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Rural Health Workforce Trends: A National Perspective

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Health Careers not just for doctors and nurses anymore! JHF, MN ORHPC ... High amenity and tourist areas. Remote small cities and towns. Frontier areas ... – PowerPoint PPT presentation

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Title: Rural Health Workforce Trends: A National Perspective


1
Rural Health Workforce Trends A National
Perspective
  • J. H. Fonkert, MN ORHPC
  • July 14, 2008

Thanks to Pam Smith, Massachusetts SORH
2
A Rural Health Workforce Partnership
Thanks to Pam Smith, Massachusetts SORH
3
10.5 Million Healthcare Employees
JHF, MN ORHPC
4
Health Careers not just for doctors and nurses
anymore!
JHF, MN ORHPC
5
551,000 Physicians
JHF, MN ORHPC
6
A NOSORH Workforce Conference conclusion
Policies based on urban practices need to be
modified to reflect rural realities.
But, what are the rural realities?
JHF, MN ORHPC
7
Whats different about Rural?
  • low population small market size
  • remoteness distance from larger markets
  • unique population ethnicity, income, insurance
    coverage.

How do these things affect health care delivery,
and what practical things can we do about it?
JHF, MN ORHPC
8
The Many kinds of Rural
  • Non-metro trade centers
  • Agricultural towns
  • High amenity and tourist areas
  • Remote small cities and towns
  • Frontier areas

Health workforce challenges are different in each.
JHF, MN ORHPC
9
3RNet
  • REcruTENTION!
  • Tom Skinner recruit to retain.

JHF, MN ORHPC
10
Rural Health Works
  • Show the impact of medical practices and
    healthcare facilities on local economies.
  • Know the impact of a medical school on a states
    economy.

Thanks to Pam Smith, Massachusetts SORH
11
Keynote - Jack Dillenberg, DDSDean, Arizona
School of Dentistry and Oral Health
  • Letter from community health center guarantees
    admissions interview.
  • Admissions emphasize volunteer work and
    community commitment.
  • Paradigm shift from primary care to
    comprehensive care to interdisciplinary care.

Thanks to Pam Smith, Massachusetts SORH
12
Workgroup Questions
  • Where are the gaps in our data?
  • What obstacles hamper rural workforce
    development?
  • Where are the greatest opportunities?
  • What things can we impact most?
  • Who are our partners?
  • What do we recommend?

JHF, MN ORHPC
13
Allied Health
  • poor national data unclear occupational
    definitions.
  • lack of rural critical mass to employ some
    occupations.
  • Need distance learning, practicum sites.
  • Need mid-career training and career paths.
  • Beware of degree creep.
  • Licensing and scope of practice issues.

JHF, MN ORHPC
14
Emergency Medical Services
  • Problems with pay and turnover.
  • Lack of state support (dependent on local
    resources).
  • Should support EMS as a public service like
    other public safety.

John Becknell Regionalize EMS and fund
readiness. (MN Rural Health Conference, June 2008)
JHF, MN ORHPC
15
Health information technology
  • Turnover competing with other industries for
    staff.
  • Need for health IT curriculum.
  • Small facilities need help with implementation
    cost.
  • Interoperability issues.

JHF, MN ORHPC
16
Mental Health
  • Gaps in care for less than chronically ill.
  • Too much reliance on part-time providers.
  • Returning veterans.
  • Role for tele-psychiatry?
  • Reimbursement issues.
  • Rural-Urban earnings gap.

JHF, MN ORHPC
17
Oral Health
  • Small, remote communities not viable for
    traditional practices.
  • High incidence of public program patients in
    rural areas.
  • Need for mid-level practitioners.
  • Need more rural rotations.
  • Make state schools accountable for serving rural
    and underserved.

JHF, MN ORHPC
18
Recommendations
  • Identify models of articulation agreements that
    could be replicated for allied health
    professions.
  • More k-12 programs for allied health
    professionals utilizing AHECs with a rural focus.
  • Cross credentialing of health care specialist
    (WA) proposed legislation.
  • Improve dissemination of working models and best
    practices

Thanks to Pam Smith, Massachusetts SORH
19
NOSORH Workforce Committee
  • To develop SORH expertise and understanding of
    workforce issues in order to provide the State
    Office of Rural Health perspective on workforce
    policy issues and serve as a link between State
    Offices of Rural Health, national partner
    organizations, the Federal Office of Rural Health
    Policy and other federal agencies.

Thanks to Pam Smith, Massachusetts SORH
20
Actions/Next Steps
  • Survey of SORHs for workforce activities
  • Provided input for Workforce Summit
  • Creating a model for cross-credentialing of
    Allied Health Professional
  • Survey of SORHs about knowledge of Allied Health
    programs in state.

Thanks to Pam Smith, Massachusetts SORH
21
Allied Health Workforce
  • What professions would you include under Allied
    Health?
  • Is Allied Health work part of your SORH work?
  • What type of work does that include?
  • Do you work with the Community Colleges on any
    workforce development?
  • Does the SORH have a role in developing allied
    health workforce?
  • Where does it fall on your list of priorities?
  • What health workforce issue ranks higher?
  • What should be the focus of the Workforce
    Committee?

Thanks to Pam Smith, Massachusetts SORH
22
Questions?
  • Jay Fonkert, Sr. Workforce Analyst, Minnesota
    Office of Rural Health and Primary Care
  • 651-201-3846
  • Jay.fonkert_at_state.mn.us

23
Presentation Overview
  • Rural Health Workforce Summit
  • Recruitment, Retention, Collaboration Model
    programs
  • Key note Highlights
  • Breakout Highlights and recommendations
  • NOSORH Workforce Committee
  • Next Steps

Thanks to Pam Smith, Massachusetts SORH
24
Recruitment, Retention, Collaboration Program
models
  • Oregon - If you recruit without keeping your eye
    on retention, you are going to fail in the long
    run.
  • Recruitention
  • Tim Skinner
  • Colorado CoRRRN, CROP and CPR
  • Statewide Initiative

Thanks to Pam Smith, Massachusetts SORH
25
Recruitment, Retention, Collaboration Program
models
  • South Dakota - Healthcare Workforce Center
  • South Carolina
  • Noon conferences with resident physicians.

Thanks to Pam Smith, Massachusetts SORH
26
Oral Health Challenges,
  • Gaps
  • - Less dentists per capita than 10 years ago.
  • - Some rural communities cannot support a
    dental practice due to low population.
  • - Definitions/scope of practice for dental
    hygienists vary greatly.

Thanks to Pam Smith, Massachusetts SORH
27
Oral Health Challenges,
  • Obstacles
  • - lack of a rural pipeline for dentists
  • - 3rd party payers
  • - Licensing boards
  • - Facilities/equipment that are inadequate
  • - Integration of dental and primary care and
    subsequent issues.
  • - All dental graduates are not created equally

Thanks to Pam Smith, Massachusetts SORH
28
Allied Health Training the Health Workforce
  • Gaps
  • Allied Health to big and becomes a catch all
  • Lack of data
  • Obstacles
  • Few distance learning opportunities
  • Salaries are too low
  • Lack of structured education for some of these
    professions

Thanks to Pam Smith, Massachusetts SORH
29
Recommendations
  • Federal loan forgiveness increase
  • Graduate Medical Education money and how it
    relates to dental residencies
  • NHSC lower dental professions shortage area 18
    for scholars
  • Incentives to practice in rural areas (loans)

Thanks to Pam Smith, Massachusetts SORH
30
Health Information Technologies
  • HIT Workforce Crisis
  • Health care industry lags all other major
    industries in IT adoption even with advances.
  • Need for HIT management is increasing.
  • Health care facilities are struggling to staff
    HIT needs and also turnover.
  • Lack of interoperability because systems are
    different.

Thanks to Pam Smith, Massachusetts SORH
31
Recommendations
  • Loan repayment program recruitment and
    retention incentives
  • Job Corp
  • Signing bonus
  • State of the art technology
  • Pay for standardization of skill set/degree
  • Support for distance education
  • Technical assistance for HIT
  • Catalog of models
  • Grants for HIT network development

Thanks to Pam Smith, Massachusetts SORH
32
EMSA unique approach to addressing rural health
needs
  • Gaps
  • - Turn over Money not there move on to RN or
    go to urban communities for bigger salaries
  • - Paying for credentialing
  • Obstacles
  • - Lack of hospital support
  • - Equipment - get hand me downs
  • - Liability insurance

Thanks to Pam Smith, Massachusetts SORH
33
Recommendations
  • Need for distance learning opportunities for EMTs
    and Paramedics due to limited training
    facilities.
  • EMS is a local public service and needs to be
    supported and funded

Thanks to Pam Smith, Massachusetts SORH
34
Behavioral Health Workforce Trends
  • Gaps
  • - Licensure lists dont reflect who can practice
    and provide mental health care
  • - Impact of returning vets, supply of mental
    health providers employed by the VA
  • Obstacles
  • - Lack of rural training
  • - Lack of funding
  • - Territorialism of existing providers

Thanks to Pam Smith, Massachusetts SORH
35
Policy issues that impede workforce development
  • Policies need to reflect reality. Policies that
    allow mid levels, telemedicine, loan repayment
    policies etc. that allow providers to be
    reimbursed for offering rural care.
  • Recommendations
  • Policies need to be changed to reflect rural
    realities

Thanks to Pam Smith, Massachusetts SORH
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