Crawford

Rural Workforce Development: Planting Seeds to Growing Roots Patricia A. Crawford, MS, CHES Lisa M. Hatcher, MS, CWDP 2010 Virginia Rural Health Summit

Objectives
Describe workforce investment in rural healthcare.
Outline essential partnerships for a successful secondary education health career stimulation program via virtual surgery linkages to rural high schools.
Advocate for the role of rural community based training in development of rural leadership potential in family practice residents.
Differentiate stages of professional motivation in promoting careers in rural health care practice.

Location, Location, Location

Workforce Investment Act (1998)
Requires Governors to establish a state workforce investment board to assist in the development of state plan that will:
Increase employment, retention and earnings of WIA participants
Improve the quality of the workforce
Reduce welfare dependency
Enhance our national productivity and competitiveness

Workforce Investment Board Regions

Purpose of Region 1 Workforce Investment Board
To promote effective economic and workforce development partnerships that develop and sustain productive workers for business, and create prosperous communities for our citizens
Encompasses 11 counties (Fayette, Greenbrier, McDowell, Mercer, Monroe, Nicholas, Pocahontas, Raleigh, Summers, Webster, Wyoming) with a combined population of 350,263

Region 1 Healthcare Consortium
Formed as response to nursing shortage identified in 2002
Partnership included 16 hospitals & over 50 healthcare related organizations & educational institutions who created Migration Map System to address nursing education needs
February 25, 2005 distributed workforce report “Understanding the Supply and Demand Alignment of Region 1 Registered Nurses”

2009 NRHA Conference
Distributed 2,000 copies to incumbent workers, adults, and students across region
Presentations at State Health Education Conference & WV Rural Health Conference
Collaboration with Health Career Opportunities Program (HCOP) & Health Sciences Technology Academy (HSTA) coordinators
Distribution of 8,000 books to students in kindergarten through second grade to raise interest in nursing profession
Health career presentations through WV Area Health Education Center & WV Rural Health Education Partnership

Region 1 Nursing Historical Demand
Employment RN, 2001 2,310
Projected Annual Growth 1998-2008 45
May 2003 Employment by projection 2,400
May 2003 Actual Employment 2,612
2003 Total Employment vs. Projection 212
2003 Employment vs. Projection 8.8%
Rather than potential shortfall RN positions grew at faster rate between 2001-2003

Current & Projected Demand vs. Supply Activity
RN Employment, 2003
2,612
Projected New Growth thru 2008 225
Projected Replacement thru 2008 245
Projected total growth 470
Nurses entering workforce 2003 (graduating) 139
Nurses entering workforce 2004 (graduating) 178 RN students enrolled
spring & fall 2004 648
Expected Graduates
2008 538
Expected to pass certification by 2008 788
Expected surplus of 318 registered nurses by 2008

Expanding Health Career Pipeline
Extend collaboration in Healthcare Consortium
Strengthen relationships with partners in secondary education
Identify students in a health career track in high school
Build Health Career Spectrum beyond nursing
Diversify the message

Healthcare Consortium Metamorphosis
Needed to assess the secondary education environment as to readiness for technological partnership to increase awareness of health careers within its student population
Needed to expand relationships to include private physicians and business partners who could support technological initiative

Partnership for 21 st Century Skills
Superintendant of Schools, Dr. Steven Paine & Governor Joe Manchin & First Lady Gayle Manchin announced joint effort to provide statewide vision to ensure every student has the necessary skills to succeed.
Health Science Technology Education must embrace 21 st century skills to attract, educate, and retain students for successful entry into healthcare industry.

Priming the Pump for Health Career Interest in Secondary Education
Technology Driven
Flashy Enough to Hold H.S. Student Interest
Sound Curriculum
Appeal to Wider Career Spectrum of Students
Deliverable to Rural Schools
Interactive & Supportive of Socialization

The Solution http://resa1.k12.wv.us/vsp/

VSP Learning Environment
Utilizes 21 st century technology to allow students to participate in an actual surgery delivered via video feed into their classrooms.
Allows students the opportunity to view the surgery while interacting with the surgeon via an interactive blog and a face to face conversation after the procedure is viewed.

Project Partners
West Virginia Department of Education
Southeastern Area Health Education Center ( located at WV School of Osteopathic Medicine )
Mountain State University
West Virginia Vascular Institute
Raleigh General Hospital
Regional Education Service Agency 1 (RESA-1 )
Verizon
Integrated Resources
Region 1 WORKFORCE West Virginia

Public Private Partnership
Verizon Communications provides grants through its WORLD SCHOOL program for educational initiatives
Workforce Investment Board Region 1 encouraged partnership with Regional Education Services Agency – RESA 1 to bring high speed internet connections to schools by installing T2 lines to regional high schools

Educational Technology
RESA 1 provided technology consultant in charge of intranet system linking high schools in area
WV State Department of Education provided curriculum experts to develop age specific curriculum on selected health issue
Southeastern AHEC (at WVSOM) provided resources for videoconferencing equipment at regional hospital

Originating Videoconferencing Classroom

Instructional Lessons
Vascular Disease: Risk Factors and Prevention
Anatomy and Physiology: An Introduction to the Cardiovascular System
Infection Control: Principles of Disease Transmission and Prevention in Medical and Surgical Asepsis
Femoropopliteal Bypass Surgery: Surgical Instruments, Operative Personnel and the Surgical Procedure
Reflections
Pre & Post Broadcast

Spreading the Message
Workforce Investment Board provided linkage with Healthcare Consortium partners
Mountain State University provided media coverage (TV & newspaper) & linkage with healthcare educational training programs

Herbert Oye, D.O. – vascular surgeon leading Raleigh General Hospital surgical team in VSP femoropopliteal bypass surgery
Magazine cover courtesy THRIVE magazine (collaboratively published by Register Herald newspaper & Mountain State University)

Student Incentives
Printed T shirts with VSP logo
Printed book bags with VSP logo
Editions of THRIVE magazine
Copy of DVD on health careers by surgical team

Outcome Evaluation 500 Rural Health Career Track Students attended – 288 evaluations returned

Grade in School & Interest in Health Career
89% have a desire to help others
64% have family members or friends who work in healthcare
80% believe they are smart enough to succeed
90% believe there are many job opportunities
78% are interested in the salaries and benefits available
5% other
3% no response
Factors Contributing to Interest in Healthcare:

Economic Background & Educational Appropriateness
The content of this project was well arranged and logically presented.
44% strongly agree
35% agree
13% neutral
5% disagree
3% strongly disagree
The project material was presented at the appropriate level for me.
41% strongly agree
38% agree
12% neutral
5% disagree

Student Approval of Physician & Program
I would recommend this project to other students.
60% strongly agree
22% agree
9% neutral
3% disagree
The physician showed a genuine
interest in helping me understand
more about the disease, the surgical
intervention, and health careers.
62% strongly agree
22% agree
8% neutral
4% disagree

Costs for the program
Cash
Technology - $17,150 (equipment, phone line fees, shipping, installation)
Incentives - $9,049
(T-shirts, book bags, DVDs, books
Total Cash for program= $26,199
In Kind
Professional - $55,667 (videography & editing, curriculum development, marketing, graphic design, PR & magazine cover design)
Support Services - $4,200 (stuffing & delivery of materials to school sites & coordination)
Total in kind = $59,867
Total Investment per student = $172 Actual cost per student = $52

Replicable in Rural Sites
Biggest cash outlay was for videoconferencing equipment – many hospitals, especially rural teaching hospitals have this equipment in place
State Department of Education often have capacity for videographers to record the surgery & develop curriculum
Main cash costs would be incentives and copying of materials (Books and DVDs)
Could be done for under $10,000 & could be grant funded

State of Healthcare Workforce Report
Released in August 2008 at the Region 1 Workforce Investment Board Office
CDs of report distributed to WV State Legislature & Hospital CEOs
Expanded healthcare workforce projections beyond nursing from 2002 report & developing new career migration pathways

Bridging the Gaps Career Migration Pathways

Rural Health Professions Training
West Virginia Legislature requires all health professional students at state funded schools to complete 3 month of rural rotations
Since 1991, a rural health training network has expanded its infrastructure to 523 sites with 879 interdisciplinary field faculty
1,201 graduates in health fields have been retained in rural communities

Goals of WV Rural Health Education Partnership & WV Area Health Education Center Programs
Increase focus of primary care in WV health sciences schools through campus community partnerships
WV health science students complete rural rotations through an interdisciplinary & service learning model
Increase recruitment & retention to underserved areas of WV

2010 Maps of Consortia/Centers

WVRHEP & WVAHEC Rotations
Utilize service learning projects based on community health needs to develop professional prevention and communication skills
Educate health sciences students and medical residents in rural settings
Recruit RHEP/AHEC graduates to rural and underserved areas in WV

WV School of Osteopathic Medicine State Wide Campus
In third year of development
Students are place in statewide consortia sites for third year rotations
Provides year long opportunity for medical students to learn about WV communities including rural surrounding sites
Many other rural rotations exist outside WVRHEP/WVAHEC network

WV Recruitment Tools
Health Science Scholarship Program (HSSP)
$20,000 physician & $10,000 other disc.
State Loan Repayment Program (SLRP)
$40,000/year & 2 years more at $25,000/year
50% federal grant & 50% state appropriation
Recruitment & Retention Community Project (maximum 4 years award) (RRCP)
$10,000 with sponsor providing 50% as match
Medical Student Loan Repayment Program (MSLRP)
$10,000 annual loan to medical students
Center for Rural Health Development Loan Fund
Turned 2 ½ million in state funds into $21 million in rural infrastructure development

Service Commitment
HSSP – 2 years in HPSA or underserved area
SLRP – 2 years in HPSA
RRCP – Sponsor must be in HPSA or MUA & 1 year by provider for each year of funding
MSLP – One year full-time practice in underserved area in WV or medical critical shortage area in WV for each $10,000 loan forgiveness

HSSP Awardees Practicing in Rural WV 2009 West Virginia Higher Education Policy Commission/Health Sciences and Rural Health Report Card

Medical Student Loan Program ¹ Funded from fees charged to medical students & unexpended funds include loan repayments ² Loan postponement data show number of borrowers who began practice in WV each fiscal year and will qualify for loan forgiveness. Loan forgiveness data show borrowers who completed full time practice in WV each fiscal year and received loan forgiveness 2009 West Virginia Higher Education Policy Commission/ Health Sciences and Rural Health Report Card 2004-05 2005-06 2006-07 2007-08 2008-09 Loans Awarded in Fiscal Year 306 317 323 296 312 Total Amount Awarded $1,586,700 $1,023,705 $1,349,155 $1,861,456 $1,881,843 Amount of Unexpended Funds ¹ $2,609,608 $3,157,511 $3,525,991 $3,145,311 $2,642,508 Loan Postponement 20 15 20 12 22 Loan Forgiveness ² 50 47 37 40 47 Default Rate on Previous Awards 3.3% 3.0% 2.9% 2.8% 2.5%

Retention Medical School Graduates 2009 West Virginia Higher Education Policy Commission/ Health Sciences and Rural Health Report Card Graduates with Completed Training, 1999 – 2004 Institutions Total Number Number in Practice in WV Number Primary Care in WV Number in Practice Rural Areas in WV West Virginia University 458 179 (39.0%) 89 (19.4%) 32 (6.9%) Marshall University 281 112 (39.8%) 69 (24.5%) 20 (7.1%) WV School of Osteopathic Medicine 401 156 (38.9%) 116 (28.9%) 65 (16.2%) Total 1,140 447 (39.2%) 274 (24.0%) 117 (10.2%)

WV School of Osteopathic Medicine Graduate Medical Education Rural Leadership Fellowship Purpose
Recruitment & Retention of Physicians to Rural & Underserved Areas of WV
Mentor new physicians on community health issues
Increase clinical skills of provider for practice in rural setting
Decrease isolation by linkage to academic center

Physician Mentor
Meets with residents and newly placed physicians to discuss rural practice issues & share training experiences
Provides opportunities for residents to explore future practice locations
Facilitates interaction with residents & physicians about team approach to prevention in primary care setting
Lorenzo Pence, D.O. Associate Dean GME at WVSOM

Rural Leadership Fellows 2005-2009 Jenny Frangos, D.O.; Ashley Fritzius, D.O; Lorenzo Pence,D.O.; LaDonna Wolfe, D.O.; Sophia Simms, D.O.; Chris Howard, D.O.; Emily Clagg, D.O. Patti Crawford; Heidi Clark, D.O., Lorenzo Pence, D.O. Bob Petrarca, D.O. Waid McMillion, D.O.

Selected Clinical Training Examples of Rural Leadership Fellows
Women’s Health
Sports Medicine
Chronic Disease Management
Coding for Primary Care
X-ray Interpretation for Primary Care
Nuclear Cardiac Stress Testing
Colposcopy Training

Stepping Stones to Rural Commitment
Awareness of community health needs
Opportunity to rotate in rural community both as medical student and family practice resident
Participate in community health intervention
Analyze clinical areas in which extended training would be beneficial to rural primary care practice and use fellowship as opportunity to receive
Share experience in presentation at state and national rural health conferences and rural health policy meetings

Thank you. The road is not always visible but if you keep traveling, you will reach your destination. For us it is quality healthcare in our rural communities.

Questions?
Lisa Hatcher, MS, CWDP
Allied Health Specialist
New River Community & Technical College
[email_address]
Patricia Crawford, MS, CHES
Graduate Medical Education Project Manager
West Virginia School of Osteopathic Medicine
[email_address]

Crawford

by Virginia Rural Health Resource Center on Mar 23, 2010

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