MU SCHOOL OF MEDICINE RURAL TRACK PIPELINE PROGRAM MU for YOU March 28, 2019

1. MU SCHOOL OF MEDICINE RURAL TRACK PIPELINE PROGRAM MU for YOU March 28, 2019 Kathleen Quinn, PhDAssociate Dean for Rural Health

2. Disparities in the U.S • By the year 2030, all baby boomers will be over age 65. • For first time in US Census history, people over 65 (78 million) will outnumber people under 18 (76.4 million). • The US will be short between 42,600 and 121,300 physicians. • Of that number, between 14,800 and 49,300 Primary Care Physicians will be needed. • An estimated 13,800 Primary Care Physicians are needed to remove the Primary Care Shortage designation from all designated shortage areas. • Becker, M. (2018) Primary Care Physicians – Missouri Workforce Update

3. Disparities in Missouri • 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. Disparities in Missouri 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. Leadership Dr. Michael Hosokawa- Senior Associate Dean of Medical EducationRural Track Management Group:Dr. James Stevermer- MUAHEC Medical Director Dr. Kathleen Quinn –Associate Dean of Rural Health Dr. Laine Young Walker– Associate Dean of Student AffairsDr. Kevin Kane – Associate Dean for Curricular Improvement Clerkship Directors (for 7 clerkships) Regional AHECS (Missouri Area Health Education Centers) Rural Track Medical Directors (at rural training sites)

9. Bryant Scholars Program

10. 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

11. 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 the 3 components of the Rural Track Program during medical school

12. Eligibility Requirements • Undergraduate graduation date two academic years from the time of application • High academic achievement during high school • Minimum 3.3 cumulative GPA and minimum 3.3 Math/Science GPA • A or B grades in required lecture/lab courses already taken at the time of application • Missouri resident • Graduated from a rural Missouri high school as defined by the National Center for Education Statistics • Enrolled full-time at an institution of higher education in Missouri or contiguous state

13. 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?

14. Student 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 (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

15. Bryant Scholars Outcomes 54.9% entered a residency program in Missouri 41.8% entered a residency program at MU 59.6% practice in a rural location 50% practice in rural Missouri 70.2% practice in Missouri Data as of 03/12/19 Total N for residency=122 Total N for practice=94

16. How Extension Can Help • Identify high school youth in your programs and/or community interested in medicine • Refer students to your regional AHEC and MU-SOM

17. Rural Scholars Program

18. Student Eligibility • All first year medical students • Number of students accepted will depend on number of incoming Bryant Scholars (max of 25 students) • Rural and urban background students

19. Student and Community Engagement Continuity Community/Region Rural Scholars will be assigned to a community/region where they will complete all their clinical training during the three clinical Rural Track programs (Summer, Clerkship, Elective) Allows the Scholar to develop a more in-depth connection with an understanding of the community/region, culture, health disparities, and health care resources in the area Continuity Community/Region Fair will be held to increase engagement of communities and familiarity with potential Scholars

20. •Rockport Summer Community Program •Canton •Quincy, IL •Lexington •North Kansas City •Holt’s Summit •Versailles •Westphalia •St. James •Mack’s Creek •Richland •Aurora Monett• •Hayti • Paid opportunity following 1st year of medical school ($1,000 or $1,500) • Students 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 student may stay with family or friends in the area • Opportunity for students to gain history-taking and physical exam skills

21. Goals for the Summer Community Program Increase knowledge of rural practice by working with an experienced preceptor. Learn about the different specialties commonly available in rural communities. Improve clinical skills in history-taking, physical examination, assessment and medical management. Explore common acute and chronic clinical problems. Compare medical practice in a community setting to practice in an academic health center.

22. 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 to students

23. Goals for the Rural Track Clerkship Program Explore and discover issues relevant to practicing medicine in a rural community. Provide students with core clinical experiences by working with a qualified preceptor. Afford students the unique opportunity to live and work in a rural community. Provide opportunities for service learning through community integration activities.

24. Participating Hospitals & Health Systems

25. Student Housing Hannibal Sikeston Branson St. Joseph Sedalia Osage Beach West Plains

26. Rural Immersion Program Chillicothe 2017 Hannibal 2018 Paid opportunity following 1styear of medical. 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. Sedalia 2019

27. 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.

28. 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 • Legislative Advocacy and Rural Health Policy

29. Student Benefits and Requirements Rural Missouri Experience Experience the rewards and challenges of working and living in a rural community Examine rural health disparities and quality of life concerns within a specific region of Missouri Develop an ongoing relationship with hospital systems and health care providers in rural Missouri Explore potential future practice locations

30. Student Benefits and Requirements Lasting Benefits Prepare for rural practice through ongoing clinical exposure Develop strong, supportive relationships with other students interested in rural care Receive personal mentoring from a rural community-based faculty member Participate in the annual rural lecture series for ongoing exposure to topics in rural health Receive a program completion scholarship during the fourth year of medical school Receive personalized assistance and support from Rural Track Pipeline Program faculty and staff Receive potential scholarships from participating hospitals and/or health systems

31. How Extension Can Help Welcome students to your region/community Provide students with a community tour Involve students in Extension events Suggest/Supervise Community Integration Projects Participate in Rural Immersion to highlight Extension in your region

32. Statewide solutions to address rural healthcare workforce

33. MU Rural Track Collaborative Projects • Health Network of Missouri • Acollaborative network formed in June 2014 to improve access and better coordinate health care for patients in the communities they serve. The six health 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

34. 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

35. Missouri Healthcare Workforce Coalition • MO Healthcare Workforce Data System – The system is based of the Cecil G. Sheps Center for Health Workforce Analysis. Statute passed in August 2016 to allow Professional Registration Boards to contract with OSEDA to analyze Missouri healthcare workforce data. To date, MO State Board of Nursing and the Board of Healing Arts has signed on. • Rural Training Track: October 2017 – MHA sent a survey to Missouri hospitals • March-April 2018 – Accreditation and Funding webinars • Summer 2018 – Hospital meetings/interviews • September 2018 – 3 HNM hospitals selected and Randy Longenecker secured as RTT Consultant

36. Rural Training Track Development • October 2018 – MU Task Force members and Dr. Longenecker made site visits to make final determinations of viability and interest in establishing an RTT • November 2018 – Dr. Longenecker’s report received • January 2019 – MU Task Force determined first of three sites to proceed with FM RTT • February 2019 – Working on HRSA grant • June 2022 – Admit residents to RTT

37. QUESTIONS?

38. THANK YOU!