Bureau of Health Workforce Program

Updatefor State Offices of Rural

Health

September 10, 2014Kimberly Kleine

Bureau of Health WorkforceHealth Resources and Services

AdministrationU.S. Department of Health and Human

Services

Bureau of Health Workforce (BHW)• Created in May 2014, the Bureau of Health Workforce

brings together HRSA’s key workforce programs previously housed in two bureaus: Health Professions and Clinician Recruitment and Service

• Better meets the need for a well-trained, well-distributed 21st century workforce through realignment and built in connectivity

• Annual Appropriation of more than $1Billion that supports over 40 workforce programs and a staff of more than 450 people

• Supports the health care workforce across the entire training continuum – from academic training of nurses, physicians, and other clinicians to clinicians currently providing health care in underserved and rural communities across the United States

Office of the Associate AdministratorAssociate Administrator

Deputy Associate Administrator

Senior Advisor

Clinical Advisor

Executive Office

Division of Policy and Shortage Designation

Division of External Affairs

Division of Business

Operations

Office of Workforce

Development and Analysis

Office of Health Careers

Office of Global Health

Affairs

National Center for

Health Workforce Analysis

Division of Medicine and

DentistryDirector

Division of Nursing and Public Health

Division of Practitioner Data Bank

Division of Participant

Support and Compliance

Division of Health Careers and Financial

Support

Division of National Health Service Corps

Division of Regional

Operations

Bureau of Health Workforce (BHW)

Office of Workforce Development and Analysis

Includes the National Center for Health Workforce Analysis; global health affairs; the National Practitioner Data Bank; and grant programs for nursing, public health, behavioral and mental health, medicine, dentistry and geriatrics.

• Office of Global Health Affairs

• National Center for Health Workforce Analysis

• Division of Medicine and Dentistry

• Division of Nursing and Public Health

• Division of Practitioner Data Bank

Office of Health Careers

Includes scholarship and loan repayment through the National Health Service Corps and NURSE Corps; as well as Area Health Centers and the pipeline programs that are important to a diverse health care workforce.

• Division of National Health Service Corps

• Division of Health Careers and Financial Support

• Division of Participant Support and Compliance

• Division of Regional Operations

Workforce Priorities• Increase health care workforce and align training and

education with changing practice environment

• Inter-professional training: classroom and clinical

• Integrate mental and oral health into primary care

• Diversity and culturally competent care

• Support placement in underserved communities

• Increase availability and timeliness of workforce projections and analyses

Supporting Rural Workforce Development

BHW Programs : Increase clinical training in rural settings

• Nearly half (10 of 24) of Mental and Behavioral Health Education and Training grantees and one third (6 of 16) of Graduate Psychology Education Program grantees focus on serving rural populations

• Scholarships for Disadvantaged Students (SDS) program redesigned to give priority to health professions schools meeting key workforce development goals, including placement of graduates in underserved areas such as rural communities• SDS grantees partnered with over 2,500

different sites across the country to provide clinical training to over 4,800 students during the 2012-2013 academic year* • 54% of sites were located in a medically underserved community

• 14% of training sites were located in rural areas

* Most recent Program performance data

• Area Health Education Centers (AHEC) expose medical students and health professions students to primary care and practice in rural and underserved communities; the AHEC program works to improve the distribution, diversity, quality and supply of the primary care health professions workforce serving in rural and underserved areas

• Public Health Training Centers (PHTC) focus on the needs of underserved populations, and many specifically focus on rural issues; grantees provide continuing education training activities for public health students, faculty, and members of the public health workforce• 25% (1 out of every 4) trainees trained during the 2012-

2013 academic year reported being employed in a medically underserved community and/or rural area

* Most recent Program performance data

• Primary Care Training and Enhancement (PCTE) • Program strengthens medical education

for physicians and physician assistants; the program provided direct financial support to 532 students, residents, and fellows during the 2012-2013 academic year*

• 25% (1 out of every 4) trainees reported coming from a rural background

* Most recent Program performance data

Teaching Health Center GME Program• Teaching Health Center Graduate Medical Education

(THCGME) Program expands residency training in community-based settings

• $230 million, five-year initiative (FY 2011-2015) created by the Affordable Care Act

• Residency programs include family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, geriatrics, and general dentistry

• Community-based settings include urban, rural, and tribal communities• Program is instrumental in increasing access to health care services for

people who are geographically isolated, economically or medically vulnerable

• 36% of THCGME programs provided clinical training at a rural site during the 2012-2013 academic year; and 29% of residents trained at a rural site, providing 38,445 hours of patient care*

• $83.4 million in ACA funding for 2014-2015 academic year

• Will support training of more than 550 residents in 60 Teaching Health Centers

• Expanding states with Teaching Health Centers from 21 to 24

* Most recent Program performance data

FY 2015 Budget Request

BHW FY 2015 Budget• Proposed investments would bolster the nation’s

health workforce and improve the delivery of health care across the country

• Targeted Support for Graduate Medical Education (TSGME)

• $530 million for FY 2015• President’s FY 2015 requested $3.23 billion for FY 2015-2024• Will support an estimated 13,000 residencies between FY 2015-2024

• National Health Service Corps (NHSC)• $810 million requested for FY 2015• President’s FY 2015 requested $3.95 billion for FY 2015-2020• To sustain a field strength of at least 15,000 NHSC clinicians, FY 2015-2020

• Rural Physician Training Grants Program• $4 million requested for FY 2015• To increase the number of medical school graduates practicing in

underserved rural communities• Funds planning, development and operation of medical education programs

to achieve this goal

BHW FY 2015 Budget• Proposed investments would bolster the nation’s

mental and behavioral health workforce and improve the delivery of health care across the country

• Graduate Psychology Education Program• $6.9 million – Trains psychologist to work in underserved

populations

• Leadership in Public Health Social Work Education Program

• $1.0 million – Develops the next generation of Public Health social workers through funding centers of excellence at schools of social work.

• President’s Now is the Time Initiative • $35 million – Partnership with SAMHSA; trains professional and

paraprofessionals

NHSC Rural Engagement

FY 2014 NHSC Funding

• $283.04 Million – ACA funding

• The President’s FY 2015 requested $3.95 billion over the next six years to support an annual field strength of 15,000 health care providers through FY 2020

NHSC Field Strength Growth & ProjectionsFY 2009 - 2015

FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 -

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

4,808

7,530

10,279* 9,908 8,899

7,520**

15,439**

*FY 2011 included funding from the Recovery Act, Affordable Care Act, and Base Appropriations. ** Projected awards

As of September 30, 2013, nearly 8,900 NHSC clinicians were working in

communities with limited access to health care

26%Physicians

17%Nurse

Practitioners

28%Mental/

Behavioral Health

Providers*

12%Dentists 13%

Physician Assistants

2%Nurse

Midwives 2%Dental

Hygienists

* Mental and Behavioral Health Provider disciplines include: Health Service Psychologist, Licensed Clinical Social Worker, Psychiatric Nurse Specialist, Marriage and Family Therapist, and Licensed Professional Counselor

*As of September 30, 2013

FY 2013 NHSC Field Strength*Nearly one-third (32 percent) of all NHSC providers are mental and behavioral

health

68%MD/DO

221

NP 170

PA23

LCSW788

LPC869

HSP622

MFT132

PNS29

NHSC Critical Access Hospital Site Pilot

• August 2011, White House Rural Council expanded eligibility for the NHSC to include Critical Access Hospitals (CAHs)

• CAHs must meet applicable program requirements and be affiliated with an outpatient, ambulatory clinic

• Over 67% of the over 1,130 CAHs are currently located in a primary care HPSA

• As of early September 2014:• 232 active CAHs have been approved to be NHSC service sites• 70 NHSC providers are working in CAHs

NHSC Rural Sites & Vacancy Data• Among the 15,000+ NHSC-approved sites , 8,804 are

rural sites• 3,990 of rural sites have completed site profiles• 2,807 (35%) of rural sites are FQHCs; 40 (.5%) are FQHC Look-a-

Likes; 878 (11%) are RHCs

• 3,340 Vacancies/Job Opportunities on NHSC Jobs Center• 1,795 rural site vacancies

• As of September 2014, rural site vacancies:• 907 primary care provider vacancies posted (among 546 sites)• 146 dental provider vacancies posted (among 130 sites)• 742 mental health provider vacancies posted (among 321 sites)• 22 rural sites have vacancies posted in all three categories

Virtual Job Fairs

• Employers and job-seeking clinicians come together virtually

• Nine NHSC Virtual Job Fairs held 2012-2014• 70% of presentations from rural NHSC sites (160 of 229)• Total of 229 presentations representing more than 1,159 unique

NHSC sites promoting >1,147 job opportunities to >1,924 job-seeking clinicians

• Three Virtual Job Fairs in 2012 focused on rural recruitment• 68 presentations representing 206 unique NHSC rural sites

from 27 states, promoting >372 job opportunities to >575 primary care clinicians

Affordable Care Act

Coverage to Care• Nearly 13 million Americans gained coverage

through the Marketplace and Medicaid and CHIP -- more than 500,000 uninsured 64-year olds will become eligible for Medicare.

• Coverage to Care • An effort to help educate the newly insured about their

coverage and to connect them with primary care and preventive services

• Connect the newly insured to primary care and preventive services to fully realize the other goals of the Affordable Care Act – improving population health and reducing health care costs

• Resources include the Roadmap, Discussion Guide, and videos at http://marketplace.cms.gov/c2c

Important Marketplace Deadlines

• November 15, 2014: Open Enrollment starts

• December 31, 2014: If enrolled in a 2014 Marketplace plan, your benefit year ends

• February 15, 2015: Open Enrollment ends

• HealthCare.gov

Questions/Discussion

Contact Information

Kimberly KleineDirector

Office of Health CareersBureau of Health Workforce

kkleine@hrsa.gov