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Hilda R. Heady, Executive Director West Virginia Rural Health Education Partnerships

Partnerships: Successes, Challenges and Strategies The Power of Local Communities to Impact Health Care Workforce. Hilda R. Heady, Executive Director West Virginia Rural Health Education Partnerships Presented to “Our Communities In Crisis” November 2, 2001 Bend, Oregon.

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Hilda R. Heady, Executive Director West Virginia Rural Health Education Partnerships

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  1. Partnerships: Successes, Challenges and Strategies The Power of Local Communities to Impact Health Care Workforce Hilda R. Heady, Executive Director West Virginia Rural Health Education Partnerships Presented to “Our Communities In Crisis” November 2, 2001 Bend, Oregon

  2. Why Partnerships and How do they succeed? • Our experience in partnership teach us about the whole, about synergy • Partnerships create a forum that honors the diversity of needs and resources

  3. Why and How Partnerships succeed • Partnerships can define and create power as an infinite and shared commodity • Partnerships can provide the foundation for social change • Partnerships can define and create power as an infinite and shared commodity • Partnerships can provide the foundation for social change

  4. West Virginia Rural Health Education Partnerships • Created by 1991 Rural Health Initiative Act and first students placed in 1992 (Kellogg and RHI) • Covers 47 counties with rural underserved areas • Significant changes in all schools in response to the needs of the state

  5. WVRHEP Infrastructure • 10 state health professions schools • 13 consortia with local boards • 17 site coordinators and secretaries • 17 Learning Resources Centers, 11 have MDTV • 130 student rotations on average per month • 318Training sites • 594 Field faculty • 670 community level partners

  6. Service to the people of West Virginia • Over 35,000 weeks of student training since 1992 • Average 150,000 community service contacts per year (740,000 since 1997)

  7. Service to the People of West Virginia • Over $4 million in uncompensated dental care • 288 Health Professionals recruited to rural underserved areas of the state

  8. WV Graduates Recruited to Rural Underserved Areas in the State 1991-2002 Total No.No. w/rural rotations MD & DO’s (91-98 grads) 124 124 Nurse Practitioners 59 59 Nurse-midwives 2 2 Physician Assistants 60 60 Dentists 48 48 Dental Hygienists 14 14 Pharmacists 69 69 Physical Therapists 26 26 TOTAL 402 402 (100%)

  9. Discovering Partner Equanimity Discovering Partner Equanimity

  10. Partner Equanimity • Role of community members as the stewards of the partnership • Role of defining power and expertise • Decision making authority of State Panel in legislation • Funding tied to functioning of the partnership i.e. school and community money in same allocation

  11. Partnerships Respond to Community Needs • Higher Education mission is one of social responsibility • A social contract with the people of the state • Decision making is not just shared it is synergistic • Releasing power creates more power • The pie gets larger and is seen as a whole instead • of various sized slices

  12. Why Does it work? • Schools had an “intensely reflective experience • No one partner group is solely responsible for outcomes • Successes and challenges are shared • Communities know best what they need and what kind of practitioners they want • Synergy of partnership is meeting in the middle

  13. How Does it Work? • Students and residents see a true picture of rural health care • Curriculum engages students in ways to learn community values • Students are invited to see their educations as a way back in instead of a way out • Community shows respect for students and involves them in all areas of community life

  14. What influences graduates to go into rural practice? • Acceptance by community and practitioners • As students getting real “hands on” training • Experiencing confidence and skill building early • Learning and seeing the rewards as well as the challenges in the real setting, not just academically

  15. What influences graduates to go into rural practice? • Having the option • Seeing their own communities differently • Bonding as a group • Learning interdependent skills

  16. Honoring and Sustaining Tradition… • Build on the strengths of community commitment • Engage community expertise in teaching and mentoring students

  17. While Innovating • Consortia prioritized service-learning activities • Tracked by State’s Healthy People 2010 Flagship objectives

  18. The Rural Health Curriculum • All health professional students complete rural rotations as a degree requirement (since 1996) • Complete clinical objectives • 20% of their time in community service-learning, research, and/or Interdisciplinary Case Management sessions.

  19. Rural Practitioners as Field Faculty • Recruited by site coordinators and schools • Approved by schools and consortia board • To pay or not to pay a consortia decision • Adjunct appointment at only one school • Reciprocity of appointment among schools • Faculty Development is interdisciplinary and discipline specific

  20. Distance Teaching Tools • Tele-health system in 10 of 13 consortia • Routine schedule (grand rounds) AND broadcasts from the field • Satellite in all learning resource centers • Web CT courses off web site (example: interdisciplinary health informatics course) • Weekly interdisciplinary case management sessions (IDS) required, disciplines rotate and student lead

  21. Retention of Other Health Sciences Graduates 19952000 WVU Dental 15 (50%) 21 (58%) Pharmacy 59 (74%) 41 (89%) Nurse Practitioner 12 (48%) 25 (93%) Marshall Nurse Practitioner 5 (56%) 14 (82%)

  22. Total MD PhysiciansActive in practice, 1998 • Percent in-state MD graduates • West Virginia 33% • Region III 32% • US 32% • WV Rank 24/45 • Source: HRSA State Health Workforce Profiles, Dec. 2000

  23. Percent MD & DO graduates in WV WV Medical Grads1987-921990-95 In WV, all specialties 317 (36%) 357 (38%) In WV, primary care 168 (19%) 219 (23%) In WV, rural areas 89 (10%) 98 (10%)

  24. Number MD & DO graduates in WV WV Med.Grads1987-921990-95Increase In WV, all specialties 317 357 + 40 (13%) In WV, primary care 168 219 +51 (30%) In WV, rural areas 89 98 +9 (10%)

  25. Medical Students’ Choice of Primary Care Residencies WVU graduates, 2000 51 (63%) Marshall graduates, 2000 32 (74%) WVSOM graduates, 1999 40 (65%) US average for MD 2000* (58%) grads *Data for DO grads not available

  26. 1995 WV Med Grads completing PC residency training by 2000 Completing PC residenciesNo. WV Practice In West Virginia 54 31 (57%) In other states 70 13 (19%)

  27. Primary Care* 61 Family Practice 12 Internal Medicine 4 Pediatrics4 OB/GYN 4 General Practice 1 Emergency Medicine * West Virginia practical definition Subspecialties 2 Orthopedic Surgery 1 Psychiatry 1 Anesthesiology 1 Radiology 1 Ophthalmology Physician Specialties of 92 recruits 1991-2000

  28. West Virginia Rural Health Education Partnerships www.wvrhep.org

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