Strategies for Developing a Rural Physician Workforce Kayse M. Shrum, D.O. President, Oklahoma State University Center for Health Sciences Dean, College of Osteopathic Medicine
MISSION AT OSU MEDICINE OSU College of Os OSU College of Osteopathic Medicine educates teopathic Medicine educates os osteopathic primar teopathic primary care ph y care physicians with an emphasis icians with an emphasis on ser on serving ing rur rural and under and underser erved Oklahoma. Oklahoma. 2
OKLAHOMA’S POOR HEALTH STATUS #35 primar primary care phy y care physicians icians #43 over #48 car overall health all health cardiovascular deaths iovascular deaths #44 premature deaths premature deaths United Health Foundation’s 2017 America’s Health Rankings Annual Report 3
PRIMARY CARE PHYSICIAN SHORTAGE 76 HPSA Counties 127.5 PCPs per 100,000 10 Counties With 1 PCP 3 Counties With no PCPs 2018 County Health Rankings & Roadmaps 4
AGING RURAL PHYSICIAN WORKFORCE average age of rural percentage of rural primary care percentage of rural primary care primary care physicians physicians over the age of 55 physicians over the age of 65 5
OSU MEDICINE GRADUATES SELECTING PRIMARY CARE RESIDENCIES (1977 – 2018) 62% 62% aver average since 1 age since 1977 producing greates pr oducing greatest % % of of TOP 20 TOP 20 primar primary care residents y care residents 6
RURAL PHYSICIAN PIPELINE MODEL Place in Rural Recruit from Rural Residencies Communities Train in Rural Clinical Settings 7
RURAL ENRICHMENT PROGRAMS Dr Dr. Pe . Pete’s Medical Immer ’s Medical Immersion Camp ion Camp Blue Coat to White Coat Blue Coat t White Coat Native Explorer Native Explorers Operation Or Oper ation Orange ange OKS OKStar ars 8
ENRICHMENT PROGRAMS BY THE NUMBERS Oper ation Or ange Blue Coat to White Coat 700 750 par tic ipants annually par tic ipants annually 9
TRIBAL ENGAGEMENT WITH RURAL TALENT IDENTIFICATION Operation Immersion Native OKstars Orange Camp Explorers Cherokee Nation Choctaw Nation In Chickasaw Nation discussion 10
11 13% 11 % MEASURABLE OUTCOME 16% 11%
MEASURABLE OUTCOME: OSU MEDICINE CLASS OF 2018 GRADUATES 16 16 American Indian medical gr American Indian medical graduates aduates 14 14% of the gr of the graduating class aduating class Tribal Nations ibal Nations Represented: presented: Cher Cherokee Nation okee Nation Chic Chickasaw Nation kasaw Nation Choct Choctaw Nation of Oklahoma w Nation of Oklahoma Muscogee (Creek) Muscogee (Creek) Nation Nation Osage Nation Osage Nation Seminole Nation of Oklahoma Seminole Nation of Oklahoma 12
3+1 ADMISSIONS PROGRAMS Acceler Accelerated medical pr ted medical progr ogram am Interest in pr Interes in practicing rur acticing rural l primary care medicine primar y care medicine Partner Par nerships with regional hips with regional universities and OSU Stillwat univer sities and OSU Stillwater 13
3+1 ADMISSIONS PARTNERING UNIVERSITIES Rogers State University Northwestern OSU University Alva Oklahoma State University Claremore Langston University Stillwater Tulsa Tahlequah University of Central Oklahoma Langston Southwestern OSU University Northeastern State University Edmond Weatherford Cameron University East Central University Ada Lawton Southeastern OSU University Durant 14
RESIDENCY PROGRAMS 2008 SNAPSHOT OSU Medical Center 130 slots (multiple) Integris SW Medical Center Tulsa 36 slots (emergency medicine) St. Anthony’s Hospital Oklahoma City 27 slots (OB/GYN & family medicine) Alliance Durant 14 slots (family medicine) Urban ‐ based residency program Rural ‐ based residency program Durant 15
RESIDENCY PROGRAMS 2018 SNAPSHOT Since 2008… 6 new rural residency programs, 118 new rural residency slots Ada: 12 slots Ada: 1 slots (family medicine) (f amily medicine) Tulsa Lawton: 28 Lawt on: 28 slots slots Tahlequah Oklahoma City (family & (f amily & emer emergency medicine) gency medicine) McAlester McAles ter: 23 23 slots slots Norman (family (f amily & int & internal medicine) rnal medicine) McAlester Norman: 2 Norman: 24 slots slots Ada (emergency (emer gency medicine) medicine) Talihina Lawton Tahlequah: 22 ahlequah: 22 slots slots (f (family amily & int & internal medicine) rnal medicine) Durant Talihina: 9 lihina: 9 slots slots (family medicine) (f amily medicine) 16
KEYS TO RURAL RESIDENCY SUCCESS EDUCATIONAL AND FUNDING PARTNERSHPS Community Tribal and and local Community support Health Partners $3.08M one ‐ time, Tobacco non ‐ recurring $3.8M grant in Settlement State appropriation in 2015 Legislature Endowment OSU 2012 Trust Medicine Rural Residencies Health HRSA teaching health Oklahoma Resources center grants in 2013 $5.6M grant in Health Care and ($150K per year for 2015 Authority Services 60 residency slots) Admin. 17
RURAL PIPELINE HOTSPOTS In negotiations to The Rural Physician establish residency program Pipeline Trifecta Effect: Enid 1. Operation Orange High School Enrichment Program 2. 3+1 Admissions University Partner Tulsa 3. Residency Program Partner Tahlequah In negotiations to Ada establish Operation Operation Orange Orange camp Lawton 3+1 Partner University Rural Residency Program Durant 18
NATION’S FIRST TRIBALLY AFFILIATED MEDICAL SCHOOL Partnership with the Cherokee Nation Located in Tahlequah, OK 60,000 ft 2 dedicated space on W.W. Hastings campus Full four years of medical school curriculum Up to 50 medical students per entering class Target date for enrollment: Fall 2020 19
SHORT-TERM SOLUTION TO RURAL PHYSICIAN SHORTAGE Project ECHO Evidence ‐ based knowledge and best practices from OSU ‐ CHS is pushed out to clinicians, cooperative extension offices, and school districts in rural communities 20
PROJECT ECHO SERVICE LINES Addiction Adult Pediatric Viral Obesity Alzheimer’s Hepatitis C Medicine Psychiatry Psychiatry Disorders Medicine 21
PROJECT ECHO MEASURABLE OUTCOME January 2017 – August 2018 261 clinics 1,967 participants 223 cases presented $23 MILLION in cost savings 22
POLICY RECOMMENDATIONS • State funding for residency models that reduces dependence on Medicare funding Create Innovative • Federal support for THC should become permanent Models for 1 • New federal programs aimed at physician Non ‐ Traditional workforce should be created Residencies 2 Support • Establish recurring state funding for programs Technology ‐ Enabled Policy like Project ECHO Care Delivery • Fund tele ‐ extensions Recommendations Models pilot programs 3 to Address Rural Physician Shortage • Increase funding for physician Expand Loan loan forgiveness and tuition subsidy programs Forgiveness and • More effective guidelines to Tuition Waiver target rural and underserved Programs areas 23
T HANK YOU! Kayse M. Shrum, D.O. President, Oklahoma State University Center for Health Sciences Dean, College of Osteopathic Medicine kayse.shrum@okstate.edu 24
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