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