The Workforce Pipeline

The Center for Rural Health works with groups throughout  the state to get people of all ages interested in health careers

What do you want to be when you grow up?  The Center for Rural Health at the UND School of Medicine and Health Sciences is working with a variety of organizations throughout the state that all want to make that answer be something in health care.

Workforce shortages are a challenge for the health care system nationwide with projected physician shortages between 85,000 and 96,000 by 2020 according to the Federal Council on Graduate Medical Education. 

“These shortages can negatively affect health care quality and access to health care services,” said Mary Amundson, M.A. ’95, assistant professor at the Center for Rural Health.  “Shortages can increase stress on available providers and contribute to higher health care costs by increasing the use of overtime pay and expensive temporary personnel.” 

A year ago, the Center for Rural Health, in partnership with the Dakota Medical Foundation and others, held a Health Care Workforce Summit in Bismarck to examine health care workforce issues in North Dakota. The purpose of the summit was to share what is currently being done to feed the state’s health care workforce pipeline, to explore current and emerging challenges associated with the supply and demand of health care workforce in the state, and to begin to develop an action plan to address these challenges.  Among the summit participants were state legislators, representatives from state government, statewide organizations, economic development commissions, health care employers, educators, and health care providers.

The Pipeline

Staff at the Center for Rural Health use the idea of a workforce pipeline to explain that getting people interested in health careers starts at a very young ages and must continue through several steps from small children through retaining current employees. 

“Each step of the pipeline offers opportunities to target specific strategies from workforce training to retention,” explained Patricia Moulton, Ph.D. (’02, ‘99, ’97), assistant professor at the Center for Rural Health. 

During December’s summit, participants identified goals and key issues within each step, barriers to achieving the goals, elements needing change, and action steps.

Students in grades K-12

Summit attendees indicated a need to increase student exposure to health care professions through education and business partnerships. An example is to provide more students with age-appropriate experiences in health care facilities including tours, presentations, and related activities to introduce students to health care professions.

For the past two years, the North Dakota Medicare Rural Hospital Flexibility (Flex) Program at the Center for Rural Health has funded several such endeavors throughout the state.  The “Fostering Opportunities in Rural Health Occupations:  Rural Hospitals and Educators Working Together to Create Local Opportunities for Children and Youth” program funds community partnerships to expose children to health occupations with the intent to increase their awareness, interest and understanding of health careers. 

One of these programs in Park River, ND, made huge strides in educating the community’s fifth graders about health careers.  First Care Health Center in Park River partnered with the Park River School to do a five-week program they called “Inspector Well Ness and the Care of the Many Medical Careers.”

Each week, two medical professionals would visit the fifth grade classrooms to discuss their health career and provide a hands-one activity relating to their chosen field.  Students heard from physician assistants and nurse practitioners, paramedics, laboratory and imaging technicians, physical therapists, nurses and dietitians.  During these visits, the students got to view real x-rays, try on a cast, had their blood pressure monitored and took a ride in an ambulance, among other activities.  On the fifth week, students visited the health center to see the equipment and meet even more health professionals.

“Introducing students to a variety of careers when they are young is very important,” said Ruth Jelinek, who headed the project for First Care Health Center.  “Most of the students didn’t know what these medical careers were.”

The students were tested on their knowledge of health careers before and after the program.  Before the five-week program, only a few students correctly matched health careers with a description of that career.  However, when they were tested after the program, there was marked improvement.  

“We were extremely pleased with the results,” said Jelinek. “We are looking forward to doing this again in the spring.” 

Students in Higher Education

Summit attendees acknowledged a need to engage community/education programs to educate undergraduate students about health care programs. 

MeritCare Health System and the UND medical school’s internal medicine residency program has been working with Moorhead’s Concordia College for a number of years to provide their pre-med students with a real-life picture of what health careers are like. 

The Concordia cooperative education class gives students credit for observing physicians and volunteering at hospitals and nursing homes.  During the semester, eight students spend a half a day a week in the internal medicine residency clinic.  They spend an additional 35 hours a semester with “mentoring physicians” either job shadowing or conversing about medical careers.  Each semester the entire class also visits the UND medical school for a day and participates in its Patient-Centered Learning curriculum.     

“They observe how care is delivered and visit with residents on what it is like to go through medical school and residency,” explained Julie Blehm, M.D. ’81, an internist and geriatrics specialist at MeritCare Health System and associate dean for the Southeast Campus of the UND School of Medicine and Health Sciences. “They get realistic impressions of what medicine is.” 

Higher Education Programs

Participants at the summit discussed designing rural interdisciplinary education programs for all health care disciplines and increase the number of rural training programs statewide. They also suggested an assessment of current programs and the potential for establishing other programs and collaborations along with further development of a rural curriculum (including interdisciplinary programs).

In recent years, the Dakota Medical Foundation based in Fargo has been supporting efforts to increase health care training in the state, especially in rural areas.  The foundation has contributed hundreds of thousands to institutions of higher education throughout the state to support their efforts to make their programs more accessible to rural residents and to make health career students more interested in careers in the rural areas.  These projects range from increasing the number of seats in nursing programs, establishing distance education programs in rural areas and provide scholarships to health profession students who intend to remain in the area.   

Most recently, the foundation contacted with the Center for Rural Health to convene the regional educational institutions that produce nurses in December to develop a long-term strategy to address the nursing shortage. 

“Our purpose is to measurably improve health and access to health care services,” said J. Pat Traynor, ’91, president of the Dakota Medical Foundation.  “We know that a key to achieving this goal is to have enough qualified health care professionals working where they are needed the most.  We are pleased to be able to help the state’s quality institutions of higher education produce those health care professionals.”

Employer Recruitment and Retention

Recruitment and Retention of health care providers is the most immediate section of the pipeline.  With fewer and fewer medical students choosing family medicine and other primary care fields, it is especially difficult for small rural communities to find physicians.

One North Dakota community, Cando, recently had success in recruiting a physician to by involving the entire community and his entire family.  Robert Hamilton, M.D., is currently a third-year physician-resident at the UND medical school’s Minot Center for Family Medicine.  He was first introduced to the community by Cando physician Greg Culver, M.D., who precepts at the Minot program.  Culver convinced Hamilton to spend his one-month rural rotation in Cando, which started a series of regular visits between the people of Cando and the Hamiltons.

The Hamiltons were welcomed not only by the hospital CEO and staff, but the whole community reached out to them including hospital board members, real estate agents, patients and other community members.  While in Cando, community members treated the Hamiltons to the best the community has to offer including trail rides, trap shooting and beautiful Devils Lake.  The result was a successful bid for Hamilton start his practice in Cando next fall.   

Next Steps

To continue the work begun at the summit, the State Office of Rural Health program at the Center for Rural Health is funding a statewide Health Care Workforce Committee that includes individuals representing state boards, state associations, medical facilities (urban, rural and Veterans Administration), long-term care, health and human services, academic and economic development. These committee members each selected a step in the pipeline to work on through conference calls to replicate efforts currently underway and to pursue newly identified strategies.   

                                       - Amanda Scurry