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  1. 1. Rural Workforce Development: Planting Seeds to Growing Roots Patricia A. Crawford, MS, CHES Lisa M. Hatcher, MS, CWDP 2010 Virginia Rural Health Summit
  2. 2. Objectives <ul><li>Describe workforce investment in rural healthcare. </li></ul><ul><li>Outline essential partnerships for a successful secondary education health career stimulation program via virtual surgery linkages to rural high schools. </li></ul><ul><li>Advocate for the role of rural community based training in development of rural leadership potential in family practice residents. </li></ul><ul><li>Differentiate stages of professional motivation in promoting careers in rural health care practice. </li></ul>
  3. 3. Location, Location, Location
  4. 4. Workforce Investment Act (1998) <ul><li>Requires Governors to establish a state workforce investment board to assist in the development of state plan that will: </li></ul><ul><ul><li>Increase employment, retention and earnings of WIA participants </li></ul></ul><ul><ul><li>Improve the quality of the workforce </li></ul></ul><ul><ul><li>Reduce welfare dependency </li></ul></ul><ul><ul><li>Enhance our national productivity and competitiveness </li></ul></ul>
  5. 5. Workforce Investment Board Regions
  6. 6. Purpose of Region 1 Workforce Investment Board <ul><li>To promote effective economic and workforce development partnerships that develop and sustain productive workers for business, and create prosperous communities for our citizens </li></ul><ul><li>Encompasses 11 counties (Fayette, Greenbrier, McDowell, Mercer, Monroe, Nicholas, Pocahontas, Raleigh, Summers, Webster, Wyoming) with a combined population of 350,263 </li></ul>
  7. 7. Region 1 Healthcare Consortium <ul><li>Formed as response to nursing shortage identified in 2002 </li></ul><ul><li>Partnership included 16 hospitals & over 50 healthcare related organizations & educational institutions who created Migration Map System to address nursing education needs </li></ul><ul><li>February 25, 2005 distributed workforce report “Understanding the Supply and Demand Alignment of Region 1 Registered Nurses” </li></ul>
  8. 8. 2009 NRHA Conference <ul><li>Distributed 2,000 copies to incumbent workers, adults, and students across region </li></ul><ul><li>Presentations at State Health Education Conference & WV Rural Health Conference </li></ul><ul><li>Collaboration with Health Career Opportunities Program (HCOP) & Health Sciences Technology Academy (HSTA) coordinators </li></ul><ul><li>Distribution of 8,000 books to students in kindergarten through second grade to raise interest in nursing profession </li></ul><ul><li>Health career presentations through WV Area Health Education Center & WV Rural Health Education Partnership </li></ul>
  9. 9. Region 1 Nursing Historical Demand <ul><li>Employment RN, 2001 2,310 </li></ul><ul><li>Projected Annual Growth 1998-2008 45 </li></ul><ul><li>May 2003 Employment by projection 2,400 </li></ul><ul><li>May 2003 Actual Employment 2,612 </li></ul><ul><li>2003 Total Employment vs. Projection 212 </li></ul><ul><li>2003 Employment vs. Projection 8.8% </li></ul><ul><li>Rather than potential shortfall RN positions grew at faster rate between 2001-2003 </li></ul>
  10. 10. Current & Projected Demand vs. Supply Activity <ul><li>RN Employment, 2003 </li></ul><ul><li> 2,612 </li></ul><ul><li>Projected New Growth thru 2008 225 </li></ul><ul><li>Projected Replacement thru 2008 245 </li></ul><ul><li>Projected total growth 470 </li></ul><ul><li>Nurses entering workforce 2003 (graduating) 139 </li></ul><ul><li>Nurses entering workforce 2004 (graduating) 178 RN students enrolled </li></ul><ul><li>spring & fall 2004 648 </li></ul><ul><li>Expected Graduates </li></ul><ul><li>2008 538 </li></ul><ul><li>Expected to pass certification by 2008 788 </li></ul>Expected surplus of 318 registered nurses by 2008
  11. 11. Expanding Health Career Pipeline <ul><li>Extend collaboration in Healthcare Consortium </li></ul><ul><li>Strengthen relationships with partners in secondary education </li></ul><ul><li>Identify students in a health career track in high school </li></ul><ul><li>Build Health Career Spectrum beyond nursing </li></ul><ul><li>Diversify the message </li></ul>
  12. 12. Healthcare Consortium Metamorphosis <ul><li>Needed to assess the secondary education environment as to readiness for technological partnership to increase awareness of health careers within its student population </li></ul><ul><li>Needed to expand relationships to include private physicians and business partners who could support technological initiative </li></ul>
  13. 13. Partnership for 21 st Century Skills <ul><li>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. </li></ul><ul><li>Health Science Technology Education must embrace 21 st century skills to attract, educate, and retain students for successful entry into healthcare industry. </li></ul>
  14. 14. Priming the Pump for Health Career Interest in Secondary Education <ul><li>Technology Driven </li></ul><ul><li>Flashy Enough to Hold H.S. Student Interest </li></ul><ul><li>Sound Curriculum </li></ul><ul><li>Appeal to Wider Career Spectrum of Students </li></ul><ul><li>Deliverable to Rural Schools </li></ul><ul><li>Interactive & Supportive of Socialization </li></ul>
  15. 15. The Solution
  16. 16. VSP Learning Environment <ul><li>Utilizes 21 st century technology to allow students to participate in an actual surgery delivered via video feed into their classrooms. </li></ul><ul><li>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. </li></ul>
  17. 17. Project Partners <ul><li>West Virginia Department of Education </li></ul><ul><li>Southeastern Area Health Education Center ( located at WV School of Osteopathic Medicine ) </li></ul><ul><li>Mountain State University </li></ul><ul><li>West Virginia Vascular Institute </li></ul><ul><li>Raleigh General Hospital </li></ul><ul><li>Regional Education Service Agency 1 (RESA-1 ) </li></ul><ul><li>Verizon </li></ul><ul><li>Integrated Resources </li></ul><ul><li>Region 1 WORKFORCE West Virginia </li></ul>
  18. 18. Public Private Partnership <ul><li>Verizon Communications provides grants through its WORLD SCHOOL program for educational initiatives </li></ul><ul><li>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 </li></ul>
  19. 19. Educational Technology <ul><li>RESA 1 provided technology consultant in charge of intranet system linking high schools in area </li></ul><ul><li>WV State Department of Education provided curriculum experts to develop age specific curriculum on selected health issue </li></ul><ul><li>Southeastern AHEC (at WVSOM) provided resources for videoconferencing equipment at regional hospital </li></ul>
  20. 20. Originating Videoconferencing Classroom
  21. 21. <ul><li>Instructional Lessons </li></ul><ul><li>Vascular Disease: Risk Factors and Prevention </li></ul><ul><li>Anatomy and Physiology: An Introduction to the Cardiovascular System </li></ul><ul><li>Infection Control: Principles of Disease Transmission and Prevention in Medical and Surgical Asepsis </li></ul><ul><li>Femoropopliteal Bypass Surgery: Surgical Instruments, Operative Personnel and the Surgical Procedure </li></ul><ul><li>Reflections </li></ul><ul><li>Pre & Post Broadcast </li></ul>
  22. 22. Spreading the Message <ul><li>Workforce Investment Board provided linkage with Healthcare Consortium partners </li></ul><ul><li>Mountain State University provided media coverage (TV & newspaper) & linkage with healthcare educational training programs </li></ul>
  23. 23. <ul><li>Herbert Oye, D.O. – vascular surgeon leading Raleigh General Hospital surgical team in VSP femoropopliteal bypass surgery </li></ul><ul><li>Magazine cover courtesy THRIVE magazine (collaboratively published by Register Herald newspaper & Mountain State University) </li></ul>
  24. 24. Student Incentives <ul><li>Printed T shirts with VSP logo </li></ul><ul><li>Printed book bags with VSP logo </li></ul><ul><li>Editions of THRIVE magazine </li></ul><ul><li>Copy of DVD on health careers by surgical team </li></ul>
  25. 25. Outcome Evaluation 500 Rural Health Career Track Students attended – 288 evaluations returned
  26. 26. Grade in School & Interest in Health Career <ul><li>89% have a desire to help others </li></ul><ul><li>64% have family members or friends who work in healthcare </li></ul><ul><li>80% believe they are smart enough to succeed </li></ul><ul><li>90% believe there are many job opportunities </li></ul><ul><li>78% are interested in the salaries and benefits available </li></ul><ul><li>5% other </li></ul><ul><li>3% no response </li></ul>Factors Contributing to Interest in Healthcare:
  27. 27. Economic Background & Educational Appropriateness <ul><li>The content of this project was well arranged and logically presented. </li></ul><ul><li>44% strongly agree </li></ul><ul><li>35% agree </li></ul><ul><li>13% neutral </li></ul><ul><li>5% disagree </li></ul><ul><li>3% strongly disagree </li></ul><ul><li>The project material was presented at the appropriate level for me. </li></ul><ul><li>41% strongly agree </li></ul><ul><li>38% agree </li></ul><ul><li>12% neutral </li></ul><ul><li>5% disagree </li></ul><ul><li>4% strongly disagree </li></ul>
  28. 28. Student Approval of Physician & Program <ul><li>I would recommend this project to other students. </li></ul><ul><li>60% strongly agree </li></ul><ul><li>22% agree </li></ul><ul><li>9% neutral </li></ul><ul><li>3% disagree </li></ul><ul><li>5% strongly disagree </li></ul><ul><li>The physician showed a genuine </li></ul><ul><li>interest in helping me understand </li></ul><ul><li>more about the disease, the surgical </li></ul><ul><li>intervention, and health careers. </li></ul><ul><li>62% strongly agree </li></ul><ul><li>22% agree </li></ul><ul><li>8% neutral </li></ul><ul><li>4% disagree </li></ul><ul><li>4% strongly disagree </li></ul>
  29. 29. Costs for the program <ul><li>Cash </li></ul><ul><li>Technology - $17,150 (equipment, phone line fees, shipping, installation) </li></ul><ul><li>Incentives - $9,049 </li></ul><ul><li>(T-shirts, book bags, DVDs, books </li></ul><ul><li>Total Cash for program= $26,199 </li></ul><ul><li>In Kind </li></ul><ul><li>Professional - $55,667 (videography & editing, curriculum development, marketing, graphic design, PR & magazine cover design) </li></ul><ul><li>Support Services - $4,200 (stuffing & delivery of materials to school sites & coordination) </li></ul><ul><li>Total in kind = $59,867 </li></ul>Total Investment per student = $172 Actual cost per student = $52
  30. 30. Replicable in Rural Sites <ul><li>Biggest cash outlay was for videoconferencing equipment – many hospitals, especially rural teaching hospitals have this equipment in place </li></ul><ul><li>State Department of Education often have capacity for videographers to record the surgery & develop curriculum </li></ul><ul><li>Main cash costs would be incentives and copying of materials (Books and DVDs) </li></ul><ul><li>Could be done for under $10,000 & could be grant funded </li></ul>
  31. 31. State of Healthcare Workforce Report <ul><li>Released in August 2008 at the Region 1 Workforce Investment Board Office </li></ul><ul><li>CDs of report distributed to WV State Legislature & Hospital CEOs </li></ul><ul><li>Expanded healthcare workforce projections beyond nursing from 2002 report & developing new career migration pathways </li></ul>
  32. 32. Bridging the Gaps Career Migration Pathways
  33. 33. Bridging the Gaps Career Migration Pathways
  34. 34. Rural Health Professions Training <ul><li>West Virginia Legislature requires all health professional students at state funded schools to complete 3 month of rural rotations </li></ul><ul><li>Since 1991, a rural health training network has expanded its infrastructure to 523 sites with 879 interdisciplinary field faculty </li></ul><ul><li>1,201 graduates in health fields have been retained in rural communities </li></ul>
  35. 35. Goals of WV Rural Health Education Partnership & WV Area Health Education Center Programs <ul><li>Increase focus of primary care in WV health sciences schools through campus community partnerships </li></ul><ul><li>WV health science students complete rural rotations through an interdisciplinary & service learning model </li></ul><ul><li>Increase recruitment & retention to underserved areas of WV </li></ul>
  36. 36. 2010 Maps of Consortia/Centers
  37. 37. WVRHEP & WVAHEC Rotations <ul><li>Utilize service learning projects based on community health needs to develop professional prevention and communication skills </li></ul><ul><li>Educate health sciences students and medical residents in rural settings </li></ul><ul><li>Recruit RHEP/AHEC graduates to rural and underserved areas in WV </li></ul>
  38. 38. WV School of Osteopathic Medicine State Wide Campus <ul><li>In third year of development </li></ul><ul><li>Students are place in statewide consortia sites for third year rotations </li></ul><ul><li>Provides year long opportunity for medical students to learn about WV communities including rural surrounding sites </li></ul><ul><li>Many other rural rotations exist outside WVRHEP/WVAHEC network </li></ul>
  39. 39. WV Recruitment Tools <ul><li>Health Science Scholarship Program (HSSP) </li></ul><ul><ul><li>$20,000 physician & $10,000 other disc. </li></ul></ul><ul><li>State Loan Repayment Program (SLRP) </li></ul><ul><ul><li>$40,000/year & 2 years more at $25,000/year </li></ul></ul><ul><ul><li>50% federal grant & 50% state appropriation </li></ul></ul><ul><li>Recruitment & Retention Community Project (maximum 4 years award) (RRCP) </li></ul><ul><ul><li>$10,000 with sponsor providing 50% as match </li></ul></ul><ul><li>Medical Student Loan Repayment Program (MSLRP) </li></ul><ul><ul><li>$10,000 annual loan to medical students </li></ul></ul><ul><li>Center for Rural Health Development Loan Fund </li></ul><ul><ul><li>Turned 2 ½ million in state funds into $21 million in rural infrastructure development </li></ul></ul>
  40. 40. Service Commitment <ul><li>HSSP – 2 years in HPSA or underserved area </li></ul><ul><li>SLRP – 2 years in HPSA </li></ul><ul><li>RRCP – Sponsor must be in HPSA or MUA & 1 year by provider for each year of funding </li></ul><ul><li>MSLP – One year full-time practice in underserved area in WV or medical critical shortage area in WV for each $10,000 loan forgiveness </li></ul>
  41. 41. HSSP Awardees Practicing in Rural WV 2009 West Virginia Higher Education Policy Commission/Health Sciences and Rural Health Report Card
  42. 42. 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%
  43. 43. 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%)
  44. 44. WV School of Osteopathic Medicine Graduate Medical Education Rural Leadership Fellowship Purpose <ul><li>Recruitment & Retention of Physicians to Rural & Underserved Areas of WV </li></ul><ul><li>Mentor new physicians on community health issues </li></ul><ul><li>Increase clinical skills of provider for practice in rural setting </li></ul><ul><li>Decrease isolation by linkage to academic center </li></ul>
  45. 45. Physician Mentor <ul><li>Meets with residents and newly placed physicians to discuss rural practice issues & share training experiences </li></ul><ul><li>Provides opportunities for residents to explore future practice locations </li></ul><ul><li>Facilitates interaction with residents & physicians about team approach to prevention in primary care setting </li></ul>Lorenzo Pence, D.O. Associate Dean GME at WVSOM
  46. 46. 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.
  47. 47. Selected Clinical Training Examples of Rural Leadership Fellows <ul><li>Women’s Health </li></ul><ul><li>Sports Medicine </li></ul><ul><li>Chronic Disease Management </li></ul><ul><li>Coding for Primary Care </li></ul><ul><li>X-ray Interpretation for Primary Care </li></ul><ul><li>Nuclear Cardiac Stress Testing </li></ul><ul><li>Colposcopy Training </li></ul>
  48. 48. Stepping Stones to Rural Commitment <ul><li>Awareness of community health needs </li></ul><ul><li>Opportunity to rotate in rural community both as medical student and family practice resident </li></ul><ul><li>Participate in community health intervention </li></ul><ul><li>Analyze clinical areas in which extended training would be beneficial to rural primary care practice and use fellowship as opportunity to receive </li></ul><ul><li>Share experience in presentation at state and national rural health conferences and rural health policy meetings </li></ul>
  49. 49. 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.
  50. 50. Questions? <ul><li>Lisa Hatcher, MS, CWDP </li></ul><ul><li>Allied Health Specialist </li></ul><ul><li>New River Community & Technical College </li></ul><ul><li>[email_address] </li></ul><ul><li>Patricia Crawford, MS, CHES </li></ul><ul><li>Graduate Medical Education Project Manager </li></ul><ul><li>West Virginia School of Osteopathic Medicine </li></ul><ul><li>[email_address] </li></ul>