Work Force and PCAs

DelRay Florida

November 2008

Agenda

Background Survey Results & Analysis Best Practices Recruitment Pros & Cons Next Steps

The Work Force (WF) Workgroup

Formed in Spring 2008 Response to prioritization process by

PCA/NACHC Steering Committee Broad-based representation Considered information flow across other WF

activities

Workgroup Composition

Members:– Annette Kowal, Co-Chair– Joe Pierle, Co-Chair– Sonya Bruton – Shawn Frick– Bruce Gray– Kevin Lewis

– Mary Looker– Patrick Monahan– Tom Curtin– Joe Gallegos– John Sawyer– Suzanne Rossel

Purpose/Charge

The WF Workgroup examined the role of PCAs in supporting Health Centers’ (HCs) WF issues and identified recommendations for. As part of this charge, the Workgroup considered a series of questions: 1. What is the appropriate role(s) for PCAs in the WF

arena?2. What are some examples of successful PCA efforts to

positively impact WF issues?3. What are the barriers or challenges that PCAs will

need to address?4. What are the kind of resources and assistance PCAs

will need to address the concerns identified in #3, above?

Work to Date

Developed and Implemented Survey Assessed Additional Information thru Follow-

up Questions Undertook Multi-tiered Analyses Coordinated with other WF activities Identified Best Practices Outlined Next Steps for Developing Long-Term

Strategies

Survey Summary

33 Survey Respondents; Targeted follow up on “one-time” funding

yielded an additional 3 responses;

Work Force: the Differing Views

Survey Results: WF Efforts Vary Across PCAs

PCA Board WF Committee– A limited number of respondents, 18%, indicated

that they had a Board WF-focused Committee – Charges for the committees included:

Recruitment & retentionClinical support--clinical performance measures,

recruitment & retentionCHC competency and new staff orientationNewly formed committee, focus to be determined

PCA Staffing:– 100% of PCA respondents indicated that they had WF

staff:The average number of staff positions = 1.7The average FTEs = .9The highest FTE = 3.0 FTEsThe lowest FTE = 0.05 FTEs24% of PCAs had less than a 0.5 FTE

– 18% utilized consultants for some aspect of WF– Titles and responsibilities varied widely

Survey Results: WF Staffing Varies Across PCAs

Many identified a strong PCA recruitment role:– 70% of all PCA respondents undertake

recruitment efforts on behalf of HCs– Providers (physicians, dentists, mid-levels and

behavioral health clinicians) are predominantly recruited by PCAs

– Nearly 50% of respondents undertake senior leadership recruitment on behalf of HCs

Survey Results: PCAs Focus on Recruitment

A Variety of Recruitment Definitions:– Recruitment activities include a wide breadth of

services:PCA staff recruit Health Center providers and staffHC Recruitment is Contracted/Collaborative On-line job posting/Internet career placement Job FairsCoordination with NHSC and SEARCH program

Survey Results: PCAs Focus on Recruitment

PCA retention effort were limited:– 27% of PCA respondents indicated that TA was

provided to support the development of HC incentive based compensation plan.

– Several other retention activities identified were undertaken by only one PCA respondent each:

Learning teamsCompensation, benchmarking, salary surveyTraining programs through distance learning and/or

at annual conferences

Survey Results: Limited PCA Focus on Retention

Limited PCA mentoring activities were identified:– 33% indicated they provide some mentoring

across various areas:12% (of total respondents) are involved SEARCH

program activities6% developed handbooks/toolkitsNHSC, programs for youth, and meetings were

identified as mentoring activities by select PCAs

Survey Results: Few Mentoring Activities

Survey Results: PCA Pipeline Activities are Limited

Limited Pipeline Activities were identified:– 12% work with the SEARCH program;– 21% indicated collaboration/work with AHECs;– Limited visits to residency/training programs.

Survey Results: Resources

It is clear that WF issues are involved and weighty.

Currently, resources to support PCA WF efforts are limited.

Survey Results: Resources (Funding)

PCAs depend on BPHC for WF funds (97%) Members’ dues (46%) and fees (18%) support PCAs’

WF activities Other Federal (HRSA-27%) and State (21%) funding

is utilized for WF Other support identified comes through:

– Dept. of Labor Pass through– Private Foundations– AHECs

One-Time (HRSA/BPHC) Funding Uses (36 respondents)– 47% recruitment supplies & materials, etc.– 36% Targeted T/TA– 31% (As of 6/08) had not determined use– 31% Building/Strengthening partnerships &

collaborations

Survey Results: Resources(One-Time BPHC Funding)

Survey Results: Resources(Collaborations)

Collaboration

Average: 1: Limited; 2: Good; 3: Close

Number of Respondents (total possible= 33)

PCO 2.18 30 AHEC 1.62 30 State Health Depts 1.82 30 Medical Society 0.88 26 Dental Society 0.79 26 Training Pgms Limited 1.53 26 Medical Schools 1.24 29 Dental Schools 1.26 30 Residencies 1.32 29 Vocational Schools 0.53 22 NACHC 1.82 28 HRSA WF Collaborative 1.29 26 Clinical Networks 0.88 22

PCO seen by PCAs as a strong partner Limited partnerships/collaborations were

noted with:– Medical & Dental Societies– Medical & Dental Schools– Residency Programs

Survey Results: Resources(Collaborations)

PCAs identified a wide range of joint collaborations, select top efforts included:– 39% Recruiting– 30% Building/Enhancing Strategic Partnerships– 30% Developing/Implementing HC training/tools– 27% Building Relationships with Higher

Education/Residencies

Survey Results: Resources(Collaborations)

Survey Results: Many WF Barriers were Identified:

Barrier

# of times Identified (out of possible 33)

Average: 1 biggest barrier to 5 least

Competition by other providers 23 2.57 Geographic Isolation--poor, economically deprived 21 2.00 Lack of focus on PC in training & residency pgms. 20 3.25 Lack of Funds 19 1.89 Lack of competitive salaries 17 3.18 Geographic Isolation--retention 14 2.86 Resistance from Medical and/or Dental schools 11 3.73 Lack of residency program 10 3.80 Member understanding/resistance 9 4.33 Spouse employment 7 3.86 Inadequate training programs 7 3.57 Housing 6 3.33

Best Practices

Pipeline:– Florida: PCA and AHEC collaboration– Mississippi: Rotation of medical and dental

students through HCs using Medicaid carve-out

Best Practices

Retention– 27% of PCA respondents indicated that TA was

provided to support the development of HC incentive based compensation plan

– 82% of respondents expressed some success with State loan repayment/redemption/tuition reimbursement program or provider incentives.

Best Practices

Recruitment– Referral approach in NM, TN, WY– MO approach to contracting with contingency

search firms

Recruitment—Pros & Cons

Pros– Addresses vacancy

issues in the short-term– Has quantifiable

outcome– Responds to members

needs/requests

Cons– Short-term focus of

limited resources on long-term and growing issue

– PCA Effectiveness against professional firms

– PCA limited/no control post placement-retention

Next Steps

Continue the “conversation;”– Define key terms/concepts– Develop high-level/best practice models for:

Recruitment Retention Pipeline

– PCA Work Force Development Summit Identify strategies to communicate among and

between key HRSA Bureaus; Continue to Coordinate with existing work force

workgroups and initiatives.