Rural health pipeline programs look to re-tool amid big policy, demographic shifts

May 19, 2019 GMT

A comprehensive study of the state’s health care workforce in 2009 showed more than half of Nebraska’s 93 counties were without primary care physicians.

The disparity between urban and rural areas, according to the Nebraska Center for Rural Health Research study, was further threatened by an aging workforce of nurses, dental providers and mental health specialists.

The center recommended Nebraska act quickly to address the needs of the state in 2020 through ongoing data collection, expanded rural health pipeline programs and the establishment of new community partnerships to further workforce development.

A recent University of Nebraska Medical Center study found “modest improvements” in the number of physicians working in the state — a total of 4,827, up from 4,056 in the 2009 report — while the Nebraska Center for Nursing projects an 18 percent increase in the nursing workforce by 2025 from a decade ago.


But along with the good news is the bad. The UNMC Center for Health Policy study said rural communities will continue to experience a “substantial deficit” when it comes to its health care workforce.

Specialty providers such as internal medicine doctors, OB-GYNs and pediatricians are in the highest demand, while many reaches of western and central Nebraska are seeing a lack of RNs, LPNs and APRNs.

“With the size of our state, that creates an issue, because you can’t expect people to drive seven or eight hours to get specialized care,” said Fernando Wilson, an associate professor who was part of the UNMC team that conducted the 2018 study update.

Looking to the next decade, Wilson said the effects of those shortages may become more critical, particularly after Nebraska voters approved Medicaid expansion, which will increase demand for primary care.

Conversely, increased diffusion of technology such as wearable health monitors, artificial intelligence, simulation and telehealth services will also change “who is providing the care,” said Dr. Rowen Zetterman, associate vice chancellor for academic affairs at UNMC.

“We’ll still have the same base — physicians, nurses, nurse practitioners, physician assistants and dentists, everything like that — but we’re going to have new health professions that will be out there for the very first time,” Zetterman said.

Devices capable of routinely scanning blood sugars, heart rates and other conditions mean patients don’t need to be in constant contact with a specialist or nurse practitioner, Zetterman added, but could instead be looked after by a clinical tech specializing in data science or a community health professional.

Driverless vehicles may even be capable of transporting patients to clinics miles away in the future, he added, where their health data has already been uploaded.


Even as Nebraska’s rural counties become sparser, the result of a population shift eastward toward large urban centers, the state has to think about how it will meet increased demand in an increasingly advanced health care delivery system.

Zetterman told a summit of higher education and rural health experts Thursday the answer was simple. Rural and urban Nebraskans, like all Americans, will still “want health care as close to their home as they can possibly get,” which reiterates the need for pipeline programs that meet demand for primary care and specialty physicians, nurses, dentists, as well as health care professions not yet created.

Scholarship program has success

Since the early 1990s, when the Nebraska Legislature created the Rural Health Education Network, UNMC and the Nebraska State College System have trained health care professionals to work in high-need areas outside the urban counties in the state.

The Rural Health Opportunities Program provides full-tuition scholarships to a limited number of qualifying students to attend one of Nebraska’s three state colleges. Upon graduation, program students are guaranteed admission into UNMC to pursue their health education before they return to practice in a rural area.

Two other programs were added later, the Kearney Health Opportunities Program, which provides a similar pathway to students attending the University of Nebraska at Kearney, and the Public Health Early Admission Student Track.

Nearly 600 students have graduated from all three programs since 1992, and 44 percent are now working in rural areas of Nebraska. Another 18 percent are employed in urban hospitals or health clinics in the state, according to UNMC’s Health Professions Tracking Service.

While the programs have been successful in getting more health care providers into shortage areas for a quarter-century, Bob Bartee, vice chancellor for external affairs at UNMC, said the trends described by Wilson and Zetterman have spurred the university to think about how the programs could be expanded or improved.

“There is urgency in thinking about how we collaborate with the state and community colleges to produce health care workers and if there’s a whole different way to think about who the health care workers of the future are,” he said.

‘Futurizing’ pipeline programs

During Thursday’s summit, hosted at UNMC’s new College of Nursing building on the UNL campus, nearly 40 leaders from the university and state college systems, as well as rural health care experts, discussed how to “futurize” the pipeline programs to reflect a changing Nebraska.

Several initial strategies emerged in the daylong event:

* Standardizing applications between campuses and conducting regional interviews of candidates could help expand the pool of applicants.

* Increased promotion and outreach to younger students about health careers available in rural Nebraska.

* Allowing unfilled slots at one state college campus to transfer to a different campus in order to ensure each cohort is full.

* Developing a collection system about undergraduate students and student outcomes in a single depository.

* Improving the connection undergraduate students feel to UNMC through tours, distance-learning sessions or teleconferencing opportunities.

Rural Health Opportunities Program graduate Dr. Jennifer Harney developed a lifelong desire to become a doctor after she was born with phenylketonuria, or PKU, a metabolic disorder that required weekly visits to a pediatrician for blood tests.

“My experience just gave me a passion about science and learning the pathophysiology,” she said. At the recommendation of a high school guidance counselor, Harney applied for and was accepted into the Rural Health Opportunities Program. She attended Wayne State College and UNMC before returning to her hometown of Aurora to practice family medicine.

While she said her experience was “excellent,” she agreed the rural pipeline could benefit from building stronger connections to rural communities.

High school students from urban areas regularly visit the campus for tours, programs or even hold internships in the cadaver lab or simulation labs, she said, while rural students often miss out on those opportunities.

“During my undergrad experience, we got to go for a tour every so often, but it would have been good to get ingrained with what med school looks like,” Harney said.

Bartee said UNMC and its partner institutions will move quickly in transforming the themes that emerged from last week’s summit into “bite-sized” action items as the university and its partners continue assessing Nebraska’s 2030 health care workforce needs.

The 2018 workforce study done by UNMC found that many of the same 2009 recommendations made to address health care shortages apply today in expanded pipeline programs, better data collection and stronger community partnerships.

Building “RHOP 2.0” is the first step, he said.

“We need to think what we would want that to look like, how we get there in this environment, and how we strengthen and define collaborations to do it.”