Rural Workforce Issues The New England Rural Health Roundtable

1. Rural Workforce IssuesThe New England Rural Health Roundtable Tom Morris Associate Administrator for Rural Health Policy Department of Health and Human Services Health Resources and Services Administration

2. Today’s Presentation Workforce Training: Key Players Current Status The Response

3. Background on ORHP and HRSA • Office of Rural Health Policy • A Policy and Grant Resource for Rural Communities • HRSA • Bureau of Health Professions

4. The HHS Role in Workforce Direct Impact HRSA: Title VII and VIII NHSC • Indirect Impact • CMS • Medicare Graduate Medical Education Payments

5. The Role of the States

6. Near-Retirement Age Primary Care Physicians Doescher MP, et al. Policy brief: the aging of the primary care physician workforce: are rural locations vulnerable? Seattle, WA: WWAMI Rural Health Research Center, University of Washington; June, 2009.

7. Trends in the Family Medicine Match

8. Work Location Type of RNs Living in Isolated Small Rural Areas Source: Gary Hart presentation, Primary Care Workforce Summit, 2009 from NSSRN: 1980, 1984, 1988, 1992, 1996, 2000, & 2004.

9. Doescher MP, et al. WWAMI Rural Health Research Center, University of Washington. Policy brief: the crisis in rural dentistry. Seattle, WA: Author; Apr 2009.

10. Number of Rural and Urban General Surgeons Per 100,000 Population, 1981-2005 • Lynge DC, et al. 2008. A longitudinal analysis of the general surgery workforce in the United States, 1981-2005. Arch Surg. 143(4):345-50.

12. So, What to Do?

13. Challenge of Workforce Efforts • Long Pipelines and Short Attention Spans • Intangibles • Spouse Issues • Education • Practice Support • Reimbursement • Lifestyle Issues

14. What Is Generally Known … • Rural In, Rural Out • Focusing on Place-Committed Folks • Retention • Team-Based Care • Use of Full Range of Primary Care Providers

15. A Modest Investment, Big Rural Return • Journal Article shows some programs work well and could be expanded …

16. The Lack of a Rural Training Infrastructure … • Rural Residency Training is Declining • Daunting Challenges for Re-Orienting

17. The Rural and Urban Underserved Primary Care Summit • August, 2009 • Next Steps

18. A Shift in the Policy Debate • Recognition of the Primary Care Challenge at National Level • MedPAC • Some Positive Signs on Oral Health • Continued Recognition of Nursing Shortage (Labor and HHS Heavily Invested and Coordinating)

19. Models • Utah Graduate Medical Education Council • AT Still University • Labor Department Programs

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22. “Within the total amount requested for Rural Health activities, the Budget includes $73 million for a new "Improve Rural Health Care" Initiative to strengthen partnerships among rural health care providers, recruit and retain rural health care professionals, and modernize the health care infrastructure in rural areas.”

23. Rural Workforce Issues • Working with the States • Possible Workforce Network Demonstration • Supporting Rural Residencies? The Rural Recruitment and Retention Network www.3rnet.org

25. Rural Assistance Center • Web-Based Services • http://www.raconline.org • Electronic Updates Subscribe on the website • Customized Assistance • Phone: 1.800.270.1898 • E-mail: info@raconline.org

26. Health Workforce Information Center • Web site - Easy access to key information on over 50 workforce topics and 80 professions, including: • Events & training • Organizations • Funding • News and Updates • Resources • HWIC Call Center • 1-888-332-4942 • info@healthworkforceinfo.org healthworkforceinfo.org

27. Contact Information Tom Morris Associate Administrator for Rural Health Policy 301-443-4269 tmorris@hrsa.gov http://ruralhealth.hrsa.gov