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 MedicineProfessor, Medical EducationAssistant Dean of Rural Medical EducationUNTHSC-TCOM

Learning Objectives

• Discuss proven strategies• Define the commitments necessary to implement

these strategies.

Proven StrategiesPhysician Workforce

• Preparation for medical school• Recruitment by medical schools• Experiences during medical school• Experiences during residency• Recruitment by communities• Retention by communities

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

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

TCOM Vision

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

ROME Mission Statement

• Preparing the osteopathic graduate for practice in a changing rural environment in the 21st century.

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.

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.

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.

TCOM GraduatesGeographic Distribution

• 2005 Data• Towns < 10,000

• 298 (11%) 216 in Texas• Towns < 25,000 >10,000

• 328 (13%) 274 in Texas

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

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

Pre-matriculation Phase

• 2 days Shadowing• Rural Faculty• Primary Care Physician

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

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

ROME Curriculum Overview

• www.hsc.unt.edu/Ruralmed/

Rural Hospital Observation

• 24 hour experience in rural hospital emergency department observing health care delivery and interaction.

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.

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

Competencies Prior to Year 3

• Intubation• Tracheotomy• Spirometry• Thoracentesis• Heart Sounds• EKG

• Nasagastric tube placement• Paracentesis• Central line placement• Chest tube

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.

Selectives - 4th Year

• Community Health Systems

• International• Public Health

• Occupational Medicine

• Dermatology • Neurology

Rural Sites - Specialty

• Longview• Plainview• Nacogdoches• Crockett• Lufkin• Gainesville• Sweetwater

• Fredericksburg• Bryan• Amarillo• Weimar

Continuity Sites

• Perryton

• Laferia• Bells• Liberty

• San Saba• Giddings• Liberty• Eagle Lake

Our Vision

• State wide rural faculty • Didactic teaching • Clinical precepting• Mentoring

• Utilize distance learning • video connectivity

• Rural residencies

What Next??

Policy Issues

• Define the commitments necessary to implement proven strategies.

Academic Health Center Policy• Major agendas

• Research• High clinical revenues• Outside funding• Promotion and tenure

• Minor agendas• Practice location of graduates

Solutions

• Develop extramural (rural) training sites• Promotion & Tenure

• Mentoring into needed specialties• Implementing community oriented curricula• Sheppard students/residents to HPSA/rural areas

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

Community Strategies

• Provide student housing• Participate in recruiting• Legislative initiatives

• Insure representation• Higher education coordinating board

• Academic Health Center• governing bodies

Academic Health CentersNeed from Communities

• Rural Faculty• academic oriented• willing• good role model

• Student Housing• Broadband

• video conferencing• telemedicine

Pre-Med Pipeline

• Collaboration with Rural Area Colleges• Specific track• Rural high school graduates• Specific Curriculum

• Scholarships• Loan Repayment Programs

Pre-Med Curriculum

• Science Courses• Anatomy

• Developmental• Mammalian

• Physiology• Genetics• Biochemistry

Pre-Med Curriculum

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

Pre-Med Clinical Exposure

• Physician Shadowing• Specific Objectives

• Community Service

www.hsc.unt.edu/Ruralmed/

Discussion