Strategies for Recruitment and Retention of a Rural Healthcare Workforce Texas Rural Health Forum

1. Strategies for Recruitment and Retention of a Rural Healthcare Workforce Texas Rural Health Forum Austin, Texas November 2010 John R. Bowling, DO, FACOFP dist. Professor, Family Medicine Professor, Medical Education Assistant Dean of Rural Medical Education UNTHSC-TCOM

2. Learning Objectives • Discuss proven strategies • Define the commitments necessary to implement these strategies.

3. Proven StrategiesPhysician Workforce • Preparation for medical school • Recruitment by medical schools • Experiences during medical school • Experiences during residency • Recruitment by communities • Retention by communities

4. Recruitment by Communities • Correlation with geographical areas • Where lived during pre-adulthood • Where attended medical school • Where did residency • Contact • Indentify early and stay in contact

5. Retention • Training • 3 or more clerkships/rotations in rural location • Self-preparedness for rural life • Those reported feeling more prepared or prepared for rural life are twice as likely to be there after 6 years • Major emphasis of TCOM’s rural programs • Voluntary choice • More likely to stay long term than those serving loan forgiveness

7. TCOM Vision • To be a recognized academic leader in primary care and rural medicine for the state of Texas and the nation

8. ROME Mission Statement Preparing the osteopathic graduate for practice in a changing rural environment in the 21st century.

9. Goals To provide a foundation for life and practice in a rural community. To provide an educational curriculum that will prepare the graduate for acceptance into premier graduate medical education programs.

10. ROME Strategies • A plan for “at the place” rural practice training. • Preparation by indoctrination, by example, and by actual training in the area of future endeavor.

11. ROME Strategies The student is expected to remain at the rural site during the hours they are not on service…they become part and parcel of rural living.

12. TCOM GraduatesGeographic Distribution • 2005 Data • Towns < 10,000 • 298 (11%) 216 in Texas • Towns < 25,000 >10,000 • 328 (13%) 274 in Texas

13. TCOM Success 2010 11th Family Practice USNWR 25-30% of graduates 19th Primary Care USNWR 22nd Rural Medicine USNWR COMLEX 1 1st COMLEX 2 1st USMLE 1 94% pass 85 % of students take

14. Application Process Seek qualified individuals who have a high probability of locating in Rural Texas Rural high school education Strong family ties to rural area Service oriented

15. Pre-matriculation Phase 2 days Shadowing Rural Faculty Primary Care Physician

16. Semesters 1- 4 Systems Courses With regular curriculum - application based Rural Medicine I, II, III, IV Selected topics/skills relative to rural medicine 35 contact hours each semester Rural Clinical Experiences Community Health Research Project

17. Early Clinical Experiences Simulation experiences Beginning semester 1 Community offices Beginning pre-matriculation Rural hospital Beginning semester 1 Rural continuity community Beginning after Semester 2

18. ROME Curriculum Overview • www.hsc.unt.edu/Ruralmed/

19. Rural Hospital Observation 24 hour experience in rural hospital emergency department observing health care delivery and interaction.

20. Community Research Project Purpose To give the student experience in “community responsiveness” and leadership through the identification and development of a plan to address a relevant community concern. Assignment The student will produce a plan to address a community-related problem.

21. Competencies Prior to Year 3 History and physical ACLS Insertion of Foley catheter Casting and taping Venapuncture Insertion of N/G tube Giving injections Gynecological exam Colonoscopy Telemedicine consultation Proper use of microscope Clinical lab procedures Sterile technique Rx writing CDLS, BDLS Joint Injections Suturing

22. Competencies Prior to Year 3 Intubation Tracheotomy Spirometry Thoracentesis Heart Sounds EKG Nasagastric tube placement Paracentesis Central line placement Chest tube

33. Years 3 & 4 Urban and Rural training sites. Traditional block rotation experiences may be combined where possible. Students are accountable for all didactic material required in conventional curriculum.

34. Selectives - 4th Year • Community Health Systems • International • Public Health • Occupational Medicine • Dermatology • Neurology

35. Rural Sites - Specialty • Longview • Plainview • Nacogdoches • Crockett • Lufkin • Gainesville • Sweetwater • Fredericksburg • Bryan • Amarillo • Weimar

36. Continuity Sites • Perryton • Laferia • Bells • Liberty • San Saba • Giddings • Liberty • Eagle Lake

37. Our Vision State wide rural faculty Didactic teaching Clinical precepting Mentoring Utilize distance learning video connectivity Rural residencies

38. What Next??

39. Policy Issues • Define the commitments necessary to implement proven strategies.

40. Academic Health Center Policy • Major agendas • Research • High clinical revenues • Outside funding • Promotion and tenure • Minor agendas • Practice location of graduates

41. Solutions • Develop extramural (rural) training sites • Promotion & Tenure • Mentoring into needed specialties • Implementing community oriented curricula • Sheppard students/residents to HPSA/rural areas

42. Community Strategies • Partner with Academic Health Centers • Clinical rotations • Establish scholarships • Partner with AHEC • Recruitment into health professions • Mentor area students • Market rural Texas • Health Find and more

43. Community Strategies • Provide student housing • Participate in recruiting • Legislative initiatives • Insure representation • Higher education coordinating board • Academic Health Center • governing bodies

44. Academic Health CentersNeed from Communities • Rural Faculty • academic oriented • willing • good role model • Student Housing • Broadband • video conferencing • telemedicine

45. Pre-Med Pipeline • Collaboration with Rural Area Colleges • Specific track • Rural high school graduates • Specific Curriculum • Scholarships • Loan Repayment Programs

46. Pre-Med Curriculum • Science Courses • Anatomy • Developmental • Mammalian • Physiology • Genetics • Biochemistry

47. Pre-Med Curriculum • Non Science Courses • Psychology- Child and Adolescent • Sociology- (study of cultures) • Greek Words in English • English Literature • Fine Arts • Biostatistics

48. Pre-Med Clinical Exposure • Physician Shadowing • Specific Objectives • Community Service

49. www.hsc.unt.edu/Ruralmed/

50. Discussion