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 Recruitention Tim Skinner Tim Skinner Colorado – CoRRRN, CROP and CPR Statewide Initiative Statewide Initiative

5. Recruitment, Retention, Collaboration – Program models South Dakota - Healthcare Workforce Center South Dakota - Healthcare Workforce Center South Carolina – South Carolina – Noon conferences with resident physicians. 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. - Less dentists per capita than 10 years ago. - Some rural communities cannot support a dental practice due to low population. - Some rural communities cannot support a dental practice due to low population. - Definitions/scope of practice for dental hygienists vary greatly. - Definitions/scope of practice for dental hygienists vary greatly.

9. Oral Health: Challenges,  Obstacles - lack of a rural pipeline for dentists - lack of a rural pipeline for dentists - 3 rd party payers - 3 rd party payers - Licensing boards - Licensing boards - Facilities/equipment that are inadequate - Facilities/equipment that are inadequate - Integration of dental and primary care and subsequent issues. - Integration of dental and primary care and subsequent issues. - All dental graduates are not created equally - 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 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 - Turn over Money not there move on to RN or go to urban communities for bigger salaries - Paying for credentialing - Paying for credentialing  Obstacles - Lack of hospital support - Lack of hospital support - Equipment - get hand me downs - Equipment - get hand me downs - Liability insurance - 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 - 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 - Impact of returning vets, supply of mental health providers employed by the VA  Obstacles - Lack of rural training - Lack of rural training - Lack of funding - Lack of funding - Territorialism of existing providers - 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 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 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. 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. 01060 Northampton, MA. 01060 (413) 586- 7525 (413) 586- 7525  Pamela.Smith@state.ma.us Pamela.Smith@state.ma.us