DRAFT

West Virginia Rural Health Education Partnerships

West Virginia Area Health Education Centers

Rural Health Advisory Panel Meeting

Monday, March 13, 2006

Days Inn, Flatwoods, WV

Rural Health Advisory Panel Members in Attendance: Dennis McCutcheon, Chair, Carla See, Richard Meckstroth, Tom Hefner, Loretta Jones, Gaye Mitchell, Patricia Crawford (proxy for Dean Adelman), John Callaway, Betsy Degges, Alison Witte, Walter McNutt,

Office of Rural Health Staff in Attendance: April Vestal, Sandra Pope, Sharon Giles, Kim Robinson, Hilda Heady, Derrick Day, Jodie Jackson

Guests in Attendance: Chuck Connor, Alicia Tyler, Dan Brody, Deborah Curry, Penny Asbury, Carla Campbell, Malinda Turner, Lora Adkins, Dalena Riggs, Anna Reno, Lew Holloway, Kathryn Greenlief, Elizabeth Richmond, Sonnie Strader, Georgianna Tillis, Crystal Welch.

Dennis McCutcheon called the meeting to order and guests were introduced.

Call to move consent agenda - Carla See/Tom Hefner. Consent agenda was unanimously approved.

Committee Reviews & Group Reports

Faculty Development Committee - Dan Brody reported that the Faculty Development Committee is working on feedback received concerning Interdisciplinary Sessions/Interdisciplinary Experiences (IDS/IDE), service learning. The committee has met with school representatives over the past few months to receive feedback about what students are saying about IDS/IDE and service learning experiences. This has allowed the committee to get good feedback and come to consensus. The Committee also met with Schools/Curriculum Committee today and discussed some of our recommendations.

Identified issues around IDS/IDE and service learning are that quality, time and driving are an issue. The Faculty Development Committee will look at these comments and design IDS so that it is relevant to students and curriculum needs to schools. This can be accomplished through attaching objectives to IDS and addressing specific disease processes. Input from schools as to what objectives should be included will be assessed by the committee. Dr. Brody shared an example case IDS on oral health. HP 2010 objectives are chosen. For this case the objectives chosen would be how to perform an oral exam in a non-dental setting. Next, design a program that would help prevent dental caries and add a reflective piece for the student.

IDE is where a student shadows with another discipline when there are not enough disciplines present to hold an IDS. The committee is recommending that the schools incorporate all the interdisciplinary and service learning objectives a separate grade so that students are more compliant and see more value. Currently these experiences are considered in the overall grade by some schools and not by others.

Evaluation Committee - Jodie Jackson discussed data on the most recent SERFE Evaluation with the committee. Response rate for SERFE was much better this time going from 59% to 77%. The Evaluation Committee is very pleased with the response rate. Mike discovered that he was not sending out as many email reminders when a student had not filled out the survey due to a glitch in the programming. Students are now getting three reminder emails and this is believed to have assisted in the increase in the response rate.

Recruitment and Retention Committee – Alicia Tyler reported that the committee met this morning and had several presentations. Jodie presented on data from the PERD evaluation (will be sharing with committee this afternoon) Sharon Lansdale discussed two programs funded by Robert Wood Johnson. These are the Coordinated Placement and Rural Health Fellowship Programs. Each year we look at a 6 year cohort of medical school graduates – 39% are staying in state – and this is higher than the national average. We are emphasizing more residency training – retention is higher if primary care residency training is completed in WV. The retention rate increases to 79%. Alicia discussed state financial incentive programs with RHEP/AHEC activities. 40% of those that did an RHEP/AHEC rotation received financial incentives for physicians and 45% for Nurse Practitioners and Physician Assistant’s. Eight medical students received $20,000 awards. Six Nurse Practitioners received $10,000 and this year for the first time two Physical Therapy students received $10,000 each. Alicia directed those interested in more information to the website at www.wvhealthcareers.org

There is a lot of information that is searchable on health profession programs. Alicia encouraged people to look at the website and provide feedback/input.

Alicia announced that Dr. Weston has adopted a second daughter and her name is Olivia.

Joint AHEC/RHEP Meeting – Kathryn Greenlief and Deborah Curry reported on the first joint meeting of AHEC Center Directors and RHEP Site Coordinators. This meeting was to develop the process for future meetings and was held in February. The two groups came together to improve communication and discuss issues that impact both programs. The groups will be meeting every 2-3 months. IDT rotations, for example take both RHEP and AHEC to make it successful.

Strategic Planning Workgroup – Hilda reported on the progress of the workgroup. Hilda referred the group to the handout from Marsha Boggess in the panel’s information. Hilda said that the task force developed at the end of the strategic planning session in November 2005 would be moving forward on certain recommendations. The Task Force met in February. All schools are increasing their enrollments – the committee will be looking at the impact of increasing enrollments and how will we make it fit with the program’s mission and vision for the future.

Special Presentation

Jodie Jackson presented on Highlights from the Recruitment Research for the PERD Report (see text of presentation below).

RHEP Grad Survey, 2005

• 427 out of 643 RHEP grads responded to the questionnaire for a 66% response rate

– 164 physicians (83 DOs; 81 MDs)

– 130 pharmacists

– 85 RNs

– 80 PAs

– 70 dentists

– 58 NPs

– 34 PTs

– 17 DH

– 3 MT

– 1 OT; 1 CNM

Influence on Rural Practice Decisions

• 58% said that their RHEP rotation strengthened their commitment to rural health

• 9% said that they would not have gone into rural practice had it not been for RHEP

Open-ended Comments
How did RHEP influence your decision to enter rural practice

• “My RHEP experience dispelled some myths about rural practice (ie, not financially rewarding, not a good spectrum of procedures, etc)” (dent)

• “I grew up here and feel comfortable here, but without the FIP, I probably would have had to practice in a large city” (medicine)

• “Very, very good experience Never thought about rural at all before RHEP Now wouldn't do anything else” (NP)

• “Mentors who were dedicated to their patients & to their profession” (PA)

More Verbatim Comments

• “Was offered a job during my rural rotation This was the number one influence. I am still at that job.” (dentist)

• “My rural rotation was the best six weeks of my life. I loved the location and am going into practice with my rural rotation Dr.” (dentist)

• “Through rotations--I did 3 times more than required. I saw what was needed to take care of the underserved in WV, and I wanted to be part of it. This sums it up!” (medicine)

• “Helped me recognize the need for quality committed care to underserved, indigent clients Helped strengthen my commitment to the true joy of medicine--helping those in need regardless of income or insurance status.” (NP)

RHEP influence

• Percentage that completed training as a student or resident in any of the rural communities where they subsequently worked?

As an RHEP/AHEC student: 50%

As a non-RHEP/AHEC student: 19%

As a resident: 5%

Other Important Influence

• % working in their home town: 40%

RHEP’s Role in
Preparation for Rural Practice
Top 3 choices, all disciplines

• RHEP gave them a better understanding of rural communities and patients (65%)

• RHEP provided experience in primary care (64%)

• RHEP gave them experience with health care of the poor (58%)

Accessibility of their practice site to indigent patients
(med only)

• My practice site accepts all patients, regardless of their ability to pay. (76%)

• My practice site accepts indigent patients, but with some limits on numbers. (23%)

• My practice site almost always directs indigent patients elsewhere. (1%)

Transition to RHEP Field Professor

• Are you currently an RHEP/AHEC preceptor or field professor?

– All disciplines = 35%

– Medicine: 58%

Top 3 Reasons for being a Preceptor

• I find teaching is personally rewarding. 72% (medicine = 85%)

• Teaching helps me stay current in my profession 64% (medicine = 73%)

• I feel that I owe it to my profession 58% (medicine = 70%)

The RHEP Annual Recruitment Report

• First report: 1999

• The annual recruitment report gives the number of RHEP grads in rural practice at that point in time. RHEP has actually recruited more because, as to be expected, not all stay.

RHEP grads are making a difference in underserved areas

• Between 1995 and 2005, 8 whole-county HPSAs lost their HPSA status.

• Our 2004 R & R report showed that we had 20 physicians who were RHEP grads practicing in these 8 counties serving a population of 147,158

Retention

• Response to: “Are you still working in your first rural practice?”

– All disciplines: 70%

– Medicine: 76%

Retention of RHEP grads in rural areas from 1999-2004 (6 yrs)

Executive Director’s Report

Hilda reported that April 26-27, 2006 is the Health Resources and Services Administration (HRSA) federal program review for the AHEC program. Conference calls are being held to come up with measures they are going to be reviewing. One of the measures discussed is what students report in terms of quality of AHEC IDT’s and RHEP IDS sessions and if there are differences.

Another is the percentage of people who go through training and wind up in rural areas.

Federal advocacy efforts- The Congressional budget season has started. The first step is to get letters of support from rural health coalitions etc. Hilda said that she was pleased to announce that the house rural health coalition circulated their letter and the entire West Virginia delegation has already signed on. Direct phone calls are critical to influence the positions that elected officials take. This was demonstrated by the fact that one Representative who was on the fence last fall, was the first to sign the letter this year. This was very successful.

We are currently working nationally with coalitions for Title VII “family” funding and the NRHA is working to look at sending a message that cutting rural programs is not acceptable and that eliminating health programs in rural areas is not acceptable. Twenty-five counties of our RHEP program were covered by the Mountain State Geriatric Education Centers (MSGEC) Program and that program was eliminated. Chuck commented that loss of this funding was detrimental to many programs in which we are trying to get students to understand. Alicia said that Melissa Wheeler reported in the Recruitment & Retention meeting that federal money for the state loan repayment program was cut in half this year. Hilda said that Shelley Moore Capito made an effort to educate herself about these programs. She specifically asked for additional education on the Title VII program.

Hilda said that we will not have to do another Legislative audit through PERD until 2009.

The Rural Health Initiative Advisory Panel Legislation was continued during the session until June 30, 2009, giving RHEP a three year reauthorization.

The Governor will have to re-appoint all members to the panel as of July 1 of this year. Hilda needs to know if current members are going to be re-appointed or if someone else is going to be appointed from the local board. We also need a very short (paragraph) biography on each member. Kim will send you the bio we have on file and you can update this. Updates are needed by May 30. There are some vacancies that have not been filled. One is the vacancy for private schools. Hilda asked for two members from panel to appoint vacancies to the panel. Sandra Pope and Haylee Heinsberg volunteered to assist.

Dennis asked that Hilda prepare a letter to Senator Bowman thanking him for his support.

Search committee for a director of development - Hilda asked for a community member to volunteer for the search committee for this position. Sharon Giles, Parr Thacker and Chuck Conner volunteered to assist from Finance. Hilda also plans to ask Beverly Walter. Tom Hefner volunteered to assist.

Tom requested that when the Legislature passes the budget, that Hilda send an email out to the partnership.

Carla See announced that the WVU School of Pharmacy has hired a new dean of the School of Pharmacy. Patricia A. Chase, Ph.D. is presently serving as Dean at the Butler College of Pharmacy and Health Sciences in Indianapolis, IN. Dr. Chase will begin serving as WVU SOP Dean on July 1. Dean Spratto will retire at the end of July.

Dr. Chase is a big supporter of experiential education and supporter of rural health.

Kellogg foundation had its 75^th anniversary recently and sent a publication. Anyone welcome can have these. The four original Kellogg sites take one for their library.

Other Announcements

State Health Education Council (SHEC) Conference – April 30 – May 3, 2006 – Patricia Crawford is the Chair. The conference will be held at the Radisson in Morgantown, WV. Please consider attending the conference.

NRHA Conference in Reno NV – AHEC presentation and Hilda presenting on Veteran’s rural needs.

With no further business, the meeting was adjourned.