REGLONAL MEDICAL PROGRAMS CORE: STAFF ACTIVITTES IN HEALTH MANPOWER Margaret Mullins Spero Moutsatsos Evaluation Branch Office of Program Planning and Evaluation March S, 1971 TABLE OF CONTENTS PAGE Background 6 6 6 6 ee ee ee ee ee eee Design... ee ee ee ee ee ed Summary of Findings .. 1... 6 we ee ee ee ee eee 2 PART I Organizational Aspects of .Regions Influencing _ Manpower Development Activitics 1. Regional Advisory Group Activities. .........°5 2. Health Manpower Committecs. see ee ee ee ee ee 8B 3. Core Staff Manpower Focus... . eee ee eee ee 9 4. CHP and Other State Agencies or Commissions... . . 10 PART Il | Manpower Activities by Area or Emphasis 5. Manpower Survey... 6 6 6 ee eee ee ee ee ee Td 6. Legislation . 1. 6 6 ee we ew ee ee we ee ee ew ee 1 7. Committee/Consortia . . 6... 1 ee ee ee ee we ee AS 8. Physician Assistants 2... 6 6 6 ee ee ee ee 17 9. Nurse Clinicians/Practitioner .. . . 1... 4 ee se U8 10. Specific New Careers. 2... eee ee ee ee 20 i Training of Lay Personnel]l/Community Health Workers. 2... 6 ee ee ee ee ee ee 22 12 Curriculum Development. . 2. 2... 6 eee ee ee ee 4 15. Recruitment . 2. 6 6 6 eee ee ee ee ee ee ee BS 14. Reactivation/Refresher Courses... . 2.5... 1 es 26 15. Career Mobility . 2... ee eee ee ee ee ee 26 PAGE ‘10. Miscellaneous . . ae Se ee ees 2B PART II Rogional Models ' | oe 17. Bi-State Regional Medical ‘Program « Dee 2 18. - Alabama Regional Medical Program. wee ee eee . 31 | 9. Towa Regional Medical Program . See ee ee ee BS TABLES ‘Table I Distribution of Regional Medical © Program as Related to Organizational Framework Influcncing Manpower . Activity, ee ee BE . ‘Table II Distribution of Regional Medical Programs by Manpower Activity Aveda OF Heplasiss ssc 2» 2: eo'e @ 8 @ , 6 36 REGIONAL MEDICAL PROGRAMS CORE STAFF ACTIVITIES IN HEALTH MANPOWER * BACKGROUND It is currently estimated that approximately one-third of the RMP funds for operational projects are supporting over 200 manpower- related uctivities -- including training programs to improve the utilization of existing health manpower, such us physician assistants und nurse practitioncrs. It may he as- sumed that a comparable proportion of core funds are support-_ ing manpower-related activitics. However, there has been little quantitative or anecdotal information available to the RMPS to date on the character and extent of these core activities. Given the increasing national emphasis on health manpower problems and the evolving role of Regional Medical Programs in these problems, it seemed appropriate to docu- ment the current extent of core activities in this areca. DESIGN The study was conducted by the Office of Program Planning arid lvaluation staff who surveyed by telephone cach RMP coordinator during the past five months . The questionnaire instrument. used was designed to elicit pertinent information which would identify ®This report concentrates on core staff activities; occasionally an operational project is noted as an output of core staff cfforts. te core staff activities with respect to health manpower. The. response by coordinators was generally very good, in that they seemed very willing to discuss the subject. However, the metho- dology employed left much to be desired in terms of comprehen- siveness and comparability. Further examination using a struc- tured format is warranted, given the present emphasis on health manpower and the beginning of intensive regional activities by core staff as reflected by this survey. SUMMARY OF FINDINGS The level of manpower development activities of RMPs varied from virtually no activity to what appears to be a highly active and integrated program approach in a few regions. The great majority of regions had at least a few manpower activities which were generally unrelated to program objectives and rather pedestrian. Nearly all regions expressed concern about manpower development und indicated that there would be increasing emphasis on it in the future, but there scamed to be few cases where the cuordinator had a clear strategy in mind. Where activity exists, it is manifested primarily in core staff activity. This is particularly true with activity which seems to depart from traditional. approaches. Activities by RAGS and their conmittecs, as reflected by policy, priorities or accom- plishments were rather minimal. several regions had considered the problems along with other local agencies, and jointly decided that one or the other would assume major responsibility for the area of manpower develop- ment. This was encouraging from the viewpoint of avoiding duplication of effort. Data collection on manpower distribution is a common activity. Much of the data collection done by most regions appcars not to be used for planning purposes, since little stratcgy was evidenced. It would seem that this is a rather costly exercise and should be discouraged if it is being done in lieu of planning rather than in support of planning. A fair amount of duplication appears in exploratory planning and operational activity, and there seems to be little awareness of or concern with what other regions are doing which might be ap- plicable. It appears that there is no established mechanism for exchange of manpower development experience, either among RMP's or omong RMP's and other federal programs. The fore- poing practice is obviously self-limiting and certainly does not enhance the concept of cooperative sharing to reverse the present trend of a growing health manpowcr crisis. It is further noted that present manpower committee structures are all but ineffective in the area of manpower development. Methods for exploiting this expertise deserve a closer look; RMPs are accomplishing virtually nothing by maintaining such . window-dressing committees. Twenty percent of the coordinators indicated that RMPS legislation and guidelines are restrictive in regard to stipends and basic training and therefore inhibit manpower devclopment in critical areas. Others stated that thc legislation neither thwarted nor encouraged them to become involved in manpowcr. A number of regions noted problems in developing manpower pro- posals which were subsequently turned down by the National Advisory Council as being inappropriate for support. A strong plea for project brokerage at the federal level was made by several regions who felt that an interagency "funneling" committee for projects could well make local groups more responsive. Along this same Line, several coordinators called for explicit priorities in the manpower area from the NAC and one suggested that a direc- tory be developed to. identify which federal agencies fund man- power development projects. Generally the survey proved to be heartening in that it un- covered some examples of real movement in an areca not spec ifi- cally mandated by legislation or RMPS policy. It was discourag- ing, however to see how isolated are the examples, how little @ they ure related to programmatic emphasis, and to sense. the confusion felt by many coordinators over lack of an explicit policy or guidelines. The current period may prove to be a critical turning point - for RMP. It is essential that Regional Medical Programs Service develop a coordinated policy with other appropriate federal man- power agencies to jointly explore opportunitics and develop stratcgy to overcome the present health manpower crisis. I. ORGANIZATIONAL ASPECTS OF REGIONS INFLUENCING MANPOWER DEVELOPMENT ACTIVITIES * A. REGIONAL ADVISORY GROUP ACTIVITIES Approximately one-fourth of the regions stated that the @ Regional Advisory Group had adopted formal policy, priori- ties, or objectives concerning health manpower developmerit. Many others. said ‘the Regional Advisory Group recognized the issue as being important, but had taken no formal , uction to deal with it. 1. The ALABAMA Regional Advisory Group for example, has identified health manpowcr as a priority arcu. During the early phase of the program, the RAG in reviewing : / a range of health related problems recognized an acute shortage of skilled health personnel in most health care facilities. This was being compounded by a growing number of new health institutions and expand- ing existing facilities, thereby increasing the demand for additional health personne]. As a result of the RAG declaration, core staff has undcrtaken a wide range of specific Activities designed to improve the manpower situation in the region. Activities have ranged from serving as a resource on curricula develop- ment and health an legislation, to planning for manpower development in a cooperative relation- ship with official and voluntary community health agencies. The involvement of ARMP staff with the office of Mayor, Model Cities, the Veterans Administration Hospital and two community hospitals in Tuskegee has led to the devclopment of a program to train neighborhood health workers whose prime function will be nutrition consultation to families with identified health needs. In addition, core staff also provided advice and counsel to Lawson Junior College, a predominantly Black institution to develop a $230,000 proposal for a nurse training program. Serving in a role of facilitator, staff arranged for faculty assistance from nearby Jefferson Junior College. Another significant contribution of core staff has been the involvement bo With the Board of Censors of the Alabama State Medical Association in drafting legislation to recognize new categories of supportive health workers. OHIO VALLEY'S RAG has declared the main "thrust" to be improved health manpower for the delivery of ambulatory care. One cxample of the OVRMP operational activities stem- ming from the establishment of ambulatory care us a priority area has been the development of a coopera- tive home care program involving Clinton County Hospital, Somerset City Hospital and the County Health Departments in Whitley City, Jamestown and Monticello, Kentucky. The particular focus of this project is on facilitating coordination among the various institutions and health care personncl at the local level to insure that the quality and wuantity of patient cure are adequate. The program is of significant importance because it | offers a means of expanding the rather limited capacity of the health delivery system through improving efficiency in use of health workers and institutional resources. Among the primary shared resources to be developed are a centralized record and reporting system; a Single agency for recruitment and training of health personnel for all affiliated agencics and an arcawide program of continuing cducation for physicians focusing various aspects of home care. ‘The service area involved - ®- covers a five county area in extreme South Central Kentucky with a population of approximately 75,000. 3. In ARKANSAS, as a result of the RAG's priority setting, RMP's director of education is heavily involved in as- sisting the development of a School of Health Related Professions to be located at the University of Arkansas Medical Center at Little Rock. ARMP is playing a major role in this effort which would bring together the thirtcen schools and departments in allied health education at the University under one umbrella. At the present time an ad hoc committee representative of allied health profes- sionals,of which the director of education is a member is in the process of seeking a dean for this activity. Two other examples of RAG priority setting are Metropolitan D.C.,whose second priority is health manpower following outpatient care, and New York Metropolitan whose first prior- ity is manpower development through broad recruitment and continuing education. Be HLALTIY MANPOWER COMMITTEES Roughly one-fourthof the regions have manpower committces within their structure. Many more, of course, have commit- tees concerned with continuing education or allied health, but these were not included since their primary foaus was “judged to be other than manpower development as defined for this study. Several regions noted that manpower committees have been dissolvéd because members felt the issue could be handled better through categorical disease or cont inuing education committees. The impression left by coordinators was that manpower com- mittees, where they exist, were generally ineffective in influencing Regional Medical Programs! direction in manpower program planning. CORE STAFF MANPOWER FOCUS Approximately one-third of the regions indicated that their core staff included a person whose primary responsibility was health manpower. General continuing education special- ists are not included in this number. 1. OHIO STATE, for example, has designated a staff person "to assist with further development and improvement of the present health manpower and health carcers programs by creating a coordinating mechanism designed to increase the supply of health manpower and achieve effective utilization of existing resources." Activi- ties have ranged from consultation services for the organization of local groups and assistance to existing groups concerned with health carcers and manpower to the. establishment of the OS-RMP as the ‘information. . center for health curcers and health manpower ih the region. The Director of the OS-RMP licalth Manpower Services has been instrumental in developing coopera- tive arrangements witn the Ohio Office of Comprehensive Health Planning ("'A" agency) to determine the best methods of increasing the supply and effective utili- zation of health manpower bo . WESTERN PENNSYLVANIA RMP's manpower designee has inia- tiated a training project for nursing home personnel to improve the quality of nursing and administrative services. An intensive 8-month course, planned and implemented with the support of specialists in hospital Management and nursing education, hus trained 137 nurses and administrators. Nursing practices in the participating homes have been significantly improved as have the social scrvices provided by the homes. Various administrative procedures have been improved through the development of such practices as prospec- tive budgeting and personnel] management. CHP AND OTHER STATE AGENCTLS OR COMMISSTONS ‘Twelve regions indicated that a core staff member sat on the State CHP agency or comparable manpower commission. (Other cxamples are cited in legislation section and other parts of study.) 4 - ij - i 1. for cxample, ARKANSAS RMP core staff have been involved with the Arkansas Mcdical Society and the GP state agency to assess the current health manpower situation and to plan a course of action necessary to provide better health care in the State. This is an ongoing activity. 2. In CONNECTICUT, a part-time core stuff member works with the State Board of Education, charting a compre- hensive design for both physician and allied health _ Manpower. 3. In GREATER DELAWARE VALLEY, an institutionally affiliated core member was appointed by the Governor to the State health manpower commission. MANPOWER ACTIVITIES BY AREA OR EMPHASIS* MANPOWER SURVEYS Most of the manpower surveys mentioned by coordinators were concerned with distribution of physicians and allied health personnel and most included data on only one or two other professional categories of personnel. Several exceptions should be noted: PUERT) RICO's distribution study included data on 51 categories of personnel; WESTERN NEW YORK's included 22 categories. Only two regions (NORTHWEST OHIO AND NORTHLANDS) indicated that distribution data is compu- terized and is updated periodically. ¥ See Table (fT Note: - 12 - The KANSAS RMP has facilitated the implementation of of a health manpower inventory shared with the kansas Comprehensive Health Planning Agency and the Kansas Health Careers Council. Activities to date include the collection of data pertaining to professional and health-related personnel of the State and surveying the educational programs of the institutions of higher learning to determine how future programs may improve the pool of health manpower. Three regions have studied physician and nursing activities to determine time spent on non-medical matters. For example, in ALABAMA a task analysis of nursing services at Huntsville Hospital, covering RN's, LPNs, aides, ward secretaries and attendants in nine categorics of activities was conducted. Results of the study prompted a restructuring of nursing service at the hospital and the RMP fecls that findings can be gencralizcd to other health institutions in the State and perhaps other parts of the country. Four regions reported compiling (and several published) data on educational programs for health personnel in the region- Several rather serious qucstions arc raised by what coordina- tors did not report: . There was little, if any, mention of utilization of existing data on manpower distribution of utilization. Among those who had conducted surveys, there were notably few comments on either why the data was col- lected or how it has been uscd. Two regions noted physician mobility studics; two others studied the distribution of physicians us part of layer patient flow pattern studies. For example, the WESTERN NEW YORK RMP in a coopera- tive venture with the Department of Preventive Medicine, School of Medicine at Buffalo, conducted a survey to determine the current resources and distribution of physicians including 21 allied health categories. A particular focus of the study was to identify areas of present manpower necds due to maldistribution or in- adcquate supply and to obtain baseline information which could be related to manpower requirements of future projects. B. LEGISLATION Ten regions described core staff activity in the area of legislation influencing manpower development. In most cases, efforts were relatcd to loosening of legislative barriers to use of new hcalth personnel and recognition or certification of new catcyories of manpower. In MINNESOTA, the Northlands RMP and the State CP agency have established a study group to review current proposec ‘legislation to loosen legal barriers for utilization of medical assistants, i.e., physician assistants in the region. In the current session of the State Legislature, the State Medical Society has introduced uw bill which would recognize the practice of these new health workers under direct supervision of practicing physicians. The bill also calls for the certification of these assistants to be placed under the State Board of Medical Lxaminers. In this connection, Northlands RMP and CHP have recom- mended that registration be set up apart from the medical examining board and instead be placed under the acgis of a proposed new state board, Health Manpower Coordi - nating Commission. The proposed Commission would include public accountability which is presently absent in other comparable Commissions or Boards. In CALIFORNIA Area IV, a district coordinator succeeded in getting legislation passed for the training of fire- men in coronary care techniques which will allow them to be utilized as ambulance personnel. in HAWATI, RMP and CHP are working jointly to change licensure laws regarding health professionals trained out-of State. - 15 - BI-STATE succeeded in obtaining a waiver from the Council on Higher Education to allow non-high school graduates to enter junior colleges for training as aide-level neighborhood health workers. C. COMMITTEES/ CONSORTIA There is certainly an abundance of talk about manpower devclop- ment in the regions. Thcre were six regions where RMP seems to have stimulated regionwide, high level committees which have great potential for influencing manpower development and utilization. l. Bi-State core staff facilitated formation of, provides staff support for, and chairs a permanent committee of representatives with planning level responsibility from all allied health education institutions in the greater St. Louis Metropolitan urea. This committee acts in an advisory capacity to cffect coordinated centralized planning and implementation of manpowcr development. CONNECTICUT has stimulated a Stutc Coordinating Council for manpower, a coalition of the State Medical ‘Society, Iospital Association, Committee on Higher Education, Blue Cross and several voluntary health agencies. It will function as a sort of "super health careers council," 1 - 16 - to deal with the questions of manpower needs, recruit- ment placement and function. The committee is chairec by the Secretary of State. Also, in Connecticut, each health service area has developed a working consortia of hospitals and local high, technical and vocational education schools for the training of allied health personnel und,more generally, to encourage hospitals to function as change agents. ILLINOIS has formed an Inter-agency Task Force on hduca- tion and Manpower, with representatives from CIP, State Education Commission, the Governor's office, Health Careers Council, and the nursing and dental association. ROCHESTER is forming a consortia of colleges in the region for health care training. SUSQUEHANNA VALLEY is planning a conference of all pertinent agencics, organizations and hospitals in the region to develop health manpower priorities and decide who will do what. The focus will be on"'physician expanders." The OHIO STATE RMP convened a meeting of other Ohio RMPs and 65 other organizations and groups interested in health careers and health manpower to form a permanent, statewide coordinating agency for health careers planning, - [7 - improvement, education and promotion. An ad hoc com- mittee of ten members, nominated by the group, will form the working committee, with the RMP providing coordinative and staff functions. e D. PHYSICIAN'S ASSISTANTS Nearly all coordinators cxpressed interest in physician assistants (MEDEX, MEDIHC) and had given it prime considera- tion. Outlined below are activities which reflect RMP discussion and/or action. 1. BI-STATE, HAWAII and KANSAS regions are surveying need for, desire for, and feasibility of utilizing physician assistants. 2. The BI-STATE RMP,in an effort to decide on an approach | to broaden the scope and practice of doctors to enhance the delivery of health care,is cooperating with the American Medical Association to examine attitudes of physicians toward utilization of physician assistants. It is expected that this study will yield information which will enable the investigators to more clearly identify factors which can serve as a basis to effect changes in the provision of hcalth care where the need is ever increasing. One major bencfit of the study has been the development of a cooperative relationship with the American Mcdical Association. - 18 - Thirtecn regions have physician assistarit projects in develop- ment or in operation. Most will utilize the assistants in _ rural ree though several are designed for implementation in urban.areas having few physicians. NORTH CAROLINA,for example, has assisted Bownan. Gray to develop a program to produce well-trained ana educated health assistants at the intermediate professional level who, by working with a physician, can supplement his services and thereby increase his productivity. The physician assistants program 1s designed especially for ex medical corpsmen or persons with two or more years of college Three regions have helped other institutions develop curri- culum for physician assistants. For example: CALIFORNIA RMP core staff has been actively involved in curriculum development for a physician assistant program with Northern California Junior Coliege and Drew Medical School. E. NURSE CLINICTAN/PRACTITIONER Additional training given nurses to qualify them as nurse practitioners was noted by nine regions as receiving atten- tion. It is interesting that actual implementation of | programs in this area seems to have been accomplished with greater ease than with physicians assistants. With a few - 19 - exceptions, nurses are being trained to work in pediatrics. Several examples of uctivity are described below. 1. I MAINT: last year sponsored as a feasibility Study the training of six RNs in an 18 week pediatric nurse prac- titioners course. They were grantcd certificates by the University of Maine and are currently at work in private physicians or in home health agencies. Licen- sure has not been a problem. Six more are currently in training. In CALIFORNIA Arca IV an informal group of pediatricians and pediatric nurses were concerned with developing a curriculum for training nurses to practice in pediatrics care settings such as OPD's, Kaiser plan centers and Head Start, but were unsuccessful in negotiating with the School of Nursing in the establishment of such a course. An RMP core staff member who also sits on the pertinent school of nursing committce was able to convene the two groups and convince the school to take action in expanding the nurses role. At this time, the curri- culum is in final stages of devclopment and the course will begin this spring. TRI-STATE RMP nas assisted the. development of a geriatric nurse practitioner program involving Cambridge Hospital (a municipal hospital) and the Boston University School ~ 20 - of Nursing, the Commonwealth Fund and the City of Cambridge. The program will tcach nurses to take over much of the care of older persons, particularly in nurs- ing homes and in cxtended care facilities. SPECTFIC NEW CAREERS Seventeen regions noted 26 discrete activities relating to development of specific new career categories. Many of these are closely related to the concept of physician assistants, but were separated because the scope of work is narrower than those categorized as physician assistants. Most of the new career activities are manifested in operational projects or proposals. Five regions, WESTERN NEW YORK, GEORGIA, METROPOLITAN D. C., MISSISSIPPI, and SUSQUEHANNA VALLEY, have implemented train- ing activities for pulmonary technicians, mostly inhalation therapists. For example, WESTERN NEW YORK RMP,in cooperation with a local community college and three area hospitals,has developed a program for the training of inhalation therapists in the region. The didactic portion of the training takes place at the college with the clinical expericnce shared by the participating hospitals. Thirty students have been accepted for the two ycur program from within the region. Following the initial funding of the project by WNYRMP, tne totai financial support will be supplied by the college. The regions of COLORADO-WYOMING, OHIO VALLEY ,- WASHINGTON- ALASKA, and SUSQUEHANNA VALLEY have focused on training of radiation/nuclear medicine technicians. For example in the COLORADO-WYOMING region there has been a concerted effort by the RMP to reduce the acute short- age of well-trained radiation therapy and nuclear medicine technologists through training cstablished in conjunction with the Denver Community College and nine surrounding hospitals. It is expected that at lcast seventy students will be graduated from the program in the immediate future and be eligible for examination and certification in radiation therapy or nuclear medicine technology by the American Registry of Radiologic Technologies. The SOUTH CAROLINA and NW MEXICO RMPs. have developed projects concerned with the training of emergency medical] personnel. In an effort to meet the needs of cardiopulmonary resuscitation training for al] levels of health person- nel, the SOUTH CAROLINA RMP has provided assistance for over 300 courses across the State. Approximately 300 physicians, 4800 nurses and over 3000 allicd health workers such as ambulance and rescuc squad personnel have received training to date. A cooperative arrange- ment among the South Carolina RMP, South Carolina Heart Association and numerous other health related agencies and institutions has proved to be a major strength of the program. ARKANSAS and MISSISSIPPI focused on training equipment/ instrumentation technicians. METROPOLITAN D. C. and WASHINGTON have developed training projects for cardio-pulmonary technicians. The remaining activitics are a mixed bay of training projects, including that for orthopcdic assistants, a new type of dental technician, electronic screening technicians, hospital unit managers, mammography technicians, ophthalmology assistants, urologic assistants, dialysis technologists, and enterostomal therapists. TRAINING OF LAY PERSONNEL/COMMUNITY HEALTH WORKERS ‘Thirtecn coordinators reported activities related to the train- ing und/or utilization of lay persons as community health workers or home health aides. Most of the persons arc drawn from umony the disadvantuged and many of these activities were in cooperation with OKO or Model Cities programs. Illustrative of this kind of activities ure the following few cxumples. A multiphasic screening program developed by the INDIANA RMP has shown that relatively uneducated, indigenous persons from the poverty area can be ef- fectively trained to conduct the testing accurately. To date, 35 technicians, many of whom did not have a high school education, have been trained. The project also has shown that it can detect diseases. Sampling of screenecs indicate that approximately 50% of these patients had a significant test abnormal- ity of which they had no previous knowledge. The multiphasic screening programs have been moved recently into neighborhood health centers ,which has resulted in an excellent follow-up on screened patients. The COLORADO-WYOMING RMP is working with the Migrant Council of Colorado to recruit and train migrants in Colorado as home health aides who will be knowledgeable about health services available, sanitation, nutrition, and record keeping for the migrant population. © A Wisconsin RMP core Staff member, us follow-up to a Milwaukee inner city student health project had develop- ed a proposal for submission. to 0.1:.0. to train community health workers. - 24 ~ In NORTH CAROLINA a Black hospital. was. about to close and their proposal to OEO for a neighborhood health center was turned down. The North Carolina RMP staff helped rewrite the proposal, including, training of community persons as home health aides, and as a result the project received one million dollars in OEFO funding. The NEW JERSEY RMP developed a screening project in the Model Cities area involving training of ghetto residents to refer people for screcning and to consti- tute a follow-up team to ensure that persons with positive findings would receive re-examination and if necessary treatment. H. CURRICULUM DEVELOPMENT Thirteen coordinators reported core activity in curriculum development, much of it directed at aiding junior colleges in establishing health training programs facilitating the tie-in of junior colleges and hospitals. 1. For example, in SOQUII| DAKOTA, a core staff member who is supported in part by CHP is working with small col- leges in the State to plan core curriculum in the heaith fields. In HAWAII, a core staff member has developed and sub- mitted to NIH a proposal for allied health core curri- culum at five community colleges under the University ‘or Hawaii. Students.would select « specialty areca. ~during the clinical phase of the training. Cat . In ALABAMA, The Ropional Technical Institute in Birmingham provides the clinical Situation for junior coliege health students. RMP funds a cooperative net- work of seventeen rural junior college deans who use the Institute. Much of the operation is directed at encourag- ing the health workers to remain in rural areas. Other core activities in curriculum devclopment vary widely, ranging from development of curriculum for comprehensive health planning for a major university to cvaluation of health graduates' performance to determine curriculum revision. It is interesting that in only one instunce did a coordinator note that a committee of the RAG and core were working together. I. RECRUTTMENT Seventeen coordinators noted recruitment to health carcers as a program activity. Roughly half of these activitics were in the form of support to Health Carcers Councils, iittle enthusiasm was expressed about ticir overall cffective- ness. Nine regions were making specific cfforts to recruit members of minority groups and disadvantaged or uncmployed persons. MY For example, in ALBANY the RMP working closely witn the State University of New York at Albany had led to the admission of approximately 600 disudvantuged students this past academic year. Core staff together with personnel from the University and medical college will provide intense counseling to insure continuation or maintenance of the students. Their involvement with the University's open-door policy has resulted in the RMP taking a new look at the area of recruitment for the allied health professions. Staff ure presently develop- ing a registry of health related cducation and training programs in the regions to be distributed to counselors and other persons concerned with counseling and recruit- ment. REACT IVATION/ REFRESHER COURSES: Six regions noted core and project activity directed toward reactivating nurses by providing refresher courses; once was similarly planning training for dicticians. CARELR MOBILUTY Eleven regions are involved in activities related to develop- ing lateral or vertical mobility for hcalth workers, with emphasis on those in nursing services. In some cases efforts are directed at expanding the role of aides anc LPNs; in others, at more formal mechanisms such as curricu.um changes and equivalency testing. 1. In CALIFORNIA Area IV, core staff has helped UCLA develop career mobility into its curriculum, which allows students completing necessary requirements to qualify as hospital aides, nursing home aides, home health aides, ctc. a 2. The NEW YORK Mctro RMP is working with the Urban Coali- tion in an attempt to get the labor unions to develop both lateral and vertical career ladders for their members and facilitating discussion between unions and other agencies concerning training to implement the above. These activities focus on LPNs, RNs and X-ray technicians. 3. The NEW JERSEY RMP in planning training for "family health"’ personnel, a new allied health ficld, has proposed a strategy which provides a “lattice mobility” for these workers. The RMP has been successful in eliciting cooperation from area hospital administra- tors to provide "release time'' for the individual to attend courses of study at a nearby university or community college. liducution coupicd with work cx- perience will provide a basis from which the individual can move vertically or horizontally within the frame- work of the employing health facility. I. MISCELLANEOUS A broad range of rather interesting, if unrelated, activities exist, which is best illustrated by scvcral examples. 1. MISSOURI uses a Heart Association "detail man" to cal] on MDs outside the metropolitan arcas to provide informa- tion about, and enlist involvement in, the primary and secondary rheumatic heart disease prevention programs of the State Division of Health. WESTERN NEW YORK provides English language lessons to foreign medical graduates in the area. The ALABAMA coordinator is working with the vice presi- dents and deans of the University of Alabama in Tusca- loosa on the planning of a two ycar medical school. The MAINE RMP has provided major planning and stimula- tion for a new medical school to train four-year graduates to practice family medicine. The plan, which would use existing facilities, available cxpertise and TV has gained support from key officials und institutions both within and outside the Stute. Til. - 29° - REGIONAL MODLLS After looking at manpower activities by category of activity, it may be helpful to review the approaches used by selected regions which seem to have substantial activity in their region. The descriptors are not intended to be comprehensive, but rather to illustrate varying approaches. A. CONVENOR OF FORMAL COMMITTEES OF KEY INTLUREST (BI-STATL) B. FACILITALOR/STIMULATOR THROUGH INFORMAL CORE CONSULTATION (ALABAMA) C. PROJECT ORIENTATION (IOWA) A. BI-STATE A main thrust of the Bi-State core staff, in accordance with the Regional Advisory Group priority on manpower, has been as a convenor of a formal committee of key interests. With Bi-State RMP staff support, a permanent Intecr-Institu- tional Committce on Allicd Health Programs, representing all interested educational institutions in metropolitan St. Louis, has been established. It was organized to exchange informa- tion, coordinate activities, and develop a variety of exchange programs. It has capability to respond to community needs and provide direct coordination among all cducational com- ponents from junior colleges to the medical schools. - 30 - According to the coordinator, "formation of this’ committee represents a major triumph in cooperation, bringing together in a common effort institutions which in the past have pre- ferred to operate independently.'' While initiative for this new spirit of cooperation cannot all be attributed to Bi-State RMP, there can be no question that if Bi-State RMP had not been in existence to lend cncouragement and sect examples, this committce would not be u reality at this time. The committee, in addition to the RMP's coordinator and associate director for allied health manpower, consists of representatives from, educational institutions in the greater metropolitan St. Louis area who positions in the area of health planning. The RMP core staff performs the following functions for the committee: Development and maintenance of continuing survey information on health manpower needs in the region. Development and maintenance of a current registry on allied health education programs. Information on standards and requirement for approval of allied health manpower programs and data on funding services available. The readiness of key institutional personnel coupled with Bi-State's ability to act as a convening and support re- source, has led to a strong cooperative effort for plan- ning and implementing central coordination, recruiting, and allocation of clinical facilities with existing and proposed training programs. B. ALABAMA Efforts by the Alabama RMP core staff to improve the health manpower situation there appears to take the form of informal consultation provided to other agencies and institutions. This is perhaps best illustrated by enumerating the acti- vities in brief form. The coordinator, Associate Dean for Community Health Services at the Medical School has played an active role in the planning and implementation of a new division of family practice. Because of above role, coordinator has aided the State Association of Genera] Practice in planning a physician's assistant program. RMP core staff developed the program and curriculum for medical assistant training at John C. Calhoun - Junior College (Medical Assistant is somewhat morc clerical than physician's assistant, with training’ -in accounting and the like.) - 32 - The RMP coordinator has helped the Board of Censors of the State Médical Association draft legislation that would recognize new paramedical fields. The cootdinator. is working with the heads of the Model City, Veterans Administration, 2 hospitals, the mayor, several key dieticians, and the Alabama Nutrition Council on a plan to train neighborhood health workers whose primary focus will be nutrition. A core staff member helped Hines Junior College develop equivalency testing for LPNs wishing to enter the associate degree nursing program. | RMP core staff has helped five hospitals in Montgomery set up a coordinated residency/intern program outide of the medical school setting. Core staff helped Lawson Junior College write a pro- posal for submission to the Division of Nursing and ' facilitated faculty arrangements and assistance from a nearby junior college. The coordinator is working with the vice president and dean of the University of Alabama in Tuscaloosa on plans for a two-ycar medical school which has been recommended. C. TOWA The Iowa RMP is one of several regions whose interest in manpower development is manifested primurily in opcrational projects. Projects in Iowa illustrate two distinct approaches to manpower development; projects that decal exclusively with innovative training or utilization of health workers and others which build manpower development into projects of somewhat broader scope. Illustrative of a project focusing exclusively on manpower development through use of a new teaching technique is Iowa's program to teach cardiac auscul ta- tion and cardiovascular examination in children, utilizing new electronic aids, to assist physicians not familar with the cquipment. The project titled, "Diagnosis and Follow-up Care of Children With Heart Disease’ has two foci. The first is described by project title. The second, and that which probably has the greatest potential for impact on the health care, system is designed to alleviate the critical manpower shortage by train- ing RNs and LPNs to provide initial, general, and follow-up medical intcrrogation, limited examination, and counsel for children and their families. Train- ing will prepare the nurses for expanded roles in c private practitioners' offices and areas with inadequate health services. Preliminary evaluation showed the training to result in clinical judgement as good as physicians making the same judgements. The Iowa RMP Multiphasic Health Screening Project in- cludes a component to train and utilize disadvantaged residents of the Model City area to help operate the project and encourage residents to take part in the screening program. The project helps to alleviate the critical physician manpower shortage by using lesser- trained professionals to conduct the screening. 35, - TABLE. I. SUMMARY OF DATA DISTRIBUTION OF REGIONAL MEDICAL’ PROGRAMS AS’ RELATED.TO - ORGANIZATIONAL FRAMEWORK INFLUENCING MANPOWER ACTIVITY > Yu m4 et lf lk - 8 oe 8 eee ee el le ll eee s @ . er ee 8 ee eel . 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Aitilization Studies i Committees/Consortia Physicians Assts.- MEDEX/MEDIHC Nurse Clinician/ Practitioner. td ‘a Defined new Carears Training of Lay Pers.- Comm, Health Workers = Recruitnent & Reactivat ion/Ref. Course Bi-State- . - - eee ee ee California .- +++ ese eg Central New York. - + 2+ «+ 5 Colorado-Wyoming» .. ++ ++ « Connecticut... .+ +--+. . Florida... Georgia . . ead Greater Delaware “Valley vee a Hawaii. «2. 0 ee ee eee Illinois. oe eae ees Indiana... - «+s ce eeee Intermountain ....-.- > coos Towa. . - ee es ee ee louisiana... 2+ eee eee Maine .. rr oe ee ee © of Memphi Metropolitan ‘Washington, DC. Michigan. -- +--+ oe ee Mississippi sss ct eee es Missouri. - + + 6 ee ee ee 8 Mountain States - +--+ ++ * Nassau-Suffolk. »- + ses e+ ¢ Nebraska-South Dakota wee. New Jersey: ss ee ee ees New Mexico. © 62 + > eee ee New York Metropolitan +++: North Carolinas »---s°¢ ss North Dakota. +--+ - ae eed Northeast Ohio- - +--+ +e ¢ Northern New England. - - + - ; Northlands. - - + + + o “| Northwest Ohio. + - - Ohio State- - +++ -« Ohio Valley -- +++ +> . Oklahoma. «5 6 ss ee es oe > x Puerto Rico - + ee es ee ee fe Rochester -- + ee es ee eo ae South Carolina. «+ «ee es fee Susquehanna Valley- +--+ + + es Tennessee Mid-South - + + + + 4+ * TexaS «+ + 6 ee he eo eee oe Tri-State «+ 5 ee eee oe Virginia, © 6 eee es Washington-Alaska - + °+ "+ * West Virginia - +++ °° se Western New York -- ++: * Western Pennsylvania: «°° * * Wisconsin > «sees eet * California Area IV: ++: ' * Total me ee oe Legislation oe eee oS ee se we we eee eee ew » ole . x . |e de . . |e |e of of of + qe le o] « ds ee a ola ed « | ds of “|e . . : | X qe . . . x . . . ‘ . “ls . . . . ‘ . ’ MN RID x x x x x x 20 an a I ae ee . ~ MX x - & 4 4 eee a ee ee Pe Ps 17 xx lo >< mt ~ 13 > im Qurriculum Development ux . “<< > Pa an wan ware < i7 es ee Bh haere ental Bo eh cnet x » | Career Mobility 11 ~ Me wR | Miscellancous wo OS