Partnerships: Successes, Challenges and Strategies The Power of Local Communities to Impact Health Care Workforce

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Partnerships Successes, Challenges
and Strategies The Power of Local Communities to
Impact Health Care Workforce
Hilda R. Heady, Executive Director West Virginia
Rural Health Education Partnerships Presented to
Our Communities In Crisis November 2,
2001 Bend, Oregon
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Why Partnerships and How do they succeed?

• Our experience in partnership teach us about the
  whole, about synergy
• Partnerships create a forum that honors the
  diversity of needs and resources

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Why and How Partnerships succeed

• Partnerships can define and create power as an
  infinite and shared commodity
• Partnerships can provide the foundation for
  social change
•  

• Partnerships can define and create power as an
  infinite and shared commodity
• Partnerships can provide the foundation for
  social change
•  

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West Virginia Rural Health Education Partnerships

• Created by 1991 Rural Health Initiative Act and
  first students placed in 1992 (Kellogg and RHI)
• Covers 47 counties with rural underserved areas
• Significant changes in all schools in response to
  the needs of the state

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WVRHEP Infrastructure

• 10 state health professions schools
• 13 consortia with local boards
• 17 site coordinators and secretaries
• 17 Learning Resources Centers, 11 have MDTV
• 130 student rotations on average per month
• 318Training sites
• 594 Field faculty
• 670 community level partners

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Service to the people of West Virginia

• Over 35,000 weeks of student training since 1992
• Average 150,000 community service contacts per
  year (740,000 since 1997)

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Service to the People of West Virginia

• Over 4 million in uncompensated dental care
• 288 Health Professionals recruited to rural
  underserved areas of the state

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WV Graduates Recruited to Rural Underserved
Areas in the State 1991-2002
Total No. No. w/rural rotations MD
DOs (91-98 grads) 124 124 Nurse
Practitioners 59 59 Nurse-midwives 2
2 Physician Assistants 60 60 Dentists 48 48 De
ntal Hygienists 14 14 Pharmacists 69 69 Physica
l Therapists 26 26 TOTAL 402 402 (100)
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Discovering Partner Equanimity
Discovering Partner Equanimity
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Partner Equanimity

• Role of community members as the stewards of the
  partnership
• Role of defining power and expertise
• Decision making authority of State Panel in
  legislation
• Funding tied to functioning of the partnership
  i.e.
• school and community money in same allocation

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Partnerships Respond to Community Needs

• Higher Education mission is one of social
  responsibility
• A social contract with the people of the state
• Decision making is not just shared it is
  synergistic
• Releasing power creates more power
• The pie gets larger and is seen as a whole
  instead
• of various sized slices

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Why Does it work?

• Schools had an intensely reflective experience
• No one partner group is solely responsible for
  outcomes
• Successes and challenges are shared
• Communities know best what they need and what
  kind of practitioners they want
• Synergy of partnership is meeting in the middle

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How Does it Work?

• Students and residents see a true picture of
  rural health care
• Curriculum engages students in ways to learn
  community values
• Students are invited to see their educations as a
  way back in instead of a way out
• Community shows respect for students and involves
  them in all areas of community life

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What influences graduates to go into rural
practice?

• Acceptance by community and practitioners
• As students getting real hands on training
• Experiencing confidence and skill building early
• Learning and seeing the rewards as well as the
  challenges in the real setting, not just
  academically

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What influences graduates to go into rural
practice?

• Having the option
• Seeing their own communities differently
• Bonding as a group
• Learning interdependent skills

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Honoring and Sustaining Tradition

• Build on the strengths of community commitment
• Engage community expertise in teaching and
  mentoring students

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While Innovating

• Consortia prioritized service-learning activities
• Tracked by States Healthy People 2010 Flagship
  objectives

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The Rural Health Curriculum

• All health professional students complete rural
  rotations as a degree requirement (since 1996)
• Complete clinical objectives
• 20 of their time in community service-learning,
  research, and/or Interdisciplinary Case
  Management sessions.

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Rural Practitioners as Field Faculty

• Recruited by site coordinators and schools
• Approved by schools and consortia board
• To pay or not to pay a consortia decision
• Adjunct appointment at only one school
• Reciprocity of appointment among schools
• Faculty Development is interdisciplinary and
  discipline specific

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Distance Teaching Tools

• Tele-health system in 10 of 13 consortia
• Routine schedule (grand rounds) AND broadcasts
  from the field
• Satellite in all learning resource centers
• Web CT courses off web site (example
  interdisciplinary health informatics course)
• Weekly interdisciplinary case management sessions
  (IDS) required, disciplines rotate and student
  lead

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Retention of Other Health Sciences Graduates
1995 2000 WVU Dental 15 (50) 21
(58) Pharmacy 59 (74) 41 (89) Nurse
Practitioner 12 (48) 25 (93) Marshall Nurse
Practitioner 5 (56) 14 (82)
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Total MD PhysiciansActive in practice, 1998
Percent in-state MD graduates West
Virginia 33 Region III 32 US 32 WV
Rank 24/45 Source HRSA State Health Workforce
Profiles, Dec. 2000
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Percent MD DO graduates in WV
WV Medical Grads 1987-92 1990-95 In WV, all
specialties 317 (36) 357 (38) In WV, primary
care 168 (19) 219 (23) In WV, rural areas 89
(10) 98 (10)
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Number MD DO graduates in WV
WV Med.Grads 1987-92 1990-95
Increase In WV, all specialties 317 357
40 (13) In WV, primary care 168 219
51 (30) In WV, rural areas 89 98
9 (10)
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Medical Students Choice of Primary Care
Residencies
WVU graduates, 2000 51 (63) Marshall
graduates, 2000 32 (74) WVSOM graduates, 1999 40
(65) US average for MD 2000
(58) grads Data for DO grads not available
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1995 WV Med Grads completing PC residency
training by 2000
Completing PC residencies No. WV
Practice In West Virginia 54 31 (57) In other
states 70 13 (19)
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Physician Specialties of 92 recruits 1991-2000

• Primary Care
• 61 Family Practice
• 12 Internal Medicine 4 Pediatrics4 OB/GYN
• 4 General Practice
• 1 Emergency Medicine
• West Virginia practical definition

• Subspecialties
• 2 Orthopedic Surgery
• 1 Psychiatry
• 1 Anesthesiology
• 1 Radiology
• 1 Ophthalmology

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West Virginia Rural Health Education
Partnerships www.wvrhep.org