Oklahoma Rural Health Conference Free Rides: A Pilot at a Rural Pediatric Clinic Marjorie Erdmann, Ipe Paramel May 29 th 2019 Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Objectives 1. Discover the methods used to develop the transportation solution 2. Understand the financial cost/benefit to the clinic in providing rides and explore a sustainable model. 3. Recognize the impact transportation had to the patients as well as to the clinic. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
What do Rural Clinics Need? Patients without Transportation are Decreasing Rural Health Capacity n=34 Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Crossroad of Health and Business: Rural Patients without Transportation Patient Health Detriment Clinic Capacity and Financial Detriment Need for care goes unattended. No show/Cancellation is in schedule. In OK, lack of transportation assistance Appropriate primary care/medical at time of urgent need which home care billing lost to ER. contributes to non emergent ER utilization) SoonerRide (Medicaid) restraints: Patients without rides are blind to the • patients have to schedule themselves, clinic until no show, cancellation, late three-day constraint for service, arrival, walk-ins. • limit on number of passengers per request, • address matching SoonerCare registered address. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
ROK-Net Clinic Volunteered for Transportation Pilot • Muskogee, OK – 39,000 population – County seat – Closest Urban Area (Tulsa) 50 miles • Pediatric Clinic: 2 Docs, 1 NP – Concern about patient ER Usage – Sick care more needed by pediatric patients: new problems higher percentage than adults (CDC) – High No-Shows (average 120 in a month) – High number of Medicaid patients – Young Parents: More likely without vehicles • ROK-Net Member, Efficiency Study Participant, AND OSU Care Management Clinic (OSU HAN) Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Solution and Study Ideation Who Needs Transport? – 80% of no-show patients address within 10 miles of trial clinic. – Parents with multiple children seeking urgent care. – Parents who may or may not be at their SoonerCare address. How Can the Clinic Retain Control of Transport Coordination? – Transportation need assessed at time of call requesting an appointment. – Transportation need assessed at time of reminder of appointment calls. – Schedulers immediately able to schedule transportation for patient online. How to Collect measures of use, cost, and satisfaction? – Dedicated car and driver over 2 test phases totaling 8 weeks. – Yellow Checker Cab: for platform with robust transportation metrics. – Clinic Administrator: for type of visit, transported patient diagnosis, billed and collected claims amounts. – Patient Survey for satisfaction and feedback. – OSU HAN case manager: for clinic patient ER utilization for days of transportation trial. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Transportation ROK-Net Partners at Children’s Clinic in Muskogee Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Two Phases for Pilot Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
“Free Ride” Findings Muskogee Pediatric Clinic Transportation need is less visible on a daily basis “drip, drip, drip” but adds up significantly and is decreasing both capacity and revenue in rural clinics. Free ride program days where at least one patient 78% transported. Average number of patients on those days that needed a ride 2 Most Patients transported in one day 4 Average mileage transported to the clinic 3.18 Total miles transported, both phases (31 more miles in fall vs 213.38 spring) Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Patients Transported patients in 31 days. 44 Categorized “sick” by office visit type (sick, 71% well, new, ADHD, Lab) Medicaid primary payer 96% Paid Claim with Medicaid 100% Round trip transportation 91% Different diagnoses 84 ER visits of transported patients during 1 entire duration of program : SUNDAY visit to ER No-showed a free ride 0 Ambulatory, no disability transportation 100% requests Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Transportation Need Families transported 25 Had missed appointment previously 100% due to no ride. Had no alternative ride by 96% appointment (2 of 44 did.) Of transported patients reported 100% missing appointments in the past due to no ride Morning Transportation Need 66% Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Transportation Need Intermittent vs Regular Need Intermittent Need: 55% “Never, Occasionally, Rarely” Regular Need: 45% “Frequently and Always” Single Utilization Patients 84% (21 of 25) Multiple Utilization Patients 16% (4 of 25) Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Clinic Revenue $4,255.75 Total Collected for 44 transported patients Average collected per transported patient $96.72 Dollars collected/transportation day (31 days) $137.28 Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Transportation Cost YCC Dedicated Car: Total Cost for 31 days $4,960 $160.00 YCC per day rate 44 patient transported calculates a per patient cost $112.00 Pay Per Ride: Total Cost of YCC Fare All Rides: 213.38 miles $651.38 Average Cost per Patient by Yellow Checker Cab Rate/Round Trip: $19.44* 6.36 miles round trip *Verified comparable to other On-Demand rates Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Solution: Dedicated Car 2 Patients/Day (study result) 3 Patients/Day (study result) Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Solution: Pay Per Ride 3 Patients/Day (study result) 2 Patients/Day (study result) Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Patient Survey Quotes Patients Appreciated On Time Service: “Driver was on time so appointment was on time.” “He was on time, even early.” “The ride was on time.” “They were on time and needed to not call days in advance.” “My kids and I were transported to appointment on time.” “It was prompt.” “I was able to make my child’s appointment.” ”On time, great service!” Patients Appreciated Convenience of Service “It was convenient. It wasn’t a headache trying to find a ride.” “Didn’t have to walk on my foot that had surgery.” “Gives me the ability to seek medical attention for my kids.” ”Didn’t have to cancel appointment, easy to use.” “This needs to be an everyday thing.” Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Potential Scope of Problem • Number of visits in a year in Oklahoma where pediatric patients were unable to access primary care due to no transportation - 52,386 • Number of visits in a year in Oklahoma sick pediatric patients were unable to attend - 36,909 • Every 2.5 minutes a pediatric patient misses their primary care visit due to lack of transportation. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Next Steps CHSI is interested in further solving the No-Show and Transportation gap need throughout Oklahoma. If you are interested please contact us: marjorie.erdmann@okstate.edu ipe@okstate.edu Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Oklahoma Rural Health Are Community Health Workers A Viable Solution? Lessons Learned from Developing a Diabetes Training for CHWs in Oklahoma Kerstin M. Reinschmidt, PhD, MPH − OUHSC Terence D. Gipson, MPH − OUHSC Angel E. Giron Lopez, BS − OUHSC Marisa New, MPH, OTR − OSDH Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Learning Objectives Objective 1: Describe outcomes and lessons learned from developing a diabetes training for CHWs in Oklahoma Objective 2: Explain how the CHW diabetes training project aligns with statewide and national efforts related to the CHW workforce Objective 3: Assess in which ways conference participants can apply the CHW diabetes training to the rural health delivery system in Oklahoma Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
APHA’s CHW Definition (2009) Frontline public health worker Trusted member of the community served Intermediary between health/social services and the community Helps provide culturally appropriate services Builds individual and community capacity Performs a broad range of activities Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Contributions of CHWs Public Health Interventions Deliver community-based public health programs in underserved communities Promote positive lifestyle behavior changes Disease Prevention and Management Improve chronic disease management (BP and HbA1c) Enhance disease prevention and screening Cost Savings Facilitate insurance enrollment Reduce unnecessary health service utilization Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Developing a Diabetes Training for CHWs in Oklahoma Aim 1: Identify current roles, training, and expressed needs of CHWs in Oklahoma Aim 2: Develop a CHW diabetes training Aim 3: Test the CHW diabetes training Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Aim 1: Identifying Current Roles & Trainings, and Expressed Needs Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Aim 1 Outcomes – 1 Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Aim 1 Outcomes – 2 CHWs are team members in clinical and community contexts CHW trainings include Basic CHW training In-house Online CHW certification College degree Evidence-based diabetes education Various other training venues and topics Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Aim 1 Outcomes – 3 Roles Connect to health and social services Screen for and address social determinants of health Provide care management Motivate engagement with medical team and health Provide diabetes education Engage in community outreach Conduct home visits Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Aim 1 Outcomes – 4 Beyond Roles: Qualities Establish trust relationships with the patients/clients and the community Have compassion, heart, and passion Are available Benefits to clients, team, and organization Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Aim 2: Develop a CHW Diabetes Training Curriculum Outline Develop a best-practices diabetes training based on Introduction Knowledge gained about The CHW Workforce CHW roles, trainings, needs Basic Knowledge of Current national CHW role Diabetes recommendations (C3) CHW Roles in Addressing Evidence-based self- Diabetes (C3) management programs CHW Self-care Appendices Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Aim 3: Test the CHW Diabetes Training May 31, 2019 Training evaluation Mixed methods pre- Conduct training to and post-tests test for effectiveness Document verbal in increasing CHW feedback capacity Results will serve to revise the training Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Lessons Learned Challenges Interests and Needs Encountered Standardized CHW training Recruiting 10 CHW certification organizations Add health focus Number of CHWs Have diverse CHW models CHW concentration in Educate about and urban areas (?) advocate for CHW workforce Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
The Community Health Worker Core Consensus (C3) Project https://www.c3project.org/ and Rosenthal EL, Redondo F , Hirsch G. 2018. Together Leaning Toward the Sky. The Community Health Worker Core Consensus (C3) Project - A Report of the 3 Project: Phase 1 and 2. A National Project to Inform Community Health Worker Practice and Policy. Texas Tech University Health Sciences Center El Paso, Texas. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
CHW Scope of Practice (C3) 1. Cultural Mediation Among Individuals, Communities, and Health and Social Service Systems 2. Providing Culturally Appropriate Health Education and Information 3. Care Coordination, Case Management, and System Navigation 4. Providing Coaching and Social Support 5. Advocating for Individuals and Communities 6. Building Individual and Community Capacity 7. Providing Direct Service 8. Implementing Individual and Community Assessments 9. Conducting Outreach 10. Participating in Evaluation and Research Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Competencies: CHW Skills (C3) 1. Communication Skills 2. Interpersonal and Relationship-building Skills 3. Service Coordination and Navigation Skills 4. Capacity Building Skills 5. Advocacy Skills 6. Education and Facilitation Skills 7. Individual and Community Assessment Skills 8. Outreach Skills 9. Professional Skills and Conduct 10. Evaluation and Research Skills 11. Knowledge Base Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Competencies: CHW Qualities (C3) Connected to the community Mature Friendly/outgoing/sociable Patient Open-minded/non-judgmental Motivated and capable of self-directed work Caring/compassionate/empathetic Committed/dedicated/desire to help the community Respectful Honest Open/eager to grow/change/learn Dependable/responsible/reliable Persistent Creative/resourceful Flexible/adaptable Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
CHWs in Oklahoma Oklahoma State Department of Health OCCHD Wellness Now Coalition 2017 White Paper on CHWs in OK 2019 CHW Work Group CHW Taskforce ( Health Workforce Subcommittee Oklahoma Public Health of the Governor’s Council for Workforce and Economic Development for partnership) Association Adapted APHA definition 2019 CHW Section Advocated for voluntary certification Other CHW projects in Oklahoma Hudson College of Public Health Oklahoma Public Health Training Center Grants submitted in 2018 & 2019 Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
In summary: CHWs work! They also work in rural areas... Build and support a strong CHW workforce Nothing about CHWs Adopt C3 recommendations Seek & support standardized CHW training without CHWs! Advocate for CHW certification Build programs with sustainable funding Explore various CHW models CHWs work in clinical AND community-based organizations Train CHWs to address various diseases as locally needed Tie in with NEW state and national organizations Oklahoma Public Health Association’s CHW Section National Association of Community Health Workers Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Questions? Suggestions? Comments? Acknowledgements Presbyterian Health Foundation for financial support Thank you CHW Taskforce of the Health Workforce Subcommittee of the Governor’s Council for Workforce and Economic Development for partnership Contact Information: Organizations and employees for Kerstin-Reinschmidt@ouhsc.edu their time and insights MarisaN@health.ok.gov Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Can Employee Fitness and Nutrition Lower Costs up to $1 Million? Lucy Muller, MSHR McAlester Regional Health Center HR Generalist Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Employee Wellness Program Background Chronic diseases such as obesity, diabetes and heart disease are highly prevalent health issues in America associated with a number of unhealthy behaviors including bad diet, not exercising and use of tobacco products (Ryan et al., 2019). Employee health issues have a high value for organizations (Jimènez, Winkler & Dunkl, 2017). Basic goal of an employee wellness program is to skills, knowledge and motivation for employees to maintain a healthy lifestyle (Hicks & Schmidt, 2016). The over-arching goal is for employees to take their skills, knowledge and motivation out to the community (Hicks & Schmidt, 2016). Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
MRHC and Our Results 95% of employees and covered spouses participation rate. Business standard is 67%. 88% of participating individuals scored in the normal range for Glucose. Business standard is 88% Over the last three years: Improved BMI of participating individuals by 1.73% Improved blood pressures of participating individuals by 25% Improved total cholesterol of participating individuals by 14% High risk individuals decrease in our self-funded medical plan from 17 to 9 individuals A reduction of paid claims of $1.2 million. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Components of an Effective Employee Wellness Program Biometric Screenings Tobacco Screening An online health assessment Activities to promote healthy lifestyle Examples: Incentives for primary care visits Incentives for preventative screenings such as mammogram, colonoscopy, etc Healthy coaching Rewards Disincentives Communication, Communication, Communication Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Leader Participation An effective employee wellness program is only effective if you have participation from your CEO down. CEOs and other executives should be first in line to participate in the required events. No employee should be exempt from 100% not participating including executives and physicians. Your biggest employee wellness marketers are your HR representatives and your middle managers. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Biometric Screening Waist Circumference Blood Pressure Total Cholesterol Triglycerides Glucose Also taken but not measured for the program: BMI Body Fat LDL HDL Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Tobacco Screening Negative cotinine swab Enrollment in cessation program Not required to complete program 1-800-QUITNOW through TSET Online options Program through physician Prescription for cessation products; however, not OTC Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Building an Employee Wellness Program Year 1 Create a baseline for employees Biometric Screenings Health Assessment Tobacco Educate employees Take a hands on approach to questions and training Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Employee Wellness Program: Year 2 Biometric Screenings Tobacco Screening Health Assessment Implement rewards and disincentives Offer challenging and fun activities to help boost moral Continue communication and education Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Employee Wellness Program: Year 3 Review aggregate employee information to identify trends Add programs/activities to target those trends Continue the annual biometric screening, tobacco screening and health assessment Continue implementing the rewards and disincentive programs Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Point Requirements Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Rewards MRHC: Requirements: Biometric Screening, Online Health Assessment and 550 Points Negative Tobacco Screening or Enrollment in cessation program Examples: PTO PTO 550 Points – Discounted Premiums 650 Points – 4 Hours HSA Contributions 750 Points – 8 Hours Gift Cards 850 Points – 16 Hours Taxable bonuses 950 Points – 24 Hours Discounts on health premiums 1100 Points – 32 Hours HSA 550 Points – Discounted Premiums 650 Points -- $50 750 Points -- $75 850 Points -- $100 950 Points -- $200 1100 Points -- $300 Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Disincentives Examples: MRHC Increased health premiums Requirements: Lower PTO Rates Biometric Screening, Online Health Assessment and 550 Points No paid sick time Negative Tobacco Screening or Enrollment in cessation program $25 additional health premium for employee not completing the Biometric, Online Health Assessment and 550 Points $25 additional health premium for not meeting tobacco requirement $25 additional health premium for spouse not completing the Biometric, Online Health Assessment and 550 Points $25 additional health premium for spouse not meeting tobacco requirement Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Activities to Boost Employee Wellness Program Steps Challenge Most employees are already Biggest Loser working to get 10K steps in due to the nature of their job. Do not use biggest loser to address weight issues within your Another tool to use for motivation. population. Use the steps challenge as another Use biggest loser as a tool of way to market your employee motivation. wellness programs and promote healthy lifestyle choices! Score all aspect of a weight loss challenge including pounds lost, inches off waist and hips lost and percentage lost. Use biggest loser as an 8 week timeframe to market your employee wellness programs and promote healthy lifestyle choices! Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Employee Wellness Week One week of the year truly devoted to employee wellness. Examples of great ideas: Physician led discussions on hot health topics HR led discussions on HR issues such as the importance of vacation, the Employee Assistance Program and other health benefit information Dietician led cooking demonstrations Fitness trainer led exercise demonstrations LPC led sessions on mental health issues Financial professional led sessions on financial wellness Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Who’s on Point? Communication is key. You have to know who your targets are in the employee wellness program and make sure you are hitting them. Emails Letters Face to face meetings Consistency is also key. Make sure that biometric screenings and due dates are consistent from year to year. Due dates are the same each year. Try to not spread out too much Having a specific person or group is much more effective than a round robin approach Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
What’s After Year 3? Start looking at your data and look to your next direction. Information share with other communities. Invite local community and business leaders to your organization and view your results Team up with marketing to market how your organization can help communities build their own employee wellness program Examples: Send residents out to businesses to do wellness checks for employees Send your therapy team out to teach how to properly lift Send your cardiologist out to business to discuss heart heathy initiatives Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
How Does Employee Wellness and Community Wellness Relate? Healthcare employees are the biggest marketers of his or her healthcare organization. Healthcare employees take their knowledge and skills home to their families, friends, neighbors and even their patients. A successful employee wellness program not only sparks conversations and motivations regarding healthy lifestyle behaviors in the workforce, but also I the community. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Conclusion Employee Wellness Programs are valuable to organizations because it shows employees that their health is valued while introducing cost savings to the health plan. Employee Wellness Programs need a structure that is well-defined and well- communicated. Employee Wellness Programs need to be in an environment that boosts morale by providing education and fun to the activities process. Employee Wellness Programs should be consistent with rewards and disincentives. Employee Wellness Programs can be visible to the community and knowledge gained and services provided by the organization promoted. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
References Hicks, L., & Schmidt, D. (2016). The healthy diploma and healthy titans: Two innnovative campus programs for progressive student, profession and community outcomes. Kinesiology Review. (5) 269. Jimènez, P ., & Winkler, B., & Dunkl, A. (2017). Creating a healthy working environmnet with leadership: The concept of health-promoting leadership. The International Journal of Human Resource Management. (28) 17. Ryan, M., McGovern, L., McCabe, K., Myers, K., Nobrega, S., Wenjun, L, Wen- Chieh , L. & Punnett, L. (2019). “Working on Wellness:” protocol for a worksite health promotion capacity building program for employers. BMC Public Health. (19) 111. Serving as a united voice for Oklahomans in the promotion of rural health issues through advocacy, education, and leadership.
Going Country: How to Highlight the Advantages of Practicing Medicine in Rural Oklahoma RURAL RECRUITMENT PLAYBOOK FOR OKLAHOMA 2019 Oklahoma Rural Health Conference
Dane Altman Senior Vice President Jackson Physician Search daltman@jacksonphysiciansearch.com JACKSON PHYSICIAN SEARCH Partnering with hospitals and healthcare facilities across the country in permanent physician placement for over 40 years. 95
LEARNING OBJECTIVES 1. How to effectively articulate the advantages – and transparently address the challenges – that are part of practicing in your rural community with physician candidates. 2. Identify best practices for recruitment into rural communities that can be adapted and implemented to address their unique challenges. 3. SWOT analysis of individual organization and community as it pertains to physician recruitment. 96
RURAL RECRUITMENT PLAYBOOK OUTLINE State of the industry and trends in rural physician recruitment Emerging strategies for recruitment into rural communities. How to use your culture to drive engagement and recruitment success. Measuring success and driving benchmarks. 97
STATE OF THE INDUSTRY Demographic trends continue to be the primary drivers of increasing demand from 2015 to 2030. Projected physician shortfall between 40,800 and 104,900 by 2030. If underserved populations had Physician’s retirement decisions are projected standard care utilization patterns , to have the greatest impact on supply . demand for physicians would rise substantially . Medical School Graduates Outnumber Residency Slots Visa Processing Backlog and Limits on Treatment Activity by Foreign Travel Advanced Practice Providers Restrictions Source: “The Complexities of Physician Supply and Demand 2017 Update.” IHS Markit for Association of American Medical Colleges. February 2017 98
ACUTE SHORTAGE OUTSIDE OF MAJOR CITIES About 20% of Americans live in rural areas where many do not have easy access to primary care or specialist services Less than 8% of physicians practice in rural areas Source: Trend Watch, American Hospital Association; Doximity 4
COMMUNITY IMPACT Adding (1) Physician to a community of 10,000 people is associated with a 5.3% reduction in average mortality. Each physician supports 14 jobs and $2.2 million in economic input for a community. 100
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