MU Rural Track Pipeline Program Missouri Rural Health Association August 21, 2019

1. MU Rural Track Pipeline ProgramMissouri Rural Health AssociationAugust 21, 2019 Presented by: Kathleen Quinn, PhD, Associate Dean for Rural Health Allison Fuemmeler, MSL, Program Coordinator

2. Agenda • Missouri Health Disparities • The Physician Shortage Challenge • Rural Track Pipeline Overview • What’s in it for the Community? Steps to Recruitment and Engagement • Statewide Solutions • Ideas & Discussion • Questions

3. Missouri Health Disparities • Missouri fell from 37th to 40th in National ranking for health—ranked 40th or below among all states in 13 out of 35 measures documented by United Health Foundations American Health Rankings. • Ranked 42nd for Senior Health and 35th for Women and Children Health. • Missouri has almost 6 million residents, 38% live in rural communities (2.23 million) • 99/101 rural counties are Primary Medical Health Professions Shortage Areas (HPSA) • 69/143 licensed MO hospitals are in rural counties – 4 rural hospitals have closed since 2010. • 32 rural counties without a hospital • 36/69 rural hospitals are Critical Access with 25 or less beds Becker, M. (2018) Primary Care Physicians – Missouri Workforce Update

4. Missouri Health Disparities • Today, the average age of Primary Care Physicians in Rural Missouri is 60, compared to that of Urban Missouri Primary Care Physicians’ average age of 54. • 61% of Rural Primary Care Physicians are over age 50, versus 52.7% of Urban Primary Care Physicians. • 19.4% of the rural population is over age 65, while only 14.7% are over age 65 in urban areas. • There are 55.9 Primary Care Physicians for every 100,000 residents in rural Missouri compared to 139 PCPs per 100,000 residents in urban areas. • (National average is 68 PCPs/100,000 rural residents and 84 PCPs/100,000 urban residents) Becker, M. (2018) Primary Care Physicians – Missouri Workforce Update

5. MO Rural vs. Urban Disparities

6. The Challenge

7. Program Beginnings The MU Rural Track Pipeline Program began in 1995 as a cooperative effort between the MU Area Health Education Center and MU School of Medicineto address the rural health workforce shortages in the state.

8. Bryant scholars pre-admissions program

9. Program Design Based on three premises from the literature: • Students who come from rural areas are more likely to return to rural areas & MO students are more likely to stay in MO • Multiple, longitudinal experiences living and working in a rural community increase the likelihood of eventual rural practice • Living and working in a rural community helps to better prepare students for eventual rural practice

10. Bryant Scholars Pre-Admissions Program • Students are offered acceptance into a particular entering class, conditional upon: • Maintaining certain academic standards • Demonstrating ongoing professional conduct; and • Participating in required activities (leadership, shadowing, retreats) • Students who matriculate are required to participate in Rural Scholars Program during medical school.

11. APPLICANT ELIGIBILITY REQUIREMENTS • Have an undergraduate graduation date two academic years from the time of application. • Show high academic achievement during high school. • Have minimum 3.3 cumulative GPA and minimum 3.3 Math/Science GPA • Have A or B grades in required lecture/lab courses already taken at the time of application. • Show evidence of leadership and interest in a variety of extracurricular activities. • Be a Missouri resident • Have graduated from a rural Missouri high school as defined by the National Center for Education Statistics (NCES). • Be full-time enrolled at public or independent four-year college or university in Missouri or a contiguous state (Iowa, Illinois, Kentucky, Tennessee, Arkansas, Oklahoma, Kansas, and Nebraska). Students currently enrolled at a Missouri or continuous state two-year public or independent college as defined by the Missouri Department of Higher Education are eligible to apply but must provide proof of acceptance at a Missouri or contiguous state four-year public or independent college or university.

12. Student Selection Total SOM class size = 112 • Dedicated rural pre-admission slots (up to 20) • Sample interview questions and evaluation score sheet addressing two main areas are provided to committee members: • Is the applicant someone who will excel as a patient-centered physician? • Is the applicant someone who is likely to practice in a rural setting? • Applications are due in June each year and interviews take place in August.

13. Undergraduate Requirements • Maintain a cumulative and math/science GPA of 3.30 and earn A or B grades in the required course work • Receive the minimum MCAT set by the SOM • Current: 503 with no sub-score lower than 124 • Attend 3 of 4 Winter and Summer Retreats • Winter Retreats are online and focus on a variety of topics (i.e. MCAT, Financial Aid/Scholarships, connecting with older students) • Summer Retreats are in person on campus and are mandatory • Complete 20 hrs. of rural physician shadowing, 20 hrs. of other health related activities, and 8 hrs. of community service per academic year • Submit 4 mentor shadowing reflection papers

14. Bryant Scholars Outcomes

16. Rural Scholars Program • As the state's leading educator of physicians practicing in Missouri, the MU School of Medicine is in a key position to improve the supply and distribution of physicians in rural Missouri. • The Rural Scholars Program is designed to offer medical students interested in rural practice a variety of experiences including lectures, mentoring, and clinical programs centered around rural care. Students interested in the Rural Scholars Program will apply their first year of medical school.   • Designed and implemented to prepare students for rural medicine as necessary to address access and disparity issues.

17. eligibility • All M1 students are eligible to apply • Up to 25 spots per year • Why should a student apply? • Interest in serving an underserved population • Interest in learning about rural health disparities and quality of life concerns in Missouri • The Rural Scholars Program was designed to expose and prepare rural-interested medical students for rural practice through a variety of experiences including lectures, mentoring, and clinical programs.

18. Rural Scholars Program benefits • Development of an ongoing relationship with leadership at major hospitals and/or health systems in rural Missouri • Experience the rewards and challenges of working and living in a rural community • Participate in unique clinical experiences starting after the first year of medical school • Receive personal mentoring from a rural community-based faculty member • Receive personalized assistance and support from Rural Track Program faculty and staff • Prepare for rural practice

19. Clinical Requirements • Complete 6 weeks of the Summer Community Program or 4 weeks of the Summer Community Program and the Rural Immersion Program during the summer between the first and second year of medical school • Complete 3 rural clerkships and a community integration project during third year of medical school • Complete one 4 week rural elective during fourth year of medical school

20. Summer Community Program • Paid opportunity following 1st year of medical school($1,000 or $1,500) • Rural Scholars work with a rural physician for 4 or 6 weeks in their continuity community/region to gain insight into rural practice. • Housing provided free of charge or Rural Scholar may stay with family or friends in the area. • Opportunity for Rural Scholar to gain history-taking and physical exam skills.

21. Continuity Community/Region • Rural Scholars will be assigned to a community/region where they will complete all of their clinical training during the three clinical Rural Track programs (Summer Community Program, Clerkship, Elective) • Allows the scholar to develop a more in-depth connection with and understanding of the community/region, culture, health disparities, and health care resources in the area • 5 Regions • Mid-MO, NWMO, NEMO, SWMO, SEMO • Training Site Fair-October 17th from 5-7 pm

22. Rural ImmersionProgram • Paid opportunity following 1styear of medical school (*$500) • Four-day experience for health professions students who are interested in living and working in a rural area. • Non-clinical experience hosted in a rural community designed to highlight the social and communal aspects of rural life. • Housing and meals provided. • Rural Scholars must also complete at least 4 weeks of the Summer Community Program. Chillicothe 2017 Hannibal 2018 * subject to change Sedalia 2019

23. Rural track clerkship program • Occurs during the 3rd year of medical school. • Rural Scholars must complete 3 rotations in their assigned continuity community/region: • Family Medicine • Child Health • Internal Medicine • Obstetrics and Gynecology • Neurology • Psychiatry • Surgery • Housing is provided free of charge by regional AHEC’s and local health systems.

24. Participating Hospitals & Health Systems

25. Community Integration Project Students research community health needs in a region of the state and develop and evaluate a community research project to address the identified needs. An academic poster and paper are submitted to reflect on the project.

26. Rural track elective program • Occurs during the 4th year of medical school. • Rural Scholars must complete one 4 week elective in their assigned continuity community/region. • Sample Elective Offerings: • Dermatology • Emergency Medicine • Family Medicine • Cardiology • Immunology/Rheumatology • Obstetrics and Gynecology • Radiology • Urology • Psychiatry • Child Health

27. Other Program Requirements • Attend 6 rural evening lectures sponsored by MU AHEC during the first and second year of medical school • Past topics include: Telehealth and the Primary Care Provider; Managing a Successful Rural Practice; Exploring Mental Health in Rural Missouri; Caring for the Underserved-Working at a Federally Qualified Health Center in Rural Missouri; Specialists in Rural Missouri; Opioid Abuse & Treatment as a Rural Provider • Establish a mentor relationship • Receive personal mentoring from a rural community-based faculty member

28. Residency match and practice location data

29. How can MRHA Help?RECRUITMENT AND eNGAGeMENT • Identify high school youth and college students in your programs and/or community interested in medicine • Refer students to your regional AHEC and MU-SOM • Welcome healthcare students to your region/community • Provide students with a community tour • Involve students in area organizations and events • Volunteer to participate in Rural Immersion to highlight your area of expertise in your region • Welcome new rural physicians and healthcare professionals into your region/community

30. What’s in it for yOUR community? • Additional health care providers to address access and disparity issues • Economic impact of health care provider in the community = $1.3 Million Annually • Role models for students • Community Leaders who serve on boards • Providers address public health issues

31. Statewide solutions to address rural healthcare workforce

32. MU Rural Track Collaborative Projects • Health Network of Missouri • A collaborative network formed in June 2014 to improve access and better coordinate health care for patients in the communities they serve. The 5health systems will work together to share best practices in business, clinical and operational practices. • Collaboration with member hospitals to develop training sites for medical students and residents • Department of Health and Senior Services • Rural Lecture Series • Rural Training Site Development with HNM members • Rural Immersion • Rural Residency Development • RME Conclave Support • Missouri Hospital Association Health Institute • Implementation of Rural Scholars Program • Summer Program Collaboration with Rural member hospitals • Rural Training Site Support for Rural member hospitals

33. Missouri Healthcare Workforce Coalition • Bring together key stakeholders in Missouri who are committed to growing a strong primary care workforce across our state. • Increase the number of primary care providers practicing in Missouri. • Retain primary care providers educated and/or trained in Missouri to continue practice in our state. • Increase the number and improve the distribution of primary care training sites and preceptors in Missouri. • Promote a statewide infrastructure by which to measure and evaluate healthcare workforce trends, assess critical needs, and inform long term, evidence-based strategies for Missouri. • Develop responsive policy proposals and engage in coordinated advocacy efforts that support a strong primary care workforce across our state.

34. Ideas and Discussion

35. Questions?

36. Thank you!