Rural Health Workforce Rural Health Workforce Trends: A National Trends: A National

PerspectivePerspectivePamela Smith, MA SORHPamela Smith, MA SORH

June 24, 2008June 24, 2008

A Rural Health Workforce A Rural Health Workforce Partnership Partnership

Presentation OverviewPresentation Overview Rural Health Workforce SummitRural Health Workforce Summit

– Recruitment, Retention, Collaboration …Recruitment, Retention, Collaboration …Model programsModel programs

– Key note HighlightsKey note Highlights– Breakout Highlights and Breakout Highlights and

recommendationsrecommendations NOSORH Workforce CommitteeNOSORH Workforce Committee Next StepsNext Steps

Recruitment, Retention, Recruitment, Retention, Collaboration – Program modelsCollaboration – Program models

Oregon - If you recruit without keeping Oregon - If you recruit without keeping your eye on retention, you are going your eye on retention, you are going to fail in the long run.to fail in the long run.

RecruitentionRecruitention Tim SkinnerTim Skinner

Colorado – CoRRRN, CROP and CPRColorado – CoRRRN, CROP and CPR Statewide InitiativeStatewide Initiative

Recruitment, Retention, Recruitment, Retention, Collaboration – Program modelsCollaboration – Program models

South Dakota - Healthcare Workforce South Dakota - Healthcare Workforce

CenterCenter

South Carolina – South Carolina – Noon conferences with resident Noon conferences with resident

physicians.physicians.

Rural Health Works: Making the Rural Health Works: Making the link to economic impact and link to economic impact and

workforceworkforce

The impact of a medical practice on The impact of a medical practice on a rural community.a rural community.

The economic impact of medical The economic impact of medical school on State’s economyschool on State’s economy

Keynote - Jack Dillenberg, DDSKeynote - Jack Dillenberg, DDS Dean Arizona School of Dentistry and Oral Dean Arizona School of Dentistry and Oral

HealthHealth The School is unique in it’s commitment to The School is unique in it’s commitment to

train dentists who will provide care to train dentists who will provide care to underserved populations who have an underserved populations who have an understanding of the public health understanding of the public health approachapproach

There needs to be a paradigm shift – move There needs to be a paradigm shift – move from primary care to comprehensive care from primary care to comprehensive care to interdisciplinary careto interdisciplinary care

Oral Health: Challenges,Oral Health: Challenges, Gaps Gaps - Less dentists per capita than 10 years - Less dentists per capita than 10 years

ago.ago. - Some rural communities cannot support - Some rural communities cannot support

a dental practice due to low population.a dental practice due to low population. - Definitions/scope of practice for dental - Definitions/scope of practice for dental

hygienists vary greatly.hygienists vary greatly.

Oral Health: Challenges,Oral Health: Challenges, ObstaclesObstacles - lack of a rural pipeline for dentists- lack of a rural pipeline for dentists - 3- 3rdrd party payers party payers - Licensing boards- Licensing boards - Facilities/equipment that are - Facilities/equipment that are

inadequateinadequate - Integration of dental and primary care - Integration of dental and primary care

and subsequent issues.and subsequent issues. - All dental graduates are not created - All dental graduates are not created

equallyequally

RecommendationsRecommendations

Federal loan forgiveness increaseFederal loan forgiveness increase Graduate Medical Education money Graduate Medical Education money

and how it relates to dental and how it relates to dental residenciesresidencies

NHSC lower dental professions NHSC lower dental professions shortage area – 18 for scholarsshortage area – 18 for scholars

Incentives to practice in rural areas Incentives to practice in rural areas (loans)(loans)

Health Information TechnologiesHealth Information Technologies

HIT Workforce CrisisHIT Workforce Crisis Health care industry lags all other major Health care industry lags all other major

industries in IT adoption even with industries in IT adoption even with advances.advances.

Need for HIT management is increasing.Need for HIT management is increasing. Health care facilities are struggling to staff Health care facilities are struggling to staff

HIT needs and also turnover.HIT needs and also turnover. Lack of interoperability because systems Lack of interoperability because systems

are different.are different.

Recommendations Recommendations Loan repayment program – recruitment and Loan repayment program – recruitment and

retention incentivesretention incentives Job CorpJob Corp Signing bonusSigning bonus State of the art technologyState of the art technology Pay for standardization of skill set/”degree”Pay for standardization of skill set/”degree” Support for distance educationSupport for distance education Technical assistance for HITTechnical assistance for HIT Catalog of modelsCatalog of models Grants for HIT network developmentGrants for HIT network development

EMS:A unique approach to EMS:A unique approach to addressing rural health needsaddressing rural health needs

GapsGaps - Turn over Money not there move on to - Turn over Money not there move on to

RN or go to urban communities for bigger RN or go to urban communities for bigger salariessalaries

- Paying for credentialing- Paying for credentialing ObstaclesObstacles - Lack of hospital support- Lack of hospital support - Equipment - get hand me downs- Equipment - get hand me downs - Liability insurance- Liability insurance

RecommendationsRecommendations Need for distance learning Need for distance learning

opportunities for EMTs and opportunities for EMTs and Paramedics due to limited training Paramedics due to limited training facilities.facilities.

EMS is a local public service and EMS is a local public service and needs to be supported and fundedneeds to be supported and funded

Behavioral Health Workforce Behavioral Health Workforce TrendsTrends

GapsGaps - Licensure lists don’t reflect who can - Licensure lists don’t reflect who can

practice and provide mental health carepractice and provide mental health care - Impact of returning vets, supply of mental - Impact of returning vets, supply of mental

health providers employed by the VAhealth providers employed by the VA ObstaclesObstacles - Lack of rural training- Lack of rural training - Lack of funding- Lack of funding - Territorialism of existing providers- Territorialism of existing providers

Policy issues that impede Policy issues that impede workforce developmentworkforce development

Policies need to reflect reality. Policies Policies need to reflect reality. Policies that allow mid levels, telemedicine, loan that allow mid levels, telemedicine, loan repayment policies etc. that allow repayment policies etc. that allow providers to be reimbursed for offering providers to be reimbursed for offering rural care.rural care.

RecommendationsRecommendations

Policies need to be changed to reflect rural Policies need to be changed to reflect rural realitiesrealities

Allied Health: Training the Health Allied Health: Training the Health WorkforceWorkforce

GapsGaps- Allied Health to big and becomes a catch Allied Health to big and becomes a catch

allall- Lack of dataLack of data

ObstaclesObstacles- Few distance learning opportunitiesFew distance learning opportunities- Salaries are too lowSalaries are too low- Lack of structured education for some of Lack of structured education for some of

these professionsthese professions

RecommendationsRecommendations Identify models of articulation agreements Identify models of articulation agreements

that could be replicated for allied health that could be replicated for allied health professions.professions.

More k-12 programs for allied health More k-12 programs for allied health professionals utilizing AHECs with a rural professionals utilizing AHECs with a rural focus.focus.

Cross credentialing of health care Cross credentialing of health care specialist (WA) proposed legislation. specialist (WA) proposed legislation.

Improve dissemination of working models Improve dissemination of working models and best practicesand best practices

NOSORH Workforce CommitteeNOSORH Workforce Committee

Purpose Purpose To develop SORH expertise and To develop SORH expertise and

understanding of workforce issues in order understanding of workforce issues in order to provide the State Office of Rural Health to provide the State Office of Rural Health perspective on workforce policy issues and perspective on workforce policy issues and serve as a link between State Offices of serve as a link between State Offices of Rural Health, national partner Rural Health, national partner organizations, the Federal Office of Rural organizations, the Federal Office of Rural Health Policy and other federal agencies.Health Policy and other federal agencies.

Actions/Next StepsActions/Next Steps Survey of SORHs for workforce Survey of SORHs for workforce

activitiesactivities Provided input for Workforce SummitProvided input for Workforce Summit Creating a model for cross-Creating a model for cross-

credentialing of Allied Health credentialing of Allied Health ProfessionalProfessional

Survey of SORHs about knowledge of Survey of SORHs about knowledge of Allied Health programs in state.Allied Health programs in state.

Allied Health WorkforceAllied Health Workforce What professions would you include under Allied What professions would you include under Allied

Health?Health? Is Allied Health work part of your SORH work?Is Allied Health work part of your SORH work? What type of work does that include?What type of work does that include? Do you work with the Community Colleges on any Do you work with the Community Colleges on any

workforce development?workforce development? Does the SORH have a role in developing allied Does the SORH have a role in developing allied

health workforce?health workforce? Where does it fall on your list of priorities?Where does it fall on your list of priorities? What health workforce issue ranks higher?What health workforce issue ranks higher? What should be the focus of the Workforce What should be the focus of the Workforce

Committee?Committee?

Contact InformationContact Information Pamela E. Smith, Program Pamela E. Smith, Program

Coordinator, MASS Department of Coordinator, MASS Department of Public Health, State Office of Rural Public Health, State Office of Rural HealthHealth

23 Service Center23 Service Center Northampton, MA. 01060Northampton, MA. 01060 (413) 586- 7525(413) 586- 7525 Pamela.Smith@state.ma.usPamela.Smith@state.ma.us