1. Rural Health Workforce Trends: A National Perspective
Pamela Smith, MA SORH
June 24, 2008

2. A Rural Health Workforce Partnership

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

4. 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

5. Recruitment, Retention, Collaboration – Program models
South Dakota - Healthcare Workforce Center
South Carolina –
Noon conferences with resident physicians.

6. Rural Health Works: Making the link to economic impact and workforce
The impact of a medical practice on a rural community.
The economic impact of medical school on State’s economy

7. Keynote - Jack Dillenberg, DDS
Dean Arizona School of Dentistry and Oral Health
The School is unique in it’s commitment to train dentists who will provide care to underserved populations who have an understanding of the public health approach
There needs to be a paradigm shift – move from primary care to comprehensive care to interdisciplinary care

8. 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.

9. 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

10. 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)

11. 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.

12. 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

13. EMS:A 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

14. 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

15. Behavioral Health Workforce Trends
Gaps
- Licensure lists don’t 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

16. 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

17. 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

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

19. NOSORH Workforce Committee
Purpose
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.

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.

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?

22. Contact Information
Pamela E. Smith, Program Coordinator, MASS Department of Public Health, State Office of Rural Health
23 Service Center
Northampton, MA
(413)