Needs and Opportunities for Implementing a Stronger Grow Your Own Model

1. Needs and Opportunities for Implementing a Stronger Grow Your Own Model Michelle Green Clark, SORH Director Susan K. Stewart, Western Maryland AHEC Director

2. Overview • Healthcare Pipeline Today in Maryland • Pieces that Exist (AHEC program) • Pieces Missing - Needs • Barriers • Opportunity • Call to Action

3. Review of Work Groups – Common Themes • Expand Workforce – Why we are here • Expansion of opportunities to learn in rural areas • Expansion of Loan Assistance Repayment Program (LARP) • Strengthening Grow Your Own Model • Telehealth Expansions • Compensation for providers in rural areas

4. Allegany Washington Cecil Garrett Kent Queen Anne’s Car - oline Talbot Dorchester Wicomico Worcester Somerset Maryland AHEC Program Allegany Allegany Washington Washington Carroll Carroll Cecil Cecil Harford Garrett Garrett Harford Frederick Baltimore Baltimore Balt. Howard Kent Kent Howard City Montgomery Anne Anne Queen Arundel Arundel Anne’s Car - oline Caroline Talbot Prince Prince Talbot George’s George’s Cal - Charles Charles Maryland AHEC Program Office University of Maryland School of Medicine Office of Policy and Planning Claudia Baquet, M.D., M.PH. Program Director vert Calvert Dorchester Dorchester Wicomico Wicomico St. Mary’s St. Mary’s Worcester Worcester Somerset AHECCenter Locations Expansion of AHEC Clinical Education Activities

5. Health Professions Education Pipeline K-12 Initiatives College & Health Professions Education Continuing Education & Training Inspire Motivate Encourage Support Assist Mentor Inform Prepare Experience Academic Support and Enrichment Financial Incentives Guarantee Placement Clinical Rotations that connect or Return Students to Communities Retention in Shortage, isolated, or Underserved Areas Partnerships and funding to build a sustainable pipeline also means high level collaboration between stakeholders, with legislative support.

6. Eastern Shore AHEC Mission Torecruit and retain health care professionals and build healthy communities through educational opportunities and collaborative partnerships. Cecil Kent Queen Caroline Talbot Dorchester Wicomico Worcester Somerset Jacob F. Frego Executive Director 410-221-2600 814 Chesapeake Drive.    PO Box 795   Cambridge, MD 21613

7. ESAHEC Pipeline Programs Elementary, middle, and high school programs in the 9 Eastern Shore counties “The Great Hospital Adventure” puppet video show Job shadowing; career mentoring by healthcare professionals Hospital tours & work-based learning experiences

8. To improve access to and promote quality in health care through educational partnerships. Western Maryland AHECMission WASHINGTON ALLEGANY GARRETT FREDERICK 11 Columbia Street Cumberland, MD 21502 301-777-9150 Susan K. Stewart Executive Director sstewart@allconet.org

9. STEM: PromotingCareers in Science Technology Engineering and Mathematics • Links K-12 schools with community professionals • Western MD STEM Task Force to address STEM initiatives on a regional level • Governor’s STEM and Economic Development Task Force

10. Exploring Careers in Health Occupations (ECHO) • Residential summer health careers program • Trips to healthcare facilities, higher education institutions, Baltimore, New York, DC • Job shadowing, mentoring • College entrance advice and prep

11. Youth Health Service Corps (YHSC) • The Youth health Service Corps’ mission is to recruit diverse high school students into health care careers. • Program components • Training Curriculum • Volunteer Service • Reward and Recognition • Service learning Projects (Wii)

12. WMAHEC Clinical Education Outcomes • 449 health professionals who participated in Clinical Education subsequently practiced in the Western MD Region. • 2 of the 11 Family Practice physicians in Garrett County (or 18%) are AHEC alumni; 90% of these physicians serve as preceptors for medical students.

13. WMAHEC Clin Ed Outcomes Continued • The only Primary Care internist in Garrett County is an AHEC alumnus. This internist has precepted more than 50 students since 1985, including two who subsequently returned to Western Maryland to practice. • 1 of the 3 General Surgeons in Garrett county is an AHEC alumnus (or 33%).

14. WMAHEC Clin Ed Outcomes Continued • 1 of the 5 orthopedic surgeons in Allegany County is and AHEC alumnus (or 20%). • At least 16 medical students or residents have practiced or still practice in the region.

15. ESAHEC Clinical Education Outcomes • 330 health care professionals (includes physicians, nurses, pharmacists and social workers) who participated through AHEC as part of their training are now practicing or have practiced on the Eastern Shore. • At least one-third of the medical preceptors are former Clinical Education participants.

16. ESAHEC Clin Ed Outcomes Continued • According to UMES, 14 clinical education students over the past 3 years have chosen to relocate to or remain on the Shore. (33% of all students participating from UMES) • At least 9 pharmacy students served by the Center have returned to practice in the region.

17. “Grow Your Own” in Maryland: Public Schools STEM Certificate Programs (CNA) - Dual enrollment with 2 & 4 Year Colleges Health Occupations Students of America, Medical Academy, Gear Up, Project Yes, & others Maryland Department of Education (MSDE) Enrichment and Summer Opportunities Maryland Rural Health Association Planning state’s first Med Bee Scholarship for winners who go into health careers

18. “Grow Your Own” in Maryland: Community Colleges and Universities Discipline specific collaborations with public schools Degree collaborations with each other Cecil County Dental School Expansion Summer and other programs Upward Bound, Regional Science Center Robotics camps at Garrett College and Frostburg State University

19. “Grow Your Own” in Maryland:Local Hospitals Medical Explorers, teen volunteer programs Career Ladders that encourage and pave the way for employees to move from administrative positions into clinical positions Scholarships for nursing education In-house training for careers not requiring licensure

20. Not Another Committee on the Healthcare Workforce – But Action New Zealand, Tony Myall MP – March 26, 2008, National Party Health Spokesman “With its many army of bureaucrats, Labour has produced at least 43 reports on the health workforce since 2000. No one seriously believes this will all be fixed by yet another report!”

21. Rural Student = Rural Health Professionals • Rural Student more likely to return to rural areas to practice (Wiener, 1993) • Patterns show rural go back to rural and those from underserved areas go back to underserved areas (Bowman, 2008) • Rural training gives broader responsibility and competency skills (Hunsaker et al., 2006)

22. Rural Training = Rural Provider • Jeffererson Medical College – Physician Shortage Area Program (PSAP) (Rabinowitz, 1991) • 4 times as likely to practice family medicine and in a rural area • 2.5 times more likely if had a senior rural preceptorship (Rabinowitz, 2001) • Other predictor if not in PSAP to return to a rural area is growing up there (Rabinowitz, 1999)

23. Strong AHEC through rural areas Strong Training sites in Maryland Federal and State Funded K-12 Pipeline programs (ECHO) Clinical rotation opportunities for students Youth Health Service Corps Expanding Housing and Preceptors Commitment to Economic Development in Rural Areas Some support to rural facilities in recruiting physicians Key components to a successful Grow Your Own Model

24. FORMAL Consortium of Partners Integration of University and Community College K-12 Programs Large Osteopathic School Private funding Support for rural students while in medical professional school (connections back to home) Scholarships/incentives for students to return to rural community Mandatory rotations in rural/underserved areas for clinicians Rural Residency program Missing components to a successful Grow Your Own Model

25. Foundation of Workforce Programs Task Force on HCAR Task Force on Rural Primary Care Rural AHECs CMS EHR project Financing and Staffing of recruitment programs Rural attention and focus of programs Community/local involvement Data that retention of health providers is essential to rural quality of life Key Components of R&R

26. Rural Broadband Cooperative Health Information Exchange (HIE) efforts U of M Statewide Health Network Telemedicine – Use and Reimbursement - Study 2006 Innovative Pilots Little reimbursement Liability not tested Telehealth network/consortium FEDERAL FUNDING FCC money left on table USDA money left on table Key Components of Telemedicine

27. Barriers • Tough fiscal times- no new money coming in • Stakeholders Need to Engage (Quantify and Quality) • Workforce is one of many rural public health problems • Existing factors that negatively impact reimbursement and insurance • High cost of medical and health professional education

28. Opportunities • Focus Here Today – Continue the Work • Tough Fiscal Times – Attention to most important work • SB 459 – Task Force on Rural Primary Care • Medical Home Concept • Telehealth – Innovation happening

29. Response to Workforce Issues • Addressing these issues will require the collaborative efforts of providers, community based organizations, businesses, and policy makers • Stakeholders in rural health care systems must be as vigilant in protecting and building upon the resources currently available as in addressing the challenges that remain New England Roundtable (2008)

30. Other State Solutions • Alabama, New Mexico, and Oregon – Tax incentives • Washington, New Mexico – Waive licensure fee • Grow Your Own Models (AL, WV, TN, TX…) • Workforce Centers – South Dakota, South Carolina • Local community solutions

31. Requirements to Change Workforce Policy • Shared perception of the problem • Public agreement, communication, frame issue, raise priority • Political Support • Broad base support • Viable policy solution • Workable, timely, affordable, proven (Skinner, 2008)

32. Time to Work!