Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.

Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:

• Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
• According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
• Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.

Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.

Sherry Rogers, RN, MSN, NEA-BC, is Chief Nursing Officer at Redington-Fairview General Hospital in Skowhegan, Maine. She is co-chair of Maine Partners in Nursing Education and Practice, a project of Partners Investing in Nursing’s Future, which is a partnership of the Robert Wood Johnson Foundation (RWJF) and the Northwest Health Foundation.

Maine is a rural state with the least dense population among states east of the Mississippi. The greater Portland area in southern Maine contains 20 percent of Maine’s residents, while northern counties have fewer than one person per square mile. A drive from the state’s southernmost hospital to its northernmost school of nursing would take approximately seven hours by car. The rural nature of Maine provides unique challenges to the state’s 13 nursing schools when it comes to placing students in their needed clinical hospital rotations. I am helping to oversee a program aimed at overcoming those student placement challenges.

Our project, called Maine Partners in Nursing Education and Practice, partnered with the Maine Department of Labor to link the state’s schools of nursing with hospital clinical rotation sites by implementing a Maine region of the Massachusetts Centralized Clinical Placement (MCCP), a web-based program that streamlines the scheduling and management of clinical nursing education placements between health care organizations and nursing programs. The system is owned by the Massachusetts Department of Higher Education (DHE) and can be viewed at www.mcnplacement.org.

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research and trends relating to academic progression, leadership, and other critically important nursing issues.  These are some of the stories in the February issue:

RWJF Scholars Work to Strengthen Rural Nursing
Remote communities like Crawford, Colo. and Chokio, Minn. now have improved access to local health care, thanks to programs that are offering distance education and other innovative ways to educate nurses. Suzan Ulrich, DrPH, CNM, FACNM, associate dean of midwifery and women’s health at Frontier Nursing University and an RWJF Executive Nurse Fellow, is just one of the RWJF scholars working to increase access to high quality nursing care in underserved and hard-to-reach rural areas. Several Partners Investing in Nursing’s Future programs—from Alaska to Wyoming to North Carolina—also are focused on improving care in rural communities.

RWJF Nurse Scientist Discovers New Health Benefits of Tai Chi
During her 15 years studying and practicing nursing in Hong Kong, Ruth E. Taylor-Piliae, PhD, RN, FAHA, learned firsthand about the health benefits of Tai Chi, a Chinese martial art involving slow physical movements, extended concentration, and relaxed breathing. A cardiovascular nurse scientist and RWJF Nurse Faculty Scholar, Taylor-Piliae was well aware of the health benefits of Tai Chi and wondered if the practice carried similar benefits for stroke survivors, a population she studies in her research. She conducted a study on the effects of Tai Chi in adult stroke survivors, often prone to losing their balance, and found that the practice may reduce falls.

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

Former Health & Human Services Secretary Louis Sullivan, MD, penned an op-ed in yesterday’s New York Times making the case for devising more effective ways to deliver dental care to poor or rural communities across the nation.

The Secretary notes that, in 2009, 83,000 emergency room visits resulted from preventable dental problems. “In my state of Georgia,” he writes, “visits to the ER for oral health problems cost more than $23 million in 2007. According to more recent data from Florida, the bill exceeded $88 million. And dental disease is the No. 1 chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.”

He goes on to list several reasons: 50 million of us live in poor or rural areas without a dentist; most dentists do not accept Medicaid; and we have a dentist shortage that will only be exacerbated when 5.3 million children are added to Medicaid and the Children’s Health Insurance Program by way of the Affordable Care Act.

Sullivan argues that the federal government should put programs in place to train more dentists. But more than that, he argues for training dental therapists “who can provide preventive care and routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist’s office.” He says such an approach has been particularly effective in Alaska, where the state has recruited and trained dental therapists to serve many of that state’s most remote communities, including many that are accessible only by plane, dogsled or snowmobile.

A recently announced effort by the Robert Wood Johnson Foundation (RWJF) takes aim at the very same problem. The Oral Health Workforce initiative is designed to improve access to oral health care by identifying and studying replicable models that make the best use of the health and health care workforce to provide preventive oral health services.

The Department of Health & Human Services (HHS) has awarded $9.1 million to medical students participating in the National Health Service Corps’ Students to Service Loan Repayment Program. In exchange for funds to repay their medical school debts, the 77 students in the pilot program commit to provide primary care services in communities with shortages of health professionals and limited access to care.

After their residencies, participants will spend three years full-time, or six years half-time, working in clinical practice in underserved or rural communities. They can receive annual student loan repayment funds of up to $30,000 while in the program.

The pilot program, created by the Affordable Care Act—the health reform law—aims to help alleviate a shortage of primary care professionals. “This new program is an innovative approach to encouraging more medical students to work as primary care doctors," HHS Secretary Kathleen Sebelius said in a statement.

Read more about the shortage of primary care providers and efforts to recruit primary care physicians in underserved areas.

Convincing a medical student, sometimes tens of thousands of dollars in debt, to take a lower-paying job or move to a low-income, rural community can be a tough sell. So perhaps it’s not surprising that many new physicians gravitate toward high-paying specialties or urban sprawls with modern-day conveniences. But with an aging population and millions of people poised to gain insurance coverage under the health reform law, the nation is in desperate need of general primary care physicians, particularly in rural and underserved areas.

Last week, NPR reported on a technique that one rural community has used successfully to recruit primary care providers – “mission focused medicine.” At the Ashland Health Clinic in southwest Kansas, CEO Benjamin Anderson is recruiting primary care providers not by pointing to all the advantages the community offers, but by highlighting its most severe needs. And to further appeal to prospective providers’ desire to do meaningful work, Anderson offers candidates eight weeks off to do missionary or other service work overseas. Anderson hopes to find providers who are engaged and motivated by the challenges associated with providing care in a rural community.

“When you recruit a mission-focused provider…,” Anderson said, “they want to know that there's no Spanish-speaking provider in more than a one-hour drive. They want to see houses that are falling down, widows that are uncared for. They want to know that there's need and that by them coming there, they would fill a disparity that would otherwise not be filled.”

Specialization also poses a challenge to building the primary-care workforce, the Washington Post reports. A medical resident who chooses a specialty over general primary care has the potential to earn millions more over a lifetime, making it an attractive option to the often deeply in debt medical student.

Last summer the White House launched the Primary Care Residency Expansion, providing financial support for three-year primary care residency training programs at 82 hospitals around the country. Participating residents are required to work in underserved areas. All of the 172 slots funded in the first year of the program have been filled, the story reports.

What do you think? How can we recruit more primary care physicians for general practice or in underserved areas? Register below to leave a comment.

Listen to the NPR story.

Read the Washington Post story.

The University of Kansas last month opened a new medical school campus in the rural town of Salina, to teach students the complexities of rural health care and, university leaders hope, to encourage physicians to practice in small, underserved communities after graduation.

The new school, three hours from the University’s main campus in Kansas City, plans to accept only eight students a year, and has offered it first class free tuition and monthly stipends to study there and start their careers in rural communities. Students will attend virtual classes, with video and podcasts streamed from the school’s other campuses, and will receive training in local doctors’ offices and at the hospital in Salina.

“It just makes sense, and it’s great that it’s been put into practice,” Alan Morgan, the president of the National Rural Health Association, told the New York Times. “From a rural policy perspective, this is big news.”

What do you think? Will going to medical school in a rural setting help encourage physicians to practice there? What other options should medical schools and policy-makers consider to recruit and retain health care providers in rural and underserved communities? Register for a Disqus account below to leave a comment and let us know what you think.

Read more about the Salina medical campus. Read about nursing solutions to advancing health care in rural America.

The AARP Solutions Forum: “Advancing Health in Rural America: Maximizing Nursing’s Impact,” was held on June 13. This post is the fourth in a series in which Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars share their thoughts on the ideas presented. The author, Elizabeth A. Kostas-Polston, Ph.D., A.P.R.N., W.H.N.P.-B.C., is an assistant professor at Saint Louis University School of Nursing. Find out more about the forum or view the archived webcast.

Nearly one in four Americans—70 million people—live in rural America. On average, they are older, poorer, more likely to be uninsured, and suffer from higher rates of chronic health conditions.1

For the past 15 years, I have lived in south central Missouri, in a small town—population ~12,000 rural Americans. I am a nationally, board certified Women’s Health Nurse Practitioner and Colposcopist. In this role I participate by providing primary and specialty health care to rural, underserved and uninsured women who are often the target of Healthy People 2020 indicators. What’s more, the women I care for are not just faces in the crowd. They are my children’s teachers, colleagues’ wives and daughters, the lady who waits on me at the post office, the woman who rings up my groceries, my children’s friends, and my friends’ daughters—all of whom make up our community. It is no surprise, then, that the primary aim of my practice is to improve the health of women and their families. Improving the health of women and their families, in turn, positively impacts the health of our community.

As I listened to nurses such as the Honorable Mary Wakefield and Gail Finley share their thoughts regarding the challenges and opportunities that simultaneously exist as Nursing purposely and strategically moves to make its mark on the improvement of health care in rural America, I could not help but reflect on the numerous barriers which continue to interfere with my ability to practice to the full extent of my education, training, and competence.

The AARP Solutions Forum: “Advancing Health in Rural America: Maximizing Nursing’s Impact,” was held on June 13. This post is the third in a series in which Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars share their thoughts on the ideas presented. The author, Laurie Theeke, Ph.D., R.N., is an assistant professor of nursing at West Virginia University in Morgantown, West Virginia, and her research emphasizes the development of interventions that target loneliness as a psychosocial stressor that impacts overall health. Find out more about the forum or view the archived webcast.

I recently had the opportunity to listen to the AARP Solutions Forum, “Advancing Health in Rural America – Maximizing Nursing’s Impact.” I was thrilled to be able to hear about the continuing emphasis on rural health care. As a native of Appalachia, a long-term resident of West Virginia, and a Clinical Nurse Specialist in Gerontology, I often think about how we could better serve our older adults who are living in poverty with limited resources and complex chronic illness.

As I listened, I thought about how attached many of my patients are to rural living in Appalachia. Nearly everybody in the region knows the words to this popular song, “Take me Home, Country Roads” and I kept thinking that it would be wonderful if health care was available and affordable for all rural residents without having to take the long country road back to a more urban area, particularly in the winter months.