National Organization of State Offices of Rural Health - Region A June 16, 2015 Bureau of Health Workforce Health Resources and Services Administration U.S. Department of Health and Human Services Michelle Goodman Branch Chief, Division of Policy and Shortage Designation

Bureau of Health Workforce (BHW) Created in May 2014 to better meets the need for a well-trained, well-distributed 21 st century workforce through realignment and built in connectivity. Annual budget of over $1Billion  Supports over 40 workforce programs  Staff of more than 450 people Supports the health care workforce across the entire training continuum – from academic training of nurses, physicians, and other clinicians to clinicians currently providing health care in underserved and rural communities across the United States.

Bureau’s Area of Support/Programs National Center for Health Workforce Analysis Medical & Dental Residency Programs Public Health National Practitioner Data Bank Nursing Training, Faculty, Infrastructure Mental and Behavioral Health Allied Health Scholarship & Loan Repayment Programs  National Health Service Corps; NURSE Corps; Scholarships for Disadvantaged Students Pipeline Programs  Centers for Excellence; Health Careers Opportunity Program; Area Health Education Program Oral Health Programs Geriatrics

Health Workforce Priorities Increase health care workforce and align training and education with changing practice environment. Inter-professional training:  Drive the integration of practice and training.  Bring practice and academia together. Integrate mental and oral health into primary care. Focus on diversity and culturally competent care. Support placement in underserved communities. Increase availability and timeliness of workforce projections and analyses.

Highlights of FY 2016 President’s Budget Proposed investments would bolster the nation’s health workforce and improve the delivery of health care across the country Targeted Support for Graduate Medical Education (new program)  $400 million for FY 2016 in new mandatory funding  President’s Budget includes a total of $5.25 billion requested over FY  Supports ~13,000 residencies between FY Health Workforce Diversity Program (new program)  $14 million to create a career pipeline for health professions students that leads directly to service in underserved communities National Health Service Corps  $810 million requested for FY 2016  President’s FY 2016 requested $2.61 billion for FY  To sustain a field strength of at least 15,000 National Health Service Corps clinicians, FY

FY 2014 / 2015 Program Highlights

More than 47,000 clinicians have served in the NHSC  Expanding access to health care  Improving the health of people who live in urban and rural areas NHSC consists of more than 9,200 clinicians currently working in underserved communities, more than double the 3,600 serving in 2008 The NHSC has supported more than 18,000 health care providers between 2009 and National Health Service Corps (NHSC)

The NHSC provides financial support to providers in exchange for working at NHSC-approved sites. PROGRAM SCHOLARSHIP LOAN REPAYMENT PROGRAM STUDENTS TO SERVICE LOAN REPAYMENT PROGRAM STATE LOAN REPAYMENT PROGRAM National Health Service Corps Programs

FY 2015 NHSC Funding $ Million – (ACA funding) Programs Projected Awards S2S Loan Repayment Program100 NHSC Loan Repayment Program 3,901 2,272 new & 1,629 continuations NHSC Scholarship Program new & 13 continuations State Loan Repayment Program 38 Supporting 464 clinicians

NHSC Field Strength Growth & Projections FY * FY 2011 included funding from the Recovery Act, Affordable Care Act, and Base Appropriations ** Projected awards

Loan RepaymentScholarship Students to Service SLRP Physicians Dentists Nurse Practitioners Certified Nurse Midwives Physicians Assistants Registered Dental Hygienists Licensed Clinical Social Worker Marriage and Family Therapists Licensed Professional Counselors Health Services Psychologists Registered Nurses Pharmacists *Primary Care Specialties Only Overview of Eligible Disciplines

NHSC Service Obligation Requirements Program Minimum HPSA Score Financial Assistance Service Obligation Loan Repayment0-26 Up to $50,000 for initial 2 years Minimum of 2 years Students to Service14Up to $120,000Minimum of 3 years Scholarship*14 Full tuition and fees Minimum of 2 years State Loan RepaymentN/AVaries by stateMinimum of 2 years *The NHSC publishes a yearly federal Register Notice with the minimum HPSA score for the Scholarship Program by discipline Full-time, half-time service Teaching S2S and Scholars can continue in the Corps as Loan Repayors

* M/B includes Psychiatrists, NPs and PAs with mental health specialty. FY 2014 NHSC Rural Field Strength As of September 30, 2014

Search NHSC-approved sites and current job openings Online site profiles showcase languages spoken by patients, services offered, patients served annually, optional photos and much more… Site Administrators can post vacancies, update site profiles, and manage 6-month verifications for participating providers. NHSC Jobs Center

NHSC Rural Sites & Vacancy Data Among the 15,000 NHSC-approved sites, 8,094 are rural sites  3,990 of rural sites have completed site profiles  893 (11%) are RHCs  226 (3%) are CAHs  2,886 (36%) of rural sites are FQHCs 3,262 Vacancies/Job Opportunities on NHSC Jobs Center  1,414 rural site vacancies As of September 2014, rural site vacancies:  778 primary care provider vacancies posted (among 479 sites)  128 dental provider vacancies posted (among 113 sites)  508 mental health provider vacancies posted (among 268 sites)  21 rural sites have vacancies posted in all three categories

Loan repayment assistance to:  Registered Nurses & Advance Practice Nurses working in a Critical Shortage Facility  Nurse faculty employed at accredited schools of nursing Program participants receive up to 60% of their qualifying student loans in exchange for a 2-year service commitment – plus an additional 25% of their original loan balance for an optional third year. In 2014, the Nurse Corps Loan Repayment Program received over 5,800 applications and awarded 667 nurses.  140 (21%) practicing at a rural Critical Shortage Facility NURSE Corps Loan Repayment Program

NURSE Corps LRP VS NHSC LRP  Direct patient care is not required  Disadvantage background required from School of Nursing  Site application not required  Only one continuation award  Mental Health and Primary Care HPSAs are eligible for nurses  Direct patient care is required  Disadvantage background required of applicant  Site application required  Multiple continuation awards  HPSA must match discipline of applicant For more details view the NURSE Corps vs. NHSC comparative fact sheet.fact sheet Program Comparison

Helps students complete their nursing education by paying tuition, fees, other education costs, while providing a monthly living stipend. Open to full-time or part-time nursing students accepted or enrolled in diploma, associate, baccalaureate or graduate nursing programs at accredited schools located in the U.S. Upon graduation, scholarship program members fulfill a service commitment at a Critical Shortage Facility. In 2014, the NURSE Corps Scholarship Program received over 2,400 applications and awarded 242 nursing students. NURSE Corps Scholarship Program

Nurse Corps SP VS NHSC SP  Minimum two years of full time service at an approved critical shortage facility with a primary care or mental health HPSA score of 14 or higher  Tuition, fees and other reasonable costs covered  The full scholarship award is taxable  Must be accepted or enrolled full time in an accredited nursing degree program: AD, Diploma, Collegiate, or RN to BSN bridge  Minimum two years of full time service at an NHSC-approved site in a HPSA  Tuition, fees and other reasonable costs covered  The monthly stipend is taxable  Must be accepted or enrolled full time in an accredited school in one of the following disciplines: NP, MD, DO, DDS, DMD, CNM, or PA For more details view the NURSE Corps vs. NHSC comparative fact sheet.fact sheet Program Comparison

Teaching Health Centers Teaching Health Center Graduate Medical Education Program expands residency training in community-based settings  $230 million, five-year ACA initiative  Increasing access to health care services for people who are geographically isolated, economically or medically vulnerable 27% of Teaching Health Centers GME residents received training in a rural community. $83.4 million in ACA funding for academic year  Training more than 550 residents in 60 Teaching Health Centers  Expands states with Teaching Health Centers from 21 to 24  11 THCGME programs in 7 states are NHSC sites HRSA estimates that approximately $50 million will be available to support approximately 700 resident FTEs for the academic year

Oral Health Oral Health Training Programs ($34 million in FY 2015)  In FY 2015, HRSA increased the focus on preparing for practice in new and emerging models of care, including recruitment and retention programs, as well as practicing in advanced roles as allowed by States FY 2015 grant competitions  Predoctoral Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene  Postdoctoral Training in General, Pediatric and Public Health Dentistry  State Oral Health Workforce

Geriatrics Program Geriatric Workforce Enhancement Program ($38.6 million in FY 2015)  Improve health outcomes for older adults by integrating geriatrics with primary care, maximizing patient and family engagement, and transforming the healthcare system.  Redesigned in FY 2015 to combine four previously separate funding announcements. Improves ability to target programs, reduces overlap and increases administrative efficiency  Expect to make ~ 44 cooperative agreements.

Mental/Behavioral Health Programs Mental and Behavioral Health Education and Training Programs ($8.9 million for FY 2015) Graduate Psychology Education ($7.9 million in FY 2015)  Trains psychologists to work with underserved populations  Fosters an integrated and interprofessional approach Leadership in Public Health Social Work Education ($1 million in FY 2015)  Supports dual-degree programs in social work/public health

Public Health / Preventive Medicine Regional Public Health Training Centers and National Coordinating Center ($9.8 million in FY 2015 )  Continuing education for state, local, and tribal public health depts.  Program redesigned in FY 2014 with regional centers and national coordinating center (from a primarily local/state model).  Funded by HRSA and CDC and drawing on CDC’s content expertise.  ~23,000 trainees getting continuing education Preventive Medicine Residency ($7.1 million in FY 2015)  Supports physician residency programs that incorporate public health and preventive medicine.  ~55 residents in FY 2015

Advanced Nursing Education ($64 million in FY 2015)  New FY 2015 focus on innovative partnerships between academic institutions and rural/underserved clinical practice sites to improve students’ readiness to practice upon graduation Nursing

National Center for Health Workforce Analysis Recently Published: Sex, Race and Ethnic Diversity of US Health Occupations ( ) US Health Workforce: State Profiles Projecting the Supply of Non-Primary Care Specialty and Subspecialty Clinicians Projecting the Supply of Non-Primary Care Specialty and Subspecialty Clinicians National and State-Level Projections of Dentists and Dental Hygienists in the U.S National and State-Level Projections of Dentists and Dental Hygienists in the U.S Fact Sheets for Pharmacists, Therapy and Vision Occupations Upcoming reports: Projections on Behavioral and Mental Health: Work ongoing anticipated release – Fall 2015 Additional Fact Sheets on Allied Health Occupations – 2015 Research Centers: Focus on Flexible Use of Workers, Allied Health, Oral Health, and Long-term Care

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Contact Information Michelle Goodman Branch Chief Division of Policy and Shortage Designation Bureau of Health Workforce