by Beth Blevins
Remarkably, less than a year after the Idaho State Office of Rural Health (ID SORH) set a goal to find new funding for a physician loan repayment program, the state legislature appropriated $640,000 annually for it.
“It’s something we’re thrilled about,” said Mary Sheridan, ID SORH Director. “I think it points to the reasons we take advantage of new opportunities, even though we may be unsure of the ultimate outcome.”
That opportunity was a three-day meeting in June 2017, convened by the National Conference of State Legislatures (NCSL), on “Challenges and Innovations in Rural Health Policy.” Sheridan attended the meeting along with three Idaho state legislators, the Primary Care Office Program Manager, and deputy administrators from the Division of Public Health and Division of Medicaid.
The NCSL event, funded through a cooperative agreement with the Health Resources and Services Administration, included presentations from rural health policy experts and state-specific team meetings for developing collaborative action plans to improve rural health. Idaho was one of eight states attending.
“Our team there identified three goals: securing reimbursement and funding for community paramedic programs, securing funding for loan repayment, and expanding telehealth,” Sheridan said. “Afterward, the team typically met monthly to share updates and progress on all project goals. The on-going support from NCSL post-meeting was truly helpful in moving the loan repayment legislation forward.” Members of the team are currently working on the other two goals, Sheridan said.
It was a team effort that got the loan repayment legislation to the floor in the next (January 2018) legislative session. “One strategy was for me to provide a presentation on loan repayment and physician shortages to the Idaho legislature’s Health and Welfare committees,” Sheridan said. “Team members made it happen. They worked with legislative leadership to schedule it on the calendar and NCSL actually came to that presentation and lent their support. The Idaho Medical Association worked actively with legislators on the issue and it went from there.” A legislator who was on the team introduced House Bill (HB 472) to fund the loan repayment program.
“It’s remarkable how fast it went, especially when you realize this is the first time we’ve ever had state funding for loan repayment,” she said.
HB 472 provides state funding for the Rural Physician Incentive Program (RPIP), a program that already existed but which had been paid for with student fees‑Idaho students attending out-of-state medical schools in Washington and Utah at in-state tuition rates had been assessed $1,600 per year, which went into the RPIP fund. In order to qualify for loan repayment, physicians must work in a Health Professional Shortage Area (HPSA) in Idaho and receive up to $25,000 per year for four years.
According to the Idaho Physician Workforce Profile, Idaho has a significant shortage of primary care physicians, ranking 49 out of 50 states for physician workforce. “Approximately 98% of the state is designated as a HPSA for primary care and dental, and 100% for mental health,” Sheridan said. “So loan repayment is hugely important for us, and is certainly a tool for recruitment and retention of physicians in rural and underserved communities.” NCSL estimates that the $640,000 loan appropriation will fund about six more physicians per year, more than double the current number.
Sheridan said that she is pleased that so much has resulted from the NCSL meeting, especially since she initially had few expectations going into the meeting. “In fact, when I first got the invitation I thought, ‘if we’re going to just take Idaho there, why can’t we just meet in Idaho and do this very same thing?’” she said. “But I think it was that structure of being away and focused on an issue, of us learning together and having facilitated discussions to create this plan that provided an opportunity to really focus on rural health in Idaho in a very coordinated and collaborative fashion.”
Sheridan added, “The NCSL event provided a unique opportunity to identify Idaho-specific rural health issues. We’re extremely pleased to have participated. It truly provided leverage and new collaborative opportunities to advance rural health in Idaho.”
Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.
Greetings and Happy 2015,
What an honor that my first duty as NOSORH president is a Happy New Year message to you! I thought about using the opportunity to share my new year’s resolution, since you could hold me accountable and I would achieve amazing success. Right? No way… Although, Idaho SORH staff will tell you that my approach is from an opportunity perspective. I never initially say “no” to an idea or suggestion since it could lead to a great opportunity. Innovation, growth, new resources, and partnerships often start with a single idea or conversation. Even though the end result could be, “no thanks”, a willingness to listen, learn, and explore leads to new connections and opportunities to keep rural health at the forefront.
Idaho was recently awarded a four-year statewide healthcare innovation grant from the Centers for Medicare and Medicaid Innovation and our SORH has a vital presence at the table. Our goals are aligned with the Triple Aim and we will establish “virtual” patient centered medical homes in rural areas to improve access, quality, and population health. Idaho’s effort is well-aligned with our thought provoking discussion at the annual 2014 SORH/NOSORH meeting on topics such as epigenetics, population health, and social determinants of health. To further this dialogue, the NOSORH Educational Exchange committee, co-chaired by Scott Ekblad and Natalie Claiborne, will focus on innovation and other forward-thinking initiatives to help us look ahead at potential SORH opportunities.
I hope you will join me in thanking Alisa Druzba, 2014 President, for her outstanding service to NOSORH. Alisa will continue to serve as past-president and we very much appreciate her continued service. I hope you will also take a moment to thank NOSORH staff and NOSORH volunteers, including regional representatives, committee chairs, and other board members, for their service.
I’m sure 2015 will be as fast-paced as 2014, so hold on tight and don’t forget to say, “yes” (at least tentatively so), to the next idea that comes your way.
Back to January Branch
Mary Sheridan has been the director of the Idaho SORH for 10 years. Prior to that, she worked asa hospital registered nurse for 14 years before coming to the state to work its poison control office in 1995.
You’ve been a long-time director of a small SORH. What are the challenges?
We are all really highly focused on customer service–someone answers the phones here 8-5:00, M-F. We try to make sure our phones never go to voicemail. If someone is on the phone, the call rolls down to another staffer. It’s really rare that someone would call and no one would pick up the phone. When there’s a conference and we’re all there, we’ve sometimes set it to go to someone’s cell phone and they can answer it there. All our staff supports that and it’s important to everybody here.
The other challenge with having a small staff is that everyone has so much to do. I worry sometimes that I’m asking people to do too much. I don’t worry so much about myself–but I worry about the people around me. And there’s the capacity issue. Our office has two SORH FTEs, including me, plus one PCO FTE, a part-time temporary position, and an administrative assistant, responsible for six federal grants and state programs. We have to ask ourselves if we can we add one more project or one more grant and do it well. For example, there recently was a dental health workforce federal grant opportunity–95% of Idaho is a designated HPSA in dental health. Although I hoped to apply, my supervisor said “you need an FTE for that and one doesn’t currently exist.” So there’s always that question of how many more things can you take on and do well.
What are the benefits?
You get to learn so much about so many different things. I think of it sometimes as getting to be both a generalist and an expert. Maybe your work is focused on the SHIP and SORH grants, but you also have a hand in 3Rnet, or you get to learn about HPSA data collection. When someone in the office is out and you answer their phone, you have the opportunity to answer a question that
might be outside your typical job responsibilities. You get to develop new areas of expertise–you’re working to the top of your game, taking new challenges, looking for opportunities for new projects. If you worked in a bigger office and your job was exclusively Flex, you may not get to learn all these other things. And we get to really know each other and our stakeholders. We take a few minutes (every day) to check in with each, on a personal level. If someone is working way too hard, I can say, “Why don’t you get out of here for awhile?” I think people appreciate that.
What in your background has allowed you to meet these challenges? And how do you foster flexibility in your staff?
Because we’re small, we communicate on so many levels, and people can see the value and importance of what they do. That’s critical to our success. Everyone here is so important and so valued–and we appreciate each other so much. It’s so great to know that someone else is answering my phone. It’s great to know that we have that camaraderie.
One of the things that has helped me is going out into rural Idaho and meeting stakeholders, going into clinics, meeting staff, seeing their challenges and making sure our grants are aligned with their needs. That looking, asking, listening and caring, and coming back to see what you can do to help–I can see some alignment there with having been an intensive care nurse. It takes a level of
empathy and compassion.
I love my job–I love the interactions. It is the perfect match for me. I’m really lucky
NNOHA, NOSORH Information (Smith, Hansen)
FIND Program – Iowa (Heckenlaible)