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

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

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

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

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

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)

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

WV Graduates Recruited to Rural Underserved Areas in the State Total No.No. w/rural rotations MD & DO’s (91-98 grads) Nurse Practitioners5959 Nurse-midwives 2 2 Physician Assistants6060 Dentists4848 Dental Hygienists1414 Pharmacists6969 Physical Therapists2626 TOTAL (100%)

Discovering Partner Equanimity

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

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

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

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

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

What influences graduates to go into rural practice?  Having the option  Seeing their own communities differently  Bonding as a group  Learning interdependent skills

 Build on the strengths of community commitment  Engage community expertise in teaching and mentoring students Honoring and Sustaining Tradition…

While Innovating  Consortia prioritized service-learning activities  Tracked by State’s Healthy People 2010 Flagship objectives

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.

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

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

Retention of Other Health Sciences Graduates WVU Dental15 (50%)21 (58%) Pharmacy59 (74%)41 (89%) Nurse Practitioner12 (48%)25 (93%) Marshall Nurse Practitioner 5 (56%)14 (82%)

Total MD Physicians Active in practice, 1998 Percent in-state MD graduates West Virginia33% Region III32% US32% WV Rank24/45 Source: HRSA State Health Workforce Profiles, Dec. 2000

Percent MD & DO graduates in WV WV Medical Grads In WV, all specialties 317 (36%)357 (38%) In WV, primary care 168 (19%)219 (23%) In WV, rural areas 89 (10%) 98 (10%)

Number MD & DO graduates in WV WV Med.Grads Increase In WV, all specialties (13%) In WV, primary care (30%) In WV, rural areas (10%)

Medical Students’ Choice of Primary Care Residencies WVU graduates, (63%) Marshall graduates, (74%) WVSOM graduates, (65%) US average for MD 2000* (58%) grads *Data for DO grads not available

1995 WV Med Grads completing PC residency training by 2000 Completing PC residenciesNo. WV Practice In West Virginia5431 (57%) In other states7013 (19%)

Physician Specialties of 92 recruits Primary Care* 61Family Practice 12Internal Medicine 4Pediatrics 4OB/GYN 4General Practice 1Emergency Medicine * West Virginia practical definition Subspecialties 2Orthopedic Surgery 1Psychiatry 1Anesthesiology 1Radiology 1Ophthalmology

West Virginia Rural Health Education Partnerships