Loan repayment is a tool to recruit providers to shortage areas. In New Hampshire, recent legislation has boosted its State Loan Repayment Program (SLRP) so that it can be used more broadly and for a wider range of providers.
“About five years ago I asked my peers how they got more workforce funding in their states, and every one of them told me it was the function of partners coming together and picking one to five legislative priorities,” Druzba said. “That’s how they got money and how they started to gain momentum. That’s what we did in New Hampshire.”
The coalition began after a conversation with the Bi-State Primary Care Association (Bi-State) about what investments should be made to strengthen the healthcare workforce there. Increasing funding for SLRP quickly became the focus of their efforts. In addition to Bi-State, more than fifty organizations eventually joined the coalition.
When it came time to lobby before the state legislature, “the people who coordinate the coalition decided which one of that group would testify and made sure there were people in the coalition who were subject matter experts,” Druzba said. “The New Hampshire Hospital Association and leaders of FQHCs spoke about SLRP, and directors of nursing homes advocated for the parts of the bill involving Medicaid funding.”
For her part, Druzba served as the “facts person,” she said. “As a state employee I can’t advocate for specific bills, but I am allowed, with permission, to testify factually about programs. I talked about why SLRP is a good investment, what we know about it as a tool for recruitment and retention, and I shared data about participants.”
The resulting legislation increased the annual SLRP budget from $250,000 a year to $6.5 million over two years. In the first stage of the expansion, the SLRP program is adding primary care RNs (at already eligible sites), Hospitalists at Critical Access Hospitals, and licensed school psychologists who serve Medicaid-enrolled students.
“I haven’t seen anyone else doing hospitalists (with their SLRP programs),” Druzba said. “And including Medicaid school psychologists is also very unique. There is a shortage of them here and children who had qualified to get Medicaid services in schools were going without.”
Previously school psychologists in the state were licensed by the Department of Education, Druzba said. “Now they will be licensed as health providers with the Board of Psychology, which means our office won’t have to do any extra work around credentialing or vetting anybody.” (NH SORH administers the SLRP program.)
The next phase of the expansion in January 2021 will create a pilot loan repayment program for private practice dentists who serve a set amount of Medicaid clients, as well as loan repayment for behavioral health providers at eligible sites who are under supervision to acquire their license.
“The legislation also created a new position in our office (but we are at a hiring freeze because of the pandemic) and we got a promotion for an existing staff member, which is moving forward,” Druzba said.
Because of the pandemic, $4 million was taken from SLRP funding this year, Druzba said. “So we aren’t doing the level of work we would do if we had the entire $6.5 million,” she said. “But I figure even if they take $4 million out, it’s still $2 million more than I had. And so many more people now understand and appreciate the importance of SLRP. The floor of SLRP funding has been raised – it’s all incremental.”
After SLRP funding legislation passed last fall, NH SORH ran a SLRP Summit in January to get stakeholder input on ways to expand SLRP to cover more provider and/or site types. “The Summit gave everyone a baseline understanding of the program and its purpose, brought together a lot of people who have never met but have common goals, and gave us new ideas for the program,” she said. In addition, “there is an ongoing Dental SLRP Advisory group that was formed after the Summit to help us create a private practice dentist pilot.”
In terms of replication, Druzba said that any SORH could do this, especially considering how tiny her office is (there are five staff members in the SORH and Primary Care Office, combined).
“It didn’t cost me any money to do this work—what it cost was an investment in relationships,” she said. “This work was done because it was led by partnerships, but also because of the reputation our office has. When we were asked for our opinion on things and for data, we gave it, and they listened and valued our insight and expertise.”
“You can leverage all of the points in an existing system, but ultimately there will be places that simply need more capacity and resources,” Druzba continued. “In order to get those resources you need a coalition to focus on a set of specific policy goals with a funding ask, and united in their messaging.”
“If groups like workforce coalitions have a conversation on what their strategy is and they coalesce around it and use consistent communication, then they can get traction in their legislature or governor’s office, and get the support to make investments in various kinds of workforce programs,” she said.
By Beth Blevins
With an increasing shortage of rural healthcare workers, Iowa needs to recruit locally and early. That’s the idea behind the Opportunities in Health Sciences: Iowa Career Pathways, which helps high school students (and adult workers who are looking for a career change) navigate toward healthcare careers.
The Opportunities in Health Sciences project came about through the efforts of the Iowa State Office of Rural Health (IA SORH), which saw the need to recruit rural students to work in rural areas. The impetus for the project was a one-day workforce summit Iowa SORH held two years ago to gather information about the shortages and needs of the healthcare workforce in Iowa.
“Some of the recommendations at the summit came from people working at hospitals and clinics,” said Megan Hartwig, Iowa SORH Director. “Their concern was that we recruit students in healthcare careers but they end up leaving rural communities to work in urban centers. Or some rural schools don’t have the capacity to provide the curricula or experiences the kids need to help them consider further training and education in the health field.”
What followed was a discussion on how to do a better job of communicating with Iowa high school students, how to provide resources to counselors so they can help steer those who show aptitude and interest into health sciences careers, Hartwig said.
“We wanted to provide a guide that helps students realize they don’t often have to go to school for more than two years to complete training for a successful career in healthcare,” she said. “We also wanted them to understand there are healthcare employment opportunities in their own communities, and that they don’t have to just be a doctor or nurse to work in healthcare.”
The Future Ready Iowa initiative had already been set up through the governor’s office, with the Iowa Department of Education (DOE) and Iowa Workforce Development as the main partners on the project, Hartwig said. “The Iowa DOE had put together an Iowa Pathways website and guide for a few career sectors, like energy and manufacturing, but healthcare hadn’t been developed,” she said.
To get momentum behind the ideas discussed in the workforce summit, Iowa SORH applied for special project funds through the Department of Public Health’s CDC Block Grant, Hartwig said. “Our intent was to develop resources for students who might be interested in health sciences, as well as to develop marketing material around healthcare careers, specifically more of those entry-level careers,” she said.
Hartwig worked on the project with the Iowa DOE and other health industry partners. Her time on the project was funded by IA SORH, but the project itself was funded through the CDC Block Grant, she said. The project was done in tandem with Future Ready Iowa. “The work we’re doing dovetails with Future Ready Iowa and can be used in conjunction with the Health Sciences section on its website,” she said.
Hartwig said it is important that the resulting publication is available both online and as a printed document, which is being distributed to community college and high school counselors. “Not every kid has access to a computer,” she explained.
The Opportunities in Health Sciences publication includes career sections arranged by topics like Direct Patient and Therapeutic Care (“The Caregivers”), Community and Behavioral Health (“The Supporters”), and Biotechnology Research and Development (“The Innovators”), as well as information on work environment options, and career interests based on personality types.
The project also included the creation of a video by Iowa Workforce Development that discusses apprenticeship programs for healthcare careers, Hartwig said. “We are also developing a toolkit with the DOE for schools to use with local healthcare employers, to create opportunities for students to shadow them to see if they want to pursue an education and career in health sciences,” she said.
It is not just future employees and employers who have benefited from the project. Hartwig said that it has fostered greater collaboration between IA SORH and other departments in the Iowa state government. “We now have connections across three departments—IDPH, DOE, and Iowa Workforce Development,” she said. “We pick up the phone and talk to each other now, which has opened doors for more coordination.”
Hartwig concluded, “We recognize that many students love their hometowns and want to stay in their communities, but they don’t think they can make a living there, or they think they have to go away for years and years of training. We hope this project will help students understand they have options— they can go through an Associate’s Degree or certificate program in two years or less and then have a great job helping people in their own communities.”
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.
NOSORH and the National Rural Recruitment and Retention Network (3RNet) are working together via an advisory committee to identify what State Offices of Rural Health and 3RNet members most want to learn and do to address rural workforce needs. The committee purpose is to increase collaboration to identify workforce strategies, workforce TA needs, and opportunities to improve state, federal and national collaboration to improve the rural health workforce.
Twenty-four volunteers from across the nation responded with interest to join the advisory committee. The committee, led by Keith Clark, NOSORH Workforce Liaison (Nevada Office of Rural Health), will meet quarterly and provide insight on educational needs, strategies, resources and partners and help assess the feasibility to plan a national rural health collaborative summit.
“The level of enthusiasm and the background of people who volunteered for the committee is illustrative that health care workforce is a challenge throughout rural America,” said Clark.
Last month, 3RNet surveyed the members of the committee to establish some priorities for the group to focus their efforts. Early survey results show the highest interest in retention efforts using the Practice Sites platform, telehealth’s intersection with workforce, rural graduate medical education and emerging health professions. These priorities will be further refined and help shape strategies for the future.
Be on the lookout for informational webinars or fact sheets from the committee.
Given its emphasis on access to care and workforce development, it was a natural fit for the New Hampshire State Office of Rural Health (NH SORH) to be a part of the NH Legislative Commission on Primary Care Workforce Issues. The five-year commission is working to coordinate workforce as a part of Affordable Care Act (ACA) activities in the state.
“What we’re finding is that because of the ACA, people are very interested in talking about workforce development, when maybe in the past they didn’t have an understanding of these issues,” said Alisa Druzba, director of the NH SORH. “We’re focusing on using the resources we have in the most efficient manner.” Druzba is the NH Department of Health and Human Services appointee. The Commission also includes individuals who represent medical, oral health, and mental health associations and providers in the state. Additional members have been requested to bring in more diversity and non-rural representation, Druzba said. Commission members meet together on a monthly basis.
“What’s nice is that the Commission has been in a position to readily talk about workforce, and about Marketplaces—if the state does choose to do Medicaid expansion,” Druzba said.
While Druzba brings the benefit of her expertise to the Commission, there have been benefits for her SORH as well. “When the Commission first started, we put in legislation that identified my office as a health professions data center,” Druzba said. Although the center was not funded, it helped establish the idea in her SORH. “I reallocated my money to bring a data center into existence and was able to hire a staff member this April to get the surveying off and running. We get to have a leadership role around the kind of data that is collected and can use it more efficiently for shortage designation work.”
Another benefit has sprung from the Commission’s emphasis on using resources efficiently. “I report to them on SORH grants and talk about current uses of funding.” Druzba set up a schedule to discuss SORH-related topics at the Commission meetings, like “What is a patient-centered medical home?” In addition, she has been discussing the difficulty of clinicians obtaining training and residencies in the state, since many sites there are too small to take them on. “There’s been lots of energy around this,” she said. As a result, her Office is helping establish a clinical placement program—a contract went into effect in July. The contracting agency now is looking at how other states are doing this, looking at site education curriculums and the technology for managing it.
“It was just natural for us to take a leadership role when workforce came up,” Druzba said. “It was mostly being ready at the right time.”