are twice as likely to be there after 6 years• Major emphasis of TCOM’s rural programs
• Voluntary choice• More likely to stay long term than those serving loan forgiveness
TCOM Vision
• To be a recognized academic leader in primary care and rural medicine for the state of Texas and the nation
ROME Mission Statement
• Preparing the osteopathic graduate for practice in a changing rural environment in the 21st century.
Goals
• To provide a foundation for life and practice in a rural community.
• To provide an educational curriculum that will prepare the graduate for acceptance into premier graduate medical education programs.
ROME Strategies
• A plan for “at the place” rural practice training.• Preparation by indoctrination, by example, and by
actual training in the area of future endeavor.
ROME Strategies
• The student is expected to remain at the rural site during the hours they are not on service…they become part and parcel of rural living.
TCOM GraduatesGeographic Distribution
• 2005 Data• Towns < 10,000
• 298 (11%) 216 in Texas• Towns < 25,000 >10,000
• 328 (13%) 274 in Texas
TCOM Success 2010
• 11th Family Practice USNWR• 25-30% of graduates
• 19th Primary Care USNWR
• 22nd Rural Medicine USNWR
• COMLEX 1 1st
• COMLEX 2 1st • USMLE 1 94% pass
• 85 % of students take
Application Process
• Seek qualified individuals who have a high probability of locating in Rural Texas
• Rural high school education• Strong family ties to rural area• Service oriented
Pre-matriculation Phase
• 2 days Shadowing• Rural Faculty• Primary Care Physician
Semesters 1- 4
• Systems Courses• With regular curriculum - application based
• Rural Medicine I, II, III, IV• Selected topics/skills relative to rural medicine
• 35 contact hours each semester
• Rural Clinical Experiences• Community Health Research Project
Early Clinical Experiences
• Simulation experiences • Beginning semester 1
• Community offices• Beginning pre-matriculation
• Rural hospital• Beginning semester 1
• Rural continuity community• Beginning after Semester 2
Rural Hospital Observation
• 24 hour experience in rural hospital emergency department observing health care delivery and interaction.
Community Research Project
• Purpose• To give the student experience in “community
responsiveness” and leadership through the identification and development of a plan to address a relevant community concern.
• Assignment• The student will produce a plan to address a
community-related problem.
Competencies Prior to Year 3
• History and physical • ACLS• Insertion of Foley catheter• Casting and taping• Venapuncture• Insertion of N/G tube• Giving injections• Gynecological exam• Colonoscopy
• Telemedicine consultation• Proper use of microscope• Clinical lab procedures• Sterile technique• Rx writing• CDLS, BDLS• Joint Injections• Suturing
Competencies Prior to Year 3
• Intubation• Tracheotomy• Spirometry• Thoracentesis• Heart Sounds• EKG
• Nasagastric tube placement• Paracentesis• Central line placement• Chest tube
Years 3 & 4
• Urban and Rural training sites. • Traditional block rotation experiences may be
combined where possible.• Students are accountable for all didactic
material required in conventional curriculum.
Selectives - 4th Year
• Community Health Systems
• International• Public Health
• Occupational Medicine
• Dermatology • Neurology
Rural Sites - Specialty
• Longview• Plainview• Nacogdoches• Crockett• Lufkin• Gainesville• Sweetwater
• Fredericksburg• Bryan• Amarillo• Weimar
Continuity Sites
• Perryton
• Laferia• Bells• Liberty
• San Saba• Giddings• Liberty• Eagle Lake
Our Vision
• State wide rural faculty • Didactic teaching • Clinical precepting• Mentoring
• Utilize distance learning • video connectivity
• Rural residencies
What Next??
Policy Issues
• Define the commitments necessary to implement proven strategies.
Academic Health Center Policy• Major agendas
• Research• High clinical revenues• Outside funding• Promotion and tenure
• Minor agendas• Practice location of graduates
Solutions
• Develop extramural (rural) training sites• Promotion & Tenure
• Mentoring into needed specialties• Implementing community oriented curricula• Sheppard students/residents to HPSA/rural areas
Community Strategies
• Partner with Academic Health Centers• Clinical rotations• Establish scholarships
• Partner with AHEC• Recruitment into health professions• Mentor area students
• Market rural Texas• Health Find and more
Community Strategies
• Provide student housing• Participate in recruiting• Legislative initiatives
• Insure representation• Higher education coordinating board
• Academic Health Center• governing bodies
Academic Health CentersNeed from Communities
• Rural Faculty• academic oriented• willing• good role model
• Student Housing• Broadband
• video conferencing• telemedicine
Pre-Med Pipeline
• Collaboration with Rural Area Colleges• Specific track• Rural high school graduates• Specific Curriculum
• Scholarships• Loan Repayment Programs
Pre-Med Curriculum
• Science Courses• Anatomy
• Developmental• Mammalian
• Physiology• Genetics• Biochemistry
Pre-Med Curriculum
• Non Science Courses• Psychology- Child and Adolescent• Sociology- (study of cultures)• Greek Words in English• English Literature• Fine Arts• Biostatistics
Pre-Med Clinical Exposure
• Physician Shadowing• Specific Objectives
• Community Service
www.hsc.unt.edu/Ruralmed/
Discussion