WORKFORCE DEVELOPMENT

Connie BerryAmerican Academy of Family PhysiciansLegislative ConferenceNovember 7, 2015

ABOUT ME. . .

PRIMARY CARE OFFICES. . .

Measure access to primary care, dental and mental health services Analyze provider supply and recommend designations

for Health Professional Shortage Areas and Medically Underserved Areas (HPSAs and MUA/Ps)

Work with communities to improve access for underserved areas and populations Work to expand the health care safety net, including

Federally Qualified Health Centers and Rural Health Clinics

Expand the healthcare workforce in underserved areas with incentives and recruiting strategies Serve as a liaison to the National Health Service Corps,

State Loan Repayment programs and the Conrad 30/J-1 visa waiver program

HRSA Family Tree

Health Resources and Services Administration (HRSA)

Bureau of Clinician Recruitment and Services (BCRS)

Bureau of Health Professions (BHPr)

Bureau of Primary Health Care (BPHC)

Healthcare Systems Bureau

HIV/AIDS Bureau (HAB)

Maternal and Child Health Bureau (MCHB)

Office of Rural Health Policy (ORHP)

Office of Regional Operations (ORO)

Office of Special Health Affairs

PRIMARY CARE OFFICES LOOK ALIKE

BUT NOT EXACTLY ALIKE. . .

THE CHALLENGE OF WORKFORCE IN TEXAS

PHR 01791,000

PHR 02546,000

PHR 035,929,000 PHR 04

1,043,000

PHR 05748,000

PHR 065,200,500

PHR 072,477,000

PHR 082,258,000

PHR 09526,600

PHR 10733,000

PHR 111,866,000

Source: Center for Health Statistics, Population Estimates for Counties, 2003

2003 Texas Population,22,118,500

Population Served by HSRs

N Dakota

S Dakota

WyomingW Virginia

NevadaMississippi

Maryland

VermontIndiana

Hawaii

Delaware

Program Benefit Required Designation

National Health Service Corps, State Loan Repayment, Foundations

Scholarship, loan repayment

HPSA, Foundation partner clinics

Medicare Incentive Program

10% bonus on Medicare Part B

Geographic HPSA

Certification as a Rural Health Clinic (RHC)

Cost-based reimbursement

HPSA or MUA

Federal Health Center program (FQHC)

Federal grant funding, Cost-based reimbursement

MUA/P

J-1 Visa Waiver/National Interest Waiver Physicians

Recruitment of foreign physicians who can stay in the US

HPSA or MUA

DEVELOPING WORKFORCE PROGRAMS

It starts with funding* Data makes the case: Texas is one of the fastest growing

states, but ranks 46th in Primary Care physicians per 100,000. (Idaho, Nevada, Utah and Mississippi follow Texas)

Educating/informing elected officials– It Worked! Texas has invested in 5 new medical schools. One is open,

the other 4 are under construction. Number 6 is possible As Med Schools increase, Residency Slots must increase

(WHY?) The Texas Legislature increased per capita funding for

Medical School seats, increased GME funding, and continued Physician Loan Repayment adding a Mental Health component

The partners were critical in the process: Texas Academy of Family Practice, Texas Medical Association, TPCO, Office of Rural Health, Higher Education Coordinating Board, FQHC Association, Academic medical schools, Area Health Education Centers, etc.

* What about Funding?Non-traditional partners: Foundations St. David’s Foundation 46 providers receiving Loan Repayment. No state or federal funds support the LRP.

Texas Conrad State 30/J-1 Visa Waivers106 physicians, half Primary Care, half Subspecialists. Application fee supports the program

THEN WHAT?

Beaumont

YOU START SEEING THE SAME CHARACTERS. . .

Health Career Fairs (Bring Chocolate) Family Practice Residencies (bring food!) Student Medical Association Meetings (My

least favorite) Rural Health and Hospital Association

Conferences (More Chocolate) Federally Qualified Health Center Conferences

(More Chocolate) Advisory Committee Meetings (Higher

Education Coordinating Board)

But how do you get them where you need them?Let the Physicians Match Themselves:

The right tools (incentives) for the right provider inthe right place

The Texas Results:

1002 Obligated Health Professionals(July 2014-June 2015)

 July 2014 to June 2015   Program/Activities Settings

Discipline Total OHPsNational

Health Service Corps’ Sites

Texas State Loan

Repayment Program

# of OHP practicing on a

J-1 Waiver  Nurse Corps or Saint David’s

Community Health

Centers 

Health Professional

Shortage Areas (HPSAs)

# of OHP Working in

other settings 

Non psychiatric Physician (MD or DO) 512 46 351 98 17 93 363 113

Dentist (DDS/DMD) 72 55 0 0 17 59 64 13Nurse Practitioner (NP) 106 65 0 0 41 60 91 49Nurse Midwife (NM) 1 0 0 0 1 0 1 1Physician Assistant (PA) 52 46 0 0 6 24 52 2Dental Hygienist (DH) 3 3 0 0 0 2 3 1Psychiatrist (MD&DO) 69 10 49 8 2 19 43 20Clinical Psychologist (CP) 13 13 0 0 0 2 13 11

Licensed Clinical Social Worker (LCSW) 10 10 0 0 0 5 10 5

Psychiatric Nurse Specialist (PNS) 1 1 0 0 0 0 1 1

Licensed Professional Counselor (LPC) 37 37 0 0 0 5 37 31

Marriage and Family Therapist (MFT) 1 1 0 0 0 1 1 0Other (specify): Nursing Faculty, Registered Nurse, & Registered Nurse Anesthetist

125 0 0 0 125 5 125 120

Total 1002 287 400 106 209 275 804 367

BUT, WILL THEY STAY?

Don Pathman’s Principles of physician recruiting1. Retention success is achievable in any community.2. Underserved-area physicians are humans first,

professionals second:• Relationships are key• They are atypical among physicians

3. Rural and underserved practice is a marriage between a community and physician:• The match is key• The outward characteristics of the physician are

not important; what is in their heart is• The work situation needn’t be perfect, just not

bad

Don Pathman’s Principles of physician recruiting(Cont.)4.Rural physicians are locals at heart5.What physicians encounter in their practices and communities is key to retention:

• They need to feel satisfied, valued, invested and fulfilled

• They need a viable, long-term employment situation

6.Retaining and recruiting differ in important ways.

Questions?

How do the programs work?

What is the obligation?

Why doesn’t Texas participate in the State Loan Repayment Match program?

What about social media?

What about providers who default on their obligation?

Remember: Success Breeds Success

CONNIE BERRY

BERRYCONNIE@HOTMAIL.COM

512.585.2395