Developing a Health Workforce for North Carolina for the 21st Century

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Developing a Health Workforce for North Carolina
for the 21st Century

• Thomas J. Bacon, Dr.P.H.
• Executive Associate Dean
• NC AHEC Program Director
• June 13, 2008

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Major Points

• North Carolina has advantages as state in
  developing a strong health care workforce
• Still, shortages projected in most major health
  professions groups
• Renewed interest in workforce initiatives at both
  national and state levels, and concrete expansion
  plans are in place in North Carolina
• Special efforts will be required to assure a
  focus on rural and underserved populations, and,
  on issues of diversity
• Explore future opportunities

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NC Population Has Grown Faster Than the US
Population
North Carolina 11th in Population total, 9th in
growth rate (4 years)
Source US Census Bureau, NC State
Demographer Popworksheet.xls
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NC Primary Care Growth Now Equal to National Rate
of Change
Sources NC Health Professions Data System, Sheps
Center AMA Masterfile
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Primary Care Physicians per 10,000 by
Metropolitan and Non-Metropolitan Counties North
Carolina 1979 to 2004
Primary Care Physicians per 10,000
Population
Source for Metropolitan-Nonmetropolitan
definition Office of Management and Budget,
1993.
Sources North Carolina Health Professions Data
System, 1979 to 2004 North Carolina Office of
State Planning. Figures include all licensed
active, in-state, nonfederal, non-resident-in-trai
ning primary care physicians
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Persistent Health ProfessionalShortage (PHPSA)
Counties
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Shortages of Psychiatrists and Other Mental
Health Professionals

• 2006 Sheps/AHEC study showed growing shortage of
  psychiatrists, particularly in rural areas
• Even more critical shortage of child
  psychiatrists
• 69 counties had experienced a decrease in
  psychiatrists per 10,000 population from
  1999-2004
• Many of the same counties with psychiatrist
  shortages also have primary care shortages

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Dental Workforce in N.C.

• 2005 Update of 1999 Institute of Medicine (IOM)
  Dental Workforce Study found positive trends, but
  serious shortages remain
• NC still in bottom 10 of states in terms of
  dentists per 10,000 population
• Serious shortage in rural counties
• Particular shortage of dentists taking Medicaid
• Still, 2005 study observed significant increase
  in dentists taking Medicaid from two years
  earlier

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Nursing Workforce in N.C.

• 2004 NC IOM report noted projected shortage of
  9,000 RNs by 2015
• IOM recommended
• 25 increase in graduates of all ADN and BSN
  programs by 2010
• Shift toward higher percentage of BSNs
• Efforts to increase the diversity of nursing
  workforce
• Need for more mastered trained nursing faculty

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North Carolinas Response to Health Workforce
Shortages

• Medical School Expansion UNC
• Increase from 160 to 230 per class
• Add clinical campuses at Charlotte (50) and
  Asheville (20)
• Medical School Expansion ECU
• Increase Brody School of Medicine from 72 to 120
• Expand training in community sites
• Looking at model of smaller clinical teaching
  sites
• Residency Expansion
• Current task force developing a plan for the
  state
• Intent is to add at least 120 residency slots to
  match med school graduation increase
• Focus on high need areas such as primary care,
  psychiatry and general surgery

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North Carolinas Response to Health Workforce
Shortages- contd.

• Dental School Expansion ECU
• Funding in place
• First class will enter in 2010
• 4th year will be in community sites
• Dental School Expansion UNC
• Growing from 80 to 120 per class
• Expanding partnerships with CHCs, health
  departments and other community sites

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North Carolinas Response to Health Workforce
Shortages- contd.

• Nursing Education Expansion
• From 2003-2006 there was 28 increase in RN grads
• 34 increase in BSN enrollment and 11 increase
  in ADN enrollment
• Also, LPN enrollment up 36
• Then, NC has already met goals it set for 2010
• Major increase in educational masters programs as
  well

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North Carolinas Response to Health Workforce
Shortages- contd.

• Pharmacy Education Expansion
• UNC partnership with Elizabeth City State
  University
• 15 students at ECSU
• 15 more students at UNC (now 135)
• New Pharmacy School at Wingate University
• Other
• Possibly more PA programs
• Growth in FNP enrollment continues

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Policy Issues

• Will more graduates lead to the right kinds of
  providers to meet community needs
• How to better assure they practice in high need
  areas and serve vulnerable populations
• What is the right number of providers

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A National Response The Workforce Development
Collaborative

• A collaborative effort to develop strategies to
  address the growing shortages of health
  professionals in community health centers
• Modeled after the HRSA Health Disparities
  Collaboratives (HDCs) and includes several
  Bureaus
• Partnership/linkages between training and service
  delivery entities serving underserved populations
• Includes representation of health center
  clinicians, academic health center faculty, AHEC
  leaders from across the country and NACHC staff

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Why a Collaborative?

• Recruitment and retention (R R) of qualified
  primary care providers consistently ranks among
  the most urgent priorities for Health Centers.
• Training in health center settings appears to be
  the most effective way to address the recruitment
  and retention challenges facing Health Centers.
• Clearly, primary care is a team sport with many
  disciplines. However, the ideal medical home has
  at least one physician on the team, preferably a
  good one.
• Shortages of Primary Care Physicians are
  particularly severe, so physician residency and
  medical student training receive quite a bit of
  emphasis.

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Health Centers, Primary Care Associations and
AHECs Partners in Workforce Development

• Having just completed a major expansion, HRSA now
  provides federal grant funding to 1,071 health
  center grantees with over 4,000 comprehensive
  service sites that deliver primary and preventive
  care.
• These grantees include
• Community Health Centers
• Migrant Health Centers
• Health Care for the Homeless Programs
• Public Housing Primary Care Programs
• Primary Care Associations (PCAs) in all 50
  States, DC, and Puerto Rico provide training and
  technical assistance to health centers and other
  safety-net providers in areas such as planning
  for growth, recruitment and retention, and
  enhancing the quality of care provided.

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Health Centers, Primary Care Associations and
AHECs Partners in Workforce Development

• State Primary Care Offices (PCOs) assist in the
  coordination of local, State, and Federal
  resources involved in improving primary care
  service delivery and workforce availability to
  meet the needs of underserved populations. 
• Core activities include assessing the need for
  health care and for primary care providers in
  their State applying for designation of parts of
  the State as health professional shortage areas
  and recruiting providers to work in underserved
  areas.
• Significant numbers of primary care providers
  primary care physicians, nurse practitioners,
  physician assistants, nurses, dentists and others
  are required to staff the Health Centers.
• With staff turnover and a decreased number of
  U.S. medical graduates choosing primary care
  specialties, recruitment and retention (RR) is a
  key issue for HCs and PCAs.

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Area Health Education Center (AHEC) Program

• Nationwide, 53 Programs and 221 Centers aim to
• Improve the recruitment, distribution, supply,
  quality and diversity of personnel
• Increase the number of primary care practitioners
  providing services in underserved areas by
  offering educational continuum of health career
  recruitment through clinical education
• Carry out recruitment and health career awareness
  programs geared towards individuals from
  underserved areas
• Provide field placements, preceptorships, health
  professions education and training activities for
  students and practitioners
• Placement in community-based sites, e.g. Health
  Centers and other underserved area sites

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Health Center AHEC LinkagesRole of the AHEC

• Developing and maintaining an inter- disciplinary
  academic/community-based network for health
  professions training and education
• Providing opportunities for professional
  development to community-based practitioners
  through preceptor training, faculty development
  and continuing professional development
  initiatives.

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Health Center AHEC LinkagesRole of the AHEC

• Promoting site development through addition of
  learning resources, educational tools and
  telecommunication links with academic centers.
• Assisting with housing and student needs while
  training within the practice community.
• Evaluating outcomes and impact of training.

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WDC Work Product A Tool Kit

• General Introduction A Systems Approach for
  Improving Training Linkages and Enhancing
  Recruitment and Retention AHECs, Health Centers,
  and Other Health Professions Training
  Institutions
• Particular Focus on Training Programs for
  Residents and Medical Students
• Also Nursing, Dental, and Associated Health
  Professions Student Training Program
• Health Careers Development for 9-12 Grade
  Students
• Professional Development for Health Center
  providers
• Impact of the Systems Approach to Improving
  Training Linkages and Enhancing Recruitment and
  Retention

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Implications of the National Workforce
Collaborative for North Carolina
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Health Professions Training Pipeline
Source Cecil G. Sheps Center for Research
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North Carolina AHEC Core Programs

• Community-Based Student Training
• To provide students opportunities to learn from
  preceptors in the community and to have
  experiences that focus on community health,
  primary care and prevention, and rural practice
• Primary Care Residency Training
• To prepare primary care physicians, particularly
  family physicians, for practice in communities in
  the state, with a focus on rural and underserved
  areas
• Continuing Education for Health Professionals
• To keep providers up-to-date, improve the
  environment for practice, and improve quality and
  patient safety

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North Carolina AHEC Core Programs

• Health Careers and Workforce Diversity
• To recruit more underrepresented and
  disadvantaged young people into health careers
  and improve the diversity of the health workforce
• Library and Information Technology
• To provide the most up-to-date information
  resources for students, residents and health
  practitioners
• Other
• Monitoring the states health workforce situation
• 35 year collaboration with Sheps Center

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Goals for Students

• An enriched curriculum in primary care,
  prevention and other issues best taught in the
  community setting
• Exposure to community-based, full-time faculty
  and community practitioners
• Exposure to opportunitiesfor community practice
• Community-based research opportunities
• Opportunity for multidisciplinary education as
  part of healthcare team

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NC AHEC Student Rotations2006-2007 Support by
School in Student Months
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2003-2007 NC AHEC ProgramPrimary Care Health
Professions Students by HPSA

• 97 of Whole/Partial HPSA Counties have hosted
  primary care students for AHEC rotations (37 /
  38)
• 34 of all students were placed in Whole/Partial
  HPSA Counties (5,497 / 16, 119)

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2003-2007 NC AHEC ProgramPrimary Care Health
Professions Students by MSA

• 98 of Non-Metropolitan Counties have hosted
  primary care students for AHEC rotations (64 /
  65)
• 31 of all students were placed in
  Non-Metropolitan Counties (4,936 / 16,119)

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NC AHEC Primary Care Student Training in
Community Health Centers2002-2008
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Goals for Primary Care Residency Training

• Expand training capacity for primary care MDs in
  internal medicine, family medicine, pediatrics,
  and ob/gyn
• Increase likelihood of practice in underserved
  areas
• Provide curriculum more focused on rural and
  community practice
• Connect training even more closely to underserved
  areas through new rural track residencies

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Primary Care Residency Programs with AHEC Support
AHEC Primary Care Residency
Academic Health Center
Family Medicine Rural Track Site
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(No Transcript)
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Retention of Primary Care Residency Graduates in
NC1990-2006
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Residency GraduatesWorking in Underserved Area
Residency
Residency
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of Graduates Working in Underserved Settings
Indicates statistically significant, plt0.05
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Where Do We Go From Here?

• Assure that expansion of enrollments in key
  health professions programs meets the states
  needs
• Pay particular attention to rural and underserved
  community needs
• Pay particular attention to improving diversity
  of health care workforce
• Get maximum return for state on its investments
  in higher education
• Create centers of excellence for teaching in
  selected sites across the state

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AHEC Opportunities and Challenges

• Opportunities
• AHEC support for expansion of student enrollments
• UNC/ECU medical school expansion
• UNC/ECU dental school expansion
• UNC/ECSU PharmD expansion
• Expansion of residency training
• NC Institute of Medicine report focused on
  primary care, general surgery and psychiatry
• Other specialties also in short supply
• Current state task force developing plan for
  expansion
• Expansion of allied health and nursing programs
• Strengthen ties to community colleges
• Strengthen links to broaden workforce development
  efforts (Commerce Labor)

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AHEC Opportunities and Challenges

• Opportunities
• Workforce diversity initiatives
• Strengthen health careers programming
• Strengthen collaboration with HBCUs
• Mental Health workforce development
• Grants to psychiatry departments to expand rural
  training
• Mental health/primary care integration
  initiatives
• Linkages to new models of practice

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AHEC Opportunities and Challenges

• Opportunities
• Community-based translational research
• CTSA four regional translational units at AHECs
• Ethnicity, Culture and Health Outcomes (ECHO)
• Quality and patient safety initiatives
• Improving Performance in Practice (IPIP)
• Governors Quality Initiative
• Collaboration with hospitals and
  healthdepartments

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AHEC Opportunities and Challenges

• Opportunities
• Renewed Commitment to Rural Workforce
  Development
• Rural Health Scholars Program
• Rural residency expansion
• Summer rural internships
• Ultimately need designated rural tracks in
  medical schools and other health professions
  programs
• Stronger collaboration with community colleges,
  rural workforce development boards, etc.

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Questions?