Kansas Health Care Workforce Partnership Symposium

Kansas Health Care Workforce Partnership Symposium April 18 19, 211 Salina, KS Photo courtesy George Jerkovich

Kansas Health Care Workforce Partnership Symposium AGENDA Photo courtesy of George Jerkovich

HEALTH CARE WORKFORCE PARTNERSHIP COMMITTEE Kansas Health Care Workforce Partnership Symposium April 18-19, 211 Salina, KS AGENDA Monday, April 18, 211 12: 12:3 PM Registration 12:3 12:45 PM Welcome and Introductions Ed Berger, Chair, KWSB HCWP Committee 12:45 1:15 PM Overview and Setting the Context Lori Usher, Consultant, Lori Usher Consulting 1:15 1:45 PM Development of Primary Health Care Professionals Don Richards, Associate Director for Career Technical Education, Kansas Board of Regents 1:45 2:15 PM Physician Assistants Sue Nyberg, MHS, PA-C, Program Director and Department Chair, Wichita State University Dept. of Physician Assistant 2:15 2:45 PM Advanced Registered Nurse Practitioners Liane Connelly,PhD, Chair and Professor of Nursing, Fort Hays State University Department of Nursing 2:45 3: PM Break 3: 3:35 PM Physicians Heidi Chumley, MD, Senior Associate Dean for Medical Education, The University of Kansas Medical Center 3:35 4: PM Dentists Daniel Lassley, Dental Workforce Program Manager, KDH&E, Bureau of Oral Health 4: 5: PM Wrap-up and Next Steps 5: 7: PM Networking Dinner Tuesday, April 19, 211 8:3 9: AM Unanswered Questions/Clarifications from Monday and Explanation of Strategy Development Activities Lori Usher, Consultant, Lori Usher Consulting 9: Noon Strategy Development Activities Noon 12:3 PM Lunch 12:3 2: PM Form Common Vision for Implementation Grant 2: 2:3 PM Final Reflections

Kansas Health Care Workforce Partnership Symposium GRANT OVERVIEW Photo courtesy of George Jerkovich

Grant Overview Purpose HEALTH CARE WORKFORCE PARTNERSHIP COMMITTEE The Health Care Workforce Partnership (HCWP) Committee was formed in response to Health and Human Services notice of funding availability and subsequent grant award. This grant was provided as a resource for states to plan and implement programs aimed at increasing the supply of primary health care professionals^, and as part of a larger effort at the national level, to assess the workforce supply and demand, and develop uniform and consistent data sets on health care professionals in order to identify and address key health professions issues, and develop informed workforce policies. The HCWP will bring critical partners together to develop a comprehensive strategic plan that increases primary health care professionals in Kansas by 1-25% over the next ten years and to accomplish the grant s seven objectives, which are as follows: (a) Analyze State labor market information in order to create health care career pathways for students and adults, including dislocated workers; (b) Identify current and projected high demand State or regional health care sectors for purposes of planning career pathways; (c) Identify existing Federal, State, and private resources to recruit, educate or train, and retain a skilled health care workforce and strengthen partnerships; (d) Describe the academic and health care industry skill standards for high school graduation, for entry into postsecondary education, and for various credentials and licensure; (e) Describe State secondary and postsecondary education and training policies, models, or practices for the health care sector, including career information and guidance counseling; (f) Identify Federal or State policies or rules to developing a coherent, comprehensive health care workforce development strategy and barriers and a plan to resolve these barriers; and (g) Participate in programmatic evaluation and reporting activities. ^ Primary health care professionals are those able to direct the delivery of care, i.e. doctors, ARNPs, PAs, dentists, dental hygienists, and clinical mental health. Primary care means the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. The term clinician refers to an individual who uses a recognized scientific knowledge base and has the authority to direct the delivery of personal health services to patients. A clinician has direct contact with patients and might or might not be a physician (i.e. able to diagnose and write a prescription). HRSA's focus is doctors, physician assistants and advanced registered nurse practitioners. Health Care Planning Symposium 1 GRANT OVERVIEW

WORKFORCE DEVELOPMENT PLANNING GRANT ABSTRACT Project Title: Kansas Health Workforce Partnership Applicant Name: KANSASWORKS State Board, Kansas Department of Commerce Address: 1 SW Jackson, Suite 1, Topeka, KS 66612 Phone: (785) 368-729 FAX: (785) 296-144 Email: cnau@kansascommerce.com Website: http://www.kansasworksstateboard.org The Kansas Department of Commerce (Commerce) on behalf of KANSASWORKS State Board (State Board), the state workforce investment board, seeks $15, in funding through HRSA-1-284, Affordable Care Act State Health Workforce Development Planning Grants, to complete comprehensive health care workforce planning for the state of Kansas. The KANSASWORKS State Board will create a subcommittee to carry out the activities of this grant, the Kansas Health Workforce Partnership (KHWP). This partnership will include, but not be limited to, the necessary partners outlined in the grant guidance: a health care employer, labor organization, two-year institution of higher education, a four-year institution of higher education, the recognized state federation of labor, the state public secondary education agency, the state P-16 or P-2 Council, and a philanthropic organization actively engaged in health workforce activities. The goal for the KHWP will be to determine approaches and activities that will result in an expansion of the primary care full-time equivalent health care workforce among professions with current shortages in the state by between ten and twenty-five percent over the next ten years. During the planning grant, the KHWP will focus on the seven activities outlined in the grant guidance. These include analyzing state labor market information, identifying current and projected high demand state or regional health care sectors, identifying existing resources to recruit, educate or train, and retain a skilled health workforce, describing academic and health care industry skill standards, describing state secondary and postsecondary education and training policies, models, or practices for the health care sector, identifying federal or state policies or rules to develop a health care workforce development strategy and barriers and a plan to resolve them, and conducting programmatic evaluation and reporting. Kansas currently faces a severe health workforce shortage for all primary care health professions, even at the current level of demand. In Kansas, there are 94 federally-designated county-level geographic or population primary care Health Professional Shortage Areas (HPSA), 98 dental HPSAs, and 1 mental health HPSAs, out of 15 total counties. The potential for heightened demand for health providers due to a larger number of the population having access to insurance as well as the expansion of federal programs including the National Health Service Corps and the Health Center Program through the Patient Protection and Affordable Care Act will result in an even higher demand for primary care health professionals in the state. It is imperative that the state government and other stakeholders assess and plan for how to meet these needs, so that the state is better able to implement activities and strategies that will result in an increased supply of these vital health professionals. Planning grant funds will be used to pay for a full-time position to coordinate the activities of this grant as well as for programmatic expenses for the KHWP, including supplies and purchased data. This grant will develop an action plan to increase the health care workforce across the state with emphasis on the rural counties. Health Care Planning Symposium 2 GRANT OVERVIEW

Kansas Health Care Workforce Partnership Symposium THINGS TO CONSIDER Photo courtesy of George Jerkovich

Things to Consider The KANASWORKS State Board Health Care Planning Symposium is funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) Workforce Development Planning Grant awarded to Kansas in October 21. The purpose of the Health Care Planning Symposium is to develop strategies that will increase primary health care in Kansas by 1 to 25% in the next 1 years. The outcomes of the symposium will be used to develop a statewide health care workforce development plan. Outcomes will also be used to apply for HRSA s Workforce Development Implementation Grant notice of funding announcement expected in April/May 211. This notebook has been prepared to summarize the tremendous amount of work the Health Care Workforce Partnership Committee and its workgroups have done in the last four months and to supplement symposium presentations. Below is a list of questions to help spark ideas. Consider them as you hear presentations and develop strategies to meet our goal of increasing primary health care in Kansas by 1 to 25% in the next 1 years. What avenues will help us achieve our goal of a 1-25% increase? How do we marry increasing the number of primary care providers and increasing access? Will adding education slots achieve the goal? Residency slots? Would collaborative agreements for preceptors alleviate demand for clinical sites? What partnerships or collaborations could be built or expanded to achieve the goal? Data collection is imperative to this effort. What can be done to improve this? Is there one neutral party to handle data collection and dissemination? What financial resources could be utilized to change databases/collection processes for the licensing boards in order to achieve standardized data sets? Is there agreement among participants about stated barriers? What others exist? Has the veteran pool been tapped? If not, is there a way to streamline the education/licensing process of vets to meet our primary care needs? As the implementation grant is developed, what aspects should be given the highest priority? What might have been overlooked thus far that is significant? All the school/programs have increased supply recently, how do we influence the students to choose primary care? What recruiting or retention activities work? Is it something that can be replicated? Would increasing out-of-state recruitment efforts, particularly in states with many primary care educators help meet the goal? Has Kansas Welcome Home campaign been utilized for recruitment? (http://www.thinkkansas.com/tks/index.html) [Note: this might disband with new administration, but alive and well as of 3/18/11] Health Care Planning Symposium 1 THINGS TO CONSIDER

Kansas Health Care Workforce Partnership Symposium KANSAS OVERVIEW Photo courtesy of George Jerkovich

Kansas Overview POPULATION Kansas population (Source US Census Bureau 21 Quick Facts) Urban & Semi-Urban Dense Rural, Rural & Frontier 2.8 million 2. million.8 million Percent of Kansas population (Source US Census Bureau 21 Quick Facts) between 5 and 18 years of age 18% over the age of 65 13% over the age of 25 with Bachelor s Degree or higher 26% over the age of 25 with diploma 86% Average person per square mile See Attachment A (Source KDHE Bureau of Local and Rural Health) 34 Number of counties See Attachment B (Source KDHE Bureau of Local and Rural Health) 15 Urban (more than 15 people per square mile) 6 Semi-Urban (4 to 145 people per square mile) 1 Dense Rural (2-39 people per square mile) 19 Rural (6 to 29 people per square mile) 33 Frontier (less than 6 people per square mile) 37 EDUCATIONAL FACILITIES/PROGRAMS High Schools in Kansas 384 Local District 351 Private 26 State Run 7 Public Technical Training 16 Public Community Colleges 19 Public and Private Colleges & Universities 18 Primary Care Provider Programs in Kansas See Attachment C 7 ARNP Programs 5 Medicine Program 1 Physician Assistant Program 1 Health Care Planning Symposium 1 KANSAS OVERVIEW

HEALTH PROFESSIONAL SHORTAGE OR UNDERSERVED AREAS Full counties federally designated as primary care health professional shortage areas for their entire population based the number of providers for the population. See Attachment D (Source KDHE Bureau of Local and Rural Health) Full counties designated as primary care health professional shortage areas for their low-income or Medicaid population. See Attachment D (Source KDHE Bureau of Local and Rural Health) Counties with a city or partial-city primary care health professional shortage area designation. See Attachment D (Source KDHE Bureau of Local and Rural Health) Counties with an unmet medical need having a federally designated medically underserved area or population within their borders. See Attachment E (Source HRSA MUA Find) Governor designated underserved counties. See Attachment F (Source KDHE Bureau of Local and Rural Health) Number of people living in a Federally designated Health Professional Shortage Area. (Source HRSA Office of Shortage Designation 3/24/11@ http://ersrs.hrsa.gov) Kansas Nationally 27 58 3 96 8.6 million 67. million NATIONAL HEALTH SERVICE CORPS LOAN REPAYORS & SCHOLARS IN KANSAS Number of National Health Service Corps Loan Repayors in Kansas See Attachment G (Source KDHE Bureau of Local and Rural Health) 92 Primary Care 47 Dental 18 Mental Health 27 Number of National Health Service Corps Scholars in Kansas 1 Number of National Health Service Corps Loan Repayors Nationally 7,154 Number of National Health Service Corps Scholars Nationally 53 Health Care Planning Symposium 2 KANSAS OVERVIEW

HOSPITAL FACILITIES Facility Type Total Hospitals See Attachment H (Source Kansas Hospital Association) 158 Community Hospitals 126 Critical Access Hospital* 83 Hospitals with Swing Beds** 82 State Institutions 5 Federal Hospitals 4 Specialty Hospitals 23 Ambulatory Surgical Centers^ 67 Percent of hospitals located in rural communities Kansas 75% Nationally <4% KS counties with only one hospital 73 KS counties without a hospital 9 General Hospital - (K.S.A. 65-425) means an establishment with an organized medical staff of physicians; with permanent facilities that include inpatient beds; and with medical services, including physician services, and continuous registered professional nursing services for not less than 24 hours of every day, to provide diagnosis and treatment for patients who have a variety of medical conditions. *Critical Access Hospital - Small rural hospitals are designated by the State as Critical Access Hospitals, formerly Rural Primary Care Hospitals, which are linked with larger full service hospitals known as either Essential Access Community Hospitals or Supporting Hospitals. This relationship is called a Rural Health Network. Certified CAHs are eligible for Medicare costbased reimbursement. A federal grant program is administered by the Kansas Rural Health Options Project, promoting network development and the integration of emergency medical services. See Attachment I **Hospital with Swing Beds - A swing-bed is a licensed acute bed that has been designated by a hospital to provide either acute or long-term care services. The hospital must be located in a rural area. The hospital must have less than 1 acute beds. ^ Ambulatory Surgical Center - an establishment with an organized medical staff of one or more physicians; with permanent facilities that are equipped and operated primarily for the purpose of performing surgical procedures; with continuous physician services during surgical procedures and until the patient has recovered from the obvious effects of anesthetic and at all other times with physician services available whenever a patient is in the facility; with continuous registered professional nursing services whenever a patient is in the facility; and which does not provide services or other accommodations for patient to stay more than 24 hours. Health Care Planning Symposium 3 KANSAS OVERVIEW

HEALTH CLINICS: STATE AND FEDERALLY FUNDED Publically Funded Health Clinics Total Counties Served Number of Rural Health Clinics 1 177 76 State Funded Community Based Clinics 2 37 31 Federally Qualified Health Centers 3 14 182 FQHC Look-Alikes 4 1 1 (Source KDHE Bureau of Local and Rural Health) 1 Rural Health Clinic Eligible clinics must be in a rural area designated or updated within the past three calendar years as having a shortage of primary care physicians. Qualifying designations include Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), High Migrant Impact Area (HMIA), or an area designated as medically underserved by the chief executive officer (Governor) of the state. Also, RHCs must employ a midlevel provider not less than 5% of the time and meet a set of minimum standards for physical plant and services provided. RHC s are reimbursed based on a reasonable cost formula for Medicare visits, and on a modified cost-based formula or prospective payment for Medicaid visits. See Attachment J 2 State Funded Community Based Clinics State general funds are provided to assist in the development and operation of clinics that focus on improving access to health care with an emphasis on community-based services and reducing health disparities for underserved populations. Grant funds are intended to make primary medical and dental care, prescription drugs, and preventive health care services accessible and affordable to underserved Kansas residents, including uninsured individuals and those enrolled in public insurance programs with eligibility based on income that are operated by the state of Kansas and/or federal government (HealthWave/Medicaid). Clinics applying for state community-based primary care clinic funding must serve as "safety net" clinics in their communities. Applicant clinics must be not-for-profit or publicly-funded clinics providing at least primary medical and/or dental care services (or planning to provide at least primary care medical and/or dental services for clinics not yet in operation). Only clinics that are organized to serve as a medical and/or dental home for their patients are eligible for funding. See Attachment K 3 Federally Qualified Health Centers (FQHC) - The term FQHC is defined in Section 1861(aa)(4) of the Social Security Act, which states that to be an FQHC, an entity must fall under at least one of the following categories: Be receiving a grant under section 33 of the PHS Act; or Be receiving funding under a written agreement with the recipient of a section 33 grant, and meet the requirements to receive a grant under section 33 of the PHS Act; or Based on the recommendation of the Health Resources and Services Administration (HRSA), has been determined by the Centers for Medicare and Medicaid Services (CMS) to meet the requirements for receiving a section 33 grant, even though it is not actually receiving such a grant (a Look-Alike); or Health Care Planning Symposium 4 KANSAS OVERVIEW

Have been treated by CMS as a comprehensive federally-funded health center as of January 1, 199; or Is an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act or by an Urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act. The term FQHC is used by CMS to indicate eligibility for reimbursement by Medicare, Medicaid, and CHIP using specific payment methodologies. See Attachment L 4 FQHC Look Alike: Based on the recommendation of the Health Resources and Services Administration (HRSA), has been determined by the Centers for Medicare and Medicaid Services (CMS) to meet the requirements for receiving a section 33 grant, even though it is not actually receiving such a grant (a Look-Alike). They are eligible to receive reimbursement from Medicare, Medicaid and CHIP using specific payment methodologies. Health Care Planning Symposium 5 KANSAS OVERVIEW

Kansas Health Care Workforce Partnership Symposium PHYSICIANS Photo courtesy of George Jerkovich

Physicians Educational Requirements/Pathway Steps in Pathway EDUCATION Outcome Years Invested Cumulative Years High School (science-focused) Diploma 12 12 Bachelor s Degree BS 4 16 Medical Degree MD 4 2 Clinical Education (residency/license) License 3 23 Educational Facilities/Programs Institutions Location Quantity High Schools in Kansas Statewide 384 Public Universities Statewide 7 University of Kansas Medical School (same for medical school and residency programs) Kansas City Campus Wichita Campus Salina Campus 1 institution; 3 campus sites Medical School & Residency Programs Medical School Annual applications 2,5 Annual admissions (Aug 211) 191 Kansas City Campus 175 Wichita Campus 8* Salina Campus 8* Total enrolled in 28 (all 4 years) 727 Graduates (May 21) 168 *Aug 211 will increase admissions by 16 total, Aug 212 increase again by 2 in Wichita, demonstrating a net increase of 36 (18%) Residency Programs (3 years) Total residents in Kansas (28) 713 Total primary care residents (28) 3 (267 MD / 33 DO) 3 year program implies 1/year 42% Health Care Planning Symposium 1 PHYSICIANS

University of Kansas School of Medicine Primary Care Residents (21) Kansas City Wichita Salina Total Family Medicine 24 66 12 12 Family Medicine Rural 3 3 OB/GYN 13 19 32 Internal Medicine 72 29 11 Pediatrics 27 13 4 Psychiatry General 27 17 44 Psychiatry Child and Adolescent 5 5 Psychiatry Addiction 1 1 Total primary care residents (21) 172 144 12 328 SUPPLY AND DEMAND Supply Total number of primary care physicians in Kansas (Source KDHE Office of Health Assessment) Statewide population to FTE physician ratio See Attachment M (Source KDHE Office of Health Assessment) 1,595 1 primary care physician per each 1,715 population group Demand The ratio of the number of persons in a population group to the number of primary care physicians practicing in the geographic area and serving the population group per Public Health Service (42 CFR). NOTE: The law only addresses physician demand. 1 primary care physician to each 3, population group Health Care Planning Symposium 2 PHYSICIANS

Identified Gap Counties designated as Primary Care Health Professional Shortage Areas (HPSA) See Attachment D Shortage based on county s low income or Medicaid population to physician ratio Shortage based on entire population and area Governor designated shortage areas of less than 37.1 physicians per 1, population in rural counties See Attachment F 85 counties 58 counties plus 3 cities 27 counties 8 counties Outlook KS DOL short-term projections (29 to 211) 93 Family and General Practitioners 58 Internists, General 14 Obstetricians and Gynecologists 5 Pediatricians, General 9 Psychiatrists 7 KS DOL long-term projections (28 to 218) 74 Family and General Practitioners 44 Internists, General 13 Obstetricians and Gynecologists 4 Pediatricians, General 7 Psychiatrists 6 Other Factors Physicians retained in the state where they received their medical degree and their residency training. Nationally 66% (Source AAMC 29 Report) Kansas 57% The above figures indicate the importance of having a medical school and residency program in the state for retention purposes. Practices established same state student received their undergraduate medical education Nationally 39% Kansas 37% Health Care Planning Symposium 3 PHYSICIANS

AGE Kansas Data (statewide, per KHPA) Average Age Percent Over 5 MD, DOs & Residency Physicians 52 44% Family/General Practice 51 47% Obstetrics/Gynecology 49 44% Internal Medicine 51 43% Pediatrics 48 35% Geriatrics 71 66% Psychiatry 55 6% BARRIERS A rural community doctor often works long hours, is always on-call, is unable to get much time off. Primary care physicians have lower earning potential than specialty physicians. Primary care yields a lower return on investment. One can choose to be a specialty provider and be further ahead financially than choosing to be a primary care provider with a loan repayment perk. Medicare/Medicaid payments are too low to be attractive to physicians. A spouse often prefers a metropolitan area over a rural area. Kansas varying loan repayment programs are not well understood by the target audience. Funding opportunities for physicians are not well marketed. Kansas has no power to increase residency slots as they are set by the Accreditation Council for Graduate Medical Education and funded by Medicare payments. Convincing graduates to choose family practice residency is becoming increasingly difficult (some family practice residency slots are even left vacant). Health Care Planning Symposium 4 PHYSICIANS

RECRUITMENT AND RETENTION RESOURCES FOR INDIVIDUALS Source Name Amount Summary Kansas State Loan Repayment Program (SLPR) HRSA Physicians and Dentists eligible Kansas Medical Student Loan Kansas Medical Student Retroactive Loan $3, annually doctors and dentists/ $25, annually for all other eligible professions for a two year period of service; eligible to renew on a yearly basis thereafter Medical student tuition and monthly stipend Medical student tuition and monthly stipend Health professionals must commit to provide health care services at an eligible site located in a federally designated Health Professional Service Area (HPSA) for a minimum of 2 years. This loan is established to encourage students of Kansas to practice primary care medicine in the State of Kansas. For the people of Kansas, the State Legislature has established the Kansas Medical Student Loan Program to assist students at KUMC. The Kansas Medical Student Loan is awarded on an annual basis, in return for agreements to practice medicine in Kansas after residency. http://www.kumc.edu/studentcenter/documents/kmsl- InformationSheet-1-11.pdf Depending on availability, the Kansas Medical Student Loan can be awarded retroactively. Students who did not take out the KMSL when they first enrolled as a medical student may be eligible to receive it in later years, for up to the full amount that would have been received if it had been offered as an incoming student. For each Retro KMSL contract a student receives, one year of obligation will be required. For more details on the obligation, please refer to the information under Kansas Medical Student Loan Recipients of the Retro KMSL will be expected use Retro KMSL funds to repay student loans borrowed while in medical school. Any funds remaining after your medical student loan debt has been repaid can be used for other school related expenses. Health Care Planning Symposium 5 PHYSICIANS

Source Name Amount Summary Kansas Osteopathic Medical Service Scholarship $15, for 4 years Designed to encourage primary care physicians to establish practices in rural areas of Kansas. Recipients receive $15, per year for up to four years of study at nationally accredited osteopathic schools. Preference goes to first year students. Recipients return one year of practice for each year of assistance. Kansas Bridging Plan $26, The Kansas Bridging Plan loan forgiveness consists of two separate loans: one from the state of Kansas, and the other from a rural health care organization selected by the resident physician and with whom the resident physician signs a practice commitment agreement. The state of Kansas, through the Kansas Bridging Plan, will loan participating resident physicians up to $1,. A loan of $5, is usually distributed each year, during the second and third years of residency training. The rural health care organization, with whom the resident physician signs the practice commitment agreement, agrees to match the amount loaned by the state, and to loan an additional $6, upon completion of residency training. The combined total of both loans can be up to $26,. National Health Service Corp Loan Repayment (HRSA) National Health Service Corp Scholarship (HRSA) $3, per year for a two year period of service; eligible to renew on a yearly basis thereafter; halftime loan repayment also available 1 year of service at designated facility for each year of scholarship Sites must have an eligible HPSA score. Up to $17, loan repayment for 5 years of practice The National Health Service Corps scholarship pays tuition, required fees, and some other education costs, tax free, for as many as four years. Education costs may include books, clinical supplies, laboratory expenses, instruments, two sets of uniforms and travel for one clinical rotation. Recipients also receive a monthly living stipend ($1,289 in 21-211). Health Care Planning Symposium 6 PHYSICIANS

Source Name Amount Summary Scholarship for Disadvantaged Students (HRSA) Loans for Disadvantaged Students (HRSA) Primary Care Loan (HRSA) Award amounts vary depending on the funding levels each year. Loan cannot exceed the cost of attendance (tuition, reasonable educational expenses and reasonable living expenses). The maximum award for firstand second- year students is cost of attendance (including tuition, educational expenses, and reasonable living expenses). Amounts beyond this may be awarded to thirdand fourth-year students. Medical students only can apply for the Scholarship for Disadvantaged Students. This scholarship is awarded to students who come from an economic or environmentally disadvantaged background. The Loans for Disadvantaged Students program provides long-term, low-interest rate loans to fulltime, financially needy students from disadvantaged backgrounds, to pursue a degree in allopathic medicine, osteopathic medicine, dentistry, optometry, podiatric medicine, pharmacy or veterinary medicine. Participating schools are responsible for selecting loan recipients, making reasonable determinations of need and providing loans The Primary Care Loan program provides longterm, low interest rate loans. Loans to third and fourth year students may be increased to repay outstanding balances on other loans taken out while in attendance at that school. Must complete residency within four years and practice in primary care for life of the loan. Faculty Loan Repayment Program $4, Repayment of their student loans in exchange for educating tomorrow's clinicians. Primary Care Loan 5% - Interest does not begin to accrue until repayment begins. Medical student may qualify to receive a Primary Care Loan if they agree to enter and complete a residency training program in primary health care. Please view the HRSA website for a listing of examples of acceptable primary care residencies and practices http://bhpr.hrsa.gov/dsa/pcl.htm. Health Care Planning Symposium 7 PHYSICIANS

Source Name Amount Summary Kansas Career Pipeline CareerZoom Kansas KANSASWORKS.com My Skills My Future http://www.kansascareerpipeline.org/ The Kansas Career Pipeline system, a web- based tool, allows Kansans to measure their career interests, skills and work values, explore occupations, establish educational strategies, and ultimately connect with Kansas employers who need their talents. http://www.careerzoom-kansas.org/ CareerZoom Kansas, a web-based tool, helps prospective students find affordable career training. The site helps people find satisfying careers in fields where they have an interest, and the Kansas public colleges that offer the training to prepare them to work in those careers. They choose what and where they want to study, and CareerZoom gives them direct links to great colleges that fit their needs. Kansas public workforce system s job bank (post and find jobs in the state of Kansas). https://www.kansasworks.com/ada/ http://myskillsmyfuture.org/ US DOL Employment and Training web portal that allows job seekers to match their current skills with new careers and find out what training is needed to transition from one job to another. Visitors to the site can also view local job postings and locate training and education providers. Users can also select a career and identify local businesses likely to employ selected occupation. Includes private businesses, government, and non-profits. FOR COMMUNITIES Source Name USDA Rural Development Loans, Grants, and Initiatives Summary Available for communities less than 2, in size. Community Programs can make and guarantee loans to develop essential community facilities in rural areas and towns. Loans and grants are available to public entities such as municipalities, counties, and special-purpose districts, as well as to non-profit corporations and tribal governments. http://www.rurdev.usda.gov/hcf_cf.html Health Care Planning Symposium 8 PHYSICIANS

Source Name Summary Community Service Tax Credit Program Rural Assistance Center Kansas Rural Health Information Services Kansas Recruitment Center The Kansas Community Service Program (CSP) has given nonprofit organizations a way to improve their ability to undertake major capital fund-raising drives for various projects. This year, $4.1 million of tax credit has been allocated and will be awarded to selected nonprofit organizations to offer Kansas tax credits for contributions made to approved http://www.kansascommerce.com/index.aspx?nid=117 Information and resources to support rural health and rural human services delivery. Funded by HRSA located in North Dakota. http://www.raconline.org/ Announces grant opportunities available for rural communities funded by KDH&E. http://www.kdheks.gov/olrh/krhis.htm The University of Kansas Medical Center, Rural Health Education and Services supports the Kansas Recruitment Center (KRC), whose mission is to assist Kansas rural communities in recruiting and retaining physicians and other health care professionals. http://ruralhealth.kumc.edu/krc/ Kansas Connections Kansas Locum Tenens Program Kansas Connections is an online newsletter provided by the University of Kansas Rural Health Education and Services. http://ruralhealth.kumc.edu/kc/ The Kansas Locum Tenens program was established to provide temporary coverage for rural physician s medical practice, so the rural physician may have time-off for personal or professional reasons. The primary purpose of the program is to provide medical practice relief to physicians in rural communities, in addition, strengthen and expand the rural components of residency programs and academic faculty exposure. Locum Tenens services are available to rural physicians in family medicine, general internal medicine, and pediatrics. Coverage is provided to physicians in any county in Kansas, except Douglas, Johnson, Sedgwick, Shawnee, and Wyandotte. Provided by the University of Kansas Rural Health Education and Services. http://ruralhealth.kumc.edu/klt/index.html Health Care Planning Symposium 9 PHYSICIANS

Source Name Summary Kansas Medical Resource Student/residents Experiences and Rotations in Community Health (SEARCH) Kansas Medical Resource provides temporary medical coverage to physicians in rural communities for general surgery, psychiatry, radiation oncology, anesthesiology, obstetrics/gynecology, family medicine, general internal medicine, general pediatrics, and other specialties. http://ruralhealth.kumc.edu/kmr/index.html. KAMU in partnership with the KU Medical Center Area Health Education Center utilizes a grant through the National Health Service Corps, provides health professions students and residents with opportunities to work on interdisciplinary health care teams. It offers them a unique primary care training experience working with people in underserved rural and urban areas. Placement is a minimum of 2 consecutive weeks located in a HPSA area with an emphasis in placing students in a KAMU member clinic. National Health Service Corps Scholars are given priority as well as students training in Kansas or Kansas residents attending school out of state. kspca.org/index. 4 State Health Resource Partners To provide sufficient number of qualified healthcare professionals and support personnel to meet the current and future workforce demands of the four State region to include SW Missouri, SE Kansas, NE Oklahoma and NW Arkansas. http://www.fourstatehealthconsortium.com/ KDHE State 3 (Conrad) J-1 Visa Program Association of State Medical Board Directors Kansas Clinicians Network Program allows the Kansas Department of Health and Environment to recommend that international medical graduates currently holding J-1 visa status be granted a waiver of the J-1 visa two-year home county residency requirement in return for practicing medicine full-time for a minimum of three years in an "underserved" community. http://www.kdheks.gov/olrh/j-1visa_waiver_overview.htm AIM DocFinder http://www.docboard.org/docfinder.html The mission of Kansas Clinicians Network is to enable practitioners across the state of Kansas, regardless of clinical setting, to access resources, information, and other assets so that patient care is enhanced and disparities diminished. KAMU has supported KCN since its inception in 1998. http://www.kspca.org/index.php?option=com_content&view Health Care Planning Symposium 1 PHYSICIANS

Source Name Summary MD & DDS Resources Inc. National Association of Community Health Center Job Boards Priority Physician Placement DocWorking National Rural Recruitment and Retention Network (3RNet) Association of Staff Physicians KDHE Website (scroll down to Funding Sources ) Health Workforce Information Center Funding Opportunities MD & DDS Resources is the preferred physician and dental recruiting agency of the National Association of Community Health Centers. www.ddsresources.com The National Association of Community Health Centers was formed by and for community-based health center programs. http://www.nachc.org/careercenter.cfm Priority Physician Placement assists physicians in identifying their priorities, seeks to place them in practices where they can achieve their life goals, and matches them to communities where they can serve in successful long-term relationships http://www.priorityphysiciansite.com/ DocWorking (http://www.docworking.com) is an employment site targeting physicians. By offering free job postings for all employers, DocWorking provides a wide variety of positions throughout the U.S. www.docworking.com The National Rural Recruitment and Retention Network (3RNet) members are not-for-profit organizations helping health professionals find jobs in rural and underserved areas throughout the country.. https://www.3rnet.org/default.aspx The Association of Staff Physician Recruiters (ASPR) is a growing professional organization comprised of more than 1,1 in-house physician recruiters employed by hospitals, clinics, physician practices and managed care organizations. Through its website, in-house recruiters find a community to support their professional development, physicians find great jobs, and corporate partners enjoy communicating directly to their target audience. http://www.aspr.org/ http://www.kdheks.gov/olrh/olrh_links.htm#funding http://www.hwic.org/funding/ Health Care Planning Symposium 11 PHYSICIANS

Source Name Summary KANSASWORKS The Kansas public workforce system consisting of 26 workforce centers, 2 mobile centers, 22 virtual service sites, an Internet job bank, and services for both job seekers and employers. See Attachments N & O KANSASWORKS.com Health Care Hiring Fierce Healthcare job listings Universe.jobs Kansas public workforce system s job bank (post and find jobs in the state of Kansas). https://www.kansasworks.com/ada/ http://www.healthcarehiring.com/generalhospitals/kansas// Search or post medical jobs. http://www.fiercehealthcare.com/jobs/ http://universe.jobs/ The.jobs Universe is a brand new launch of a Top Level Domain (TLD) that provides an interactive, communitydriven network of job related sites. Health Care Planning Symposium 12 PHYSICIANS

Kansas Health Care Workforce Partnership Symposium PHYSICIAN ASSISTANTS Photo courtesy of George Jerkovich

Physician Assistants Educational Requirements/Pathway Steps in Pathway EDUCATION Outcome Years Invested Cumulative Years High School (science-focused) Diploma 12 12 Bachelor s Degree BS 4 16 Masters of Physician Assistant PA 2+ 18+ Clinical Education (included) License Educational Facilities/Programs Institutions Location Quantity High Schools in Kansas Statewide 384 Public Universities Statewide 7 Wichita State University PA Program Wichita 1 WSU Physician Assistant Program Quantity Annual applications 453 Annual admissions (Aug 211) 48* Total enrolled in 29 Program 84 Graduates (May 21) 42 * June 21 class size was increased from 42 to 48 students. These six additional students represent a 14% increase. Clinical Sites (13 months) Quantity Total rotations per student 8 Average length of rotations 4 to 6 weeks Rural rotations 12 weeks {minimum} Total rotation sites (21) 1 Health Care Planning Symposium 1 PHYSICIAN ASSISTANTS

SUPPLY AND DEMAND Supply Total number of active primary care physician assistants in Kansas (Source KDHE Office of Health Assessment 29) Statewide population to FTE physician assistant ratio See Attachment P (Source KDHE Office of Health Assessment 29) 176 1 primary care physician assistant per each 15,481 population group Demand The ratio of the number of persons in a population group to the number of primary care physicians practicing in the geographic area and serving the population group per Public Health Service (42 CFR). NOTE: The law only addresses physician demand. 1 primary care physician to each 3, population group Identified Gap Counties designated as Primary Care Health Professional Shortage Areas (HPSA) See Attachment D Shortage based on county s low income or Medicaid population to physician ratio Shortage based on entire population and area Governor designated shortage areas of less than 37.1 physicians per 1, population in rural counties See Attachment F 85 counties 58 counties plus 3 cities 27 counties 8 counties Outlook KS DOL short-term projections (29 to 211) 49 KS DOL long-term projections (28 to 218) 38 Health Care Planning Symposium 2 PHYSICIAN ASSISTANTS

Other Factors Percent of PA s nationally choosing primary care (28) 33% WSU PA s choosing primary care (28) 47% PA s nationally practicing in underserved communities (28) 11% WSU PA s practicing in underserved communities(28) 16% PA s nationally practicing in rural communities (28) 7% WSU PA s practicing in rural communities (28) 3% Total visits to primary care PA s (28) 1,57,738 Mean visits to each PA per week (28) 86 AGE Kansas Data (statewide, per KHPA) Average Age Percent Over 5 Physician assistants 42 22% Health Care Planning Symposium 3 PHYSICIAN ASSISTANTS

BARRIERS Physician assistants have a very defined scope of practice including limitations preventing them from practicing in nursing homes. The physician assistant field is a high growth field with multiple positions available, which forces the primary care provider positions to compete against specialists. Only 16% of the qualified applicants are selected for training and WSU does not maintain a waiting list. According to Central Application Service for Physician Assistants (CASPA), the average applicant applies to 6 different institutions. For the application year that ended in 21 (Class of 212 students) there were 14,682 people who submitted approximately 88, applications to the 156 accredited PA programs. Of those 14,682 applicants, 4,7 enrolled in PA programs, or 32%. Expansion of the physician assistant program at WSU would require: approval by Accreditation Review Commission on Education of PA; significant modification of classroom space; additional faculty and clinic sites; additional administrative staff and physical resources needed to educate a physician assistant for clinical skills; and renovation of gross anatomy and physical education labs. Difficult to recruit and retain qualified faculty for physician assistant program. There is an acute shortage of physician assistants with adequate training as educators and it would require significant time and resources to develop those skills. Salaries for physician assistant faculty are considerably lower than even the starting salary of a physician assistant, which has more than doubled in the past two decades. There is a shortage of clinical sites compounded by WSU not having funds to travel and recruit additional sites. Areas particularly short are rural family practice, general surgery, pediatrics, women s health and long-term care. Students going on clinical rotations outside of Wichita must be offered room and board. Not all potential clinical rotation sites have this available. Rural communities cannot recruit a physician assistant without a physician willing to supervise the physician assistant. Hard to determine actual need for physician assistants because HRSA s underserved areas do not currently include data for physician assistants. There are a limited number of preceptors available for training as part of the educational requirements. Health Care Planning Symposium 4 PHYSICIAN ASSISTANTS

RECRUITMENT AND RETENTION FOR INDIVIDUALS Source Name Amount Summary Kansas State Loan Repayment Program (SLPR) National Health Service Corp Loan Repayment (HRSA) National Health Service Corp Scholarship (HRSA) $25, annually for a two year period of service; eligible to renew on a yearly basis thereafter $6, for 2 years of service. $17, for up to 5 years of service. One year of service at designated facility for each year of scholarship. Compete for employment at designated HRSA sites. Health professionals must commit to provide health care services at an eligible site located in a federally designated Health Professional Service Area (HPSA) for a minimum of 2 years. The NHSC Loan Repayment Program offers fully trained primary care physicians (MD or DO), family nurse practitioners, certified nurse midwives, physician assistants, dentists, dental hygienists, and certain mental health clinicians $6, to repay student loans in exchange for 2 years serving in a community-based site in a high-need HPSA that has applied to and been approved by the NHSC as a service site. After completing their 2 years of service, loan repayors may apply for additional years of support. The loan repayment program recruits both clinicians just completing training and seasoned professionals to meet the immediate need for care throughout the Nation. The National Health Service Corps scholarship pays tuition, required fees, and some other education costs, tax free, for as many as four years. Education costs may include books, clinical supplies, laboratory expenses, instruments, two sets of uniforms and travel for one clinical rotation. Recipients also receive a monthly living stipend ($1,289 in 21-211). Health Care Planning Symposium 5 PHYSICIAN ASSISTANTS

Source Name Amount Summary Scholarship for Disadvantaged Students (HRSA) Loans for Disadvantaged Students (HRSA) Wichita State University Physician Assistant Scholarships Award amounts vary depending on the funding levels each year. Loan cannot exceed the cost of attendance (tuition, reasonable educational expenses and reasonable living expenses). This scholarship is awarded to students who come from an economic or environmentally disadvantaged background. The Loans for Disadvantaged Students program provides long-term, low-interest rate loans to fulltime, financially needy students from disadvantaged backgrounds, to pursue a degree in allopathic medicine, osteopathic medicine, dentistry, optometry, podiatric medicine, pharmacy or veterinary medicine. Participating schools are responsible for selecting loan recipients, making reasonable determinations of need, and providing loans WSU established these fellowships to help PA students. Ongoing donations to these fellowships are solicited. Harold P. (Hal) Gates Memorial Fellowship $3 to $5 Established by Mrs. Laverne Gates (widow of Harold Gates) in 1989 to honor Mr. Harold Gates for his tireless support of the Program and PA students. Mr. Gates was an initial supporter of the PA Program when it was established in 1972 at the Wichita Veteran's Hospital. Given to first year students. Dr. Marvis Lary Fellowship $3 to $5 toward tuition Established in 21 to honor Dr. Marvis Lary (former PA Program Director and a graduate of the first WSU PA Class of 1975) for her work and dedication to the WSU PA Program and the PA profession. Given to first year students. Clayton H. Shaw PA Student Society Fellowship $3, Established by the PA Class of 1979 to support students in the professional phase of the Program Dr. Tim and Kim Scanlan Fellowship $3 to $5 toward tuition Dr. Scanlan has been the Medical Director of WSU's Physician Assistant Program since 1999. Given to first year students. Health Care Planning Symposium 6 PHYSICIAN ASSISTANTS

Source Name Amount Summary Physician Assistant Foundation Scholarship (National) $3, All applicants must attend an accredited PA program, be enrolled in the professional phase of their program, and must be a student member of the AAPA. Kansas Academy of Physician Assistants Kansas Career Pipeline CareerZoom Kansas KANSASWORKS.com My Skills My Future $3 to $5 toward tuition Scholarships given to two students. The Kansas Career Pipeline system, a web- based tool, allows Kansans to measure their career interests, skills and work values, explore occupations, establish educational strategies, and ultimately connect with Kansas employers who need their talents. http://www.kansascareerpipeline.org/ CareerZoom Kansas, a web-based tool, helps prospective students find affordable career training. The site helps people find satisfying careers in fields where they have an interest, and the Kansas public colleges that offer the training to prepare them to work in those careers. They choose what and where they want to study, and CareerZoom gives them direct links to great colleges that fit their needs. http://www.careerzoom-kansas.org/ Kansas public workforce system s job bank (post and find jobs in the state of Kansas). https://www.kansasworks.com/ada/ US DOL Employment and Training web portal that allows job seekers to match their current skills with new careers and find out what training is needed to transition from one job to another. Visitors to the site can also view local job postings and locate training and education providers. Users can also select a career and identify local businesses likely to employ selected occupation. Includes private businesses, government, and non-profits. http://myskillsmyfuture.org/ Health Care Planning Symposium 7 PHYSICIAN ASSISTANTS

FOR COMMUNITIES USDA Rural Development Loans, Grants, and Initiatives Community Service Tax Credit Program Rural Assistance Center Kansas Rural Health Information Services Kansas Recruitment Center Kansas Connections Kansas Medical Resource 4 State Health Resource Partners Available for communities less than 2, in size. Community Programs can make and guarantee loans to develop essential community facilities in rural areas and towns. Loans and grants are available to public entities such as municipalities, counties, and special-purpose districts, as well as to non-profit corporations and tribal governments. http://www.rurdev.usda.gov/hcf_cf.html The Kansas Community Service Program (CSP) has given nonprofit organizations a way to improve their ability to undertake major capital fund-raising drives for various projects. This year, $4.1 million of tax credit has been allocated and will be awarded to selected nonprofit organizations to offer Kansas tax credits for contributions made to approved http://www.kansascommerce.com/index.aspx?nid=117 Information and resources to support rural health and rural human services delivery. Funded by HRSA located in North Dakota. http://www.raconline.org/ Announces grant opportunities available for rural communities funded by KDH&E. http://www.kdheks.gov/olrh/krhis.htm The University of Kansas Medical Center, Rural Health Education and Services supports the Kansas Recruitment Center, whose mission is to assist Kansas rural communities in recruiting and retaining physicians and other health care professionals. http://ruralhealth.kumc.edu/krc/ Kansas Connections is an online newsletter provided by the University of Kansas Rural Health Education and Services. http://ruralhealth.kumc.edu/kc/ Kansas Medical Resource provides temporary medical coverage to physicians in rural communities for general surgery, psychiatry, radiation oncology, anesthesiology, obstetrics/gynecology, family medicine, general internal medicine, general pediatrics, and other health care specialties. http://ruralhealth.kumc.edu/kmr/index.html. To provide sufficient number of qualified healthcare professionals and support personnel to meet the current and future workforce demands of the four state region including SW Missouri, SE Kansas, NE Oklahoma and NW Arkansas. http://www.fourstatehealthconsortium.com/ Health Care Planning Symposium 8 PHYSICIAN ASSISTANTS

Source Name Association of State Medical Board Directors Kansas Clinicians Network National Association of Community Health Center Job Boards National Rural Recruitment and Retention Network (3RNet) KDHE Website (scroll down to Funding Sources ) Health Workforce Information Center Funding Opportunities KANSASWORKS KANSASWORKS.com Health Care Hiring Fierce Healthcare job listings Universe.jobs Summary AIM DocFinder http://www.docboard.org/docfinder.html The mission of Kansas Clinicians Network (KCN) is to enable practitioners across the state of Kansas, regardless of clinical setting, to access resources, information, and other assets so that patient care is enhanced and disparities diminished. KAMU has supported KCN since its inception in 1998. http://www.kspca.org/index.php?option=com_content&view=article &id=64&itemid=66 The National Association of Community Health Centers was formed by and for community-based health center programs. http://www.nachc.org/careercenter.cfm 3RNet members are not-for-profit organizations helping health professionals find jobs in rural and underserved areas throughout the country. https://www.3rnet.org/default.aspx http://www.kdheks.gov/olrh/olrh_links.htm#funding http://www.hwic.org/funding/ The Kansas public workforce system consisting of 26 workforce centers, 2 mobile centers, 22 virtual service sites, an Internet job bank, and services for both job seekers and employers. See Attachments N & O Kansas public workforce system s job bank (post and find jobs in the state of Kansas). https://www.kansasworks.com/ada/ http://www.healthcarehiring.com/general-hospitals/kansas// Search or post medical jobs. http://www.fiercehealthcare.com/jobs/ http://universe.jobs/ The.jobs Universe is a brand new launch of a Top Level Domain (TLD) that provides an interactive, community-driven network of job related sites. Health Care Planning Symposium 9 PHYSICIAN ASSISTANTS

Kansas Health Care Workforce Partnership Symposium ARNP S Photo courtesy of George Jerkovich

Advanced Registered Nurse Practitioners (Report does not include Nurse Anesthetist specialty.) Educational Requirements/Pathway Steps in Pathway EDUCATION Outcome Years Invested Cumulative Years High School (science-focused) Diploma 12 12 Registered Nurse (RN) Licensure Programs RN License 2-4 16 Advanced Registered Nurse Practitioner (ARNP) Programs MA 2+ 16-18+ Clinical Education (included) Certification -- -- Educational Facilities/Programs Institutions Location Quantity High Schools in Kansas Statewide 384 RN Licensure Programs Statewide 46 University ARNP Programs 5 Fort Hays State University (FHSU) Pittsburg State University (PSU) University of Kansas (KU) Washburn University (WU) Wichita State University (WSU) Hays Pittsburg Kansas City Topeka Wichita Master of Nursing Program Tracts Nurse Practitioner Tract 5 Clinical Nurse Specialist Tract 3 Nurse Midwife Tract 2 See Attachment Q Advanced Registered Nursing Practitioner (ARNP) Program Admissions Graduation FHSU Program 26 5 PSU Program 67 26 KU Program 114 55 WU Program 26 9 WSU Program 4 34 21 Total 273* 129* * ARNP Programs do not require students to enroll and complete the program as a lock step. Programs allow for part-time students. Health Care Planning Symposium 1 ARNP

ARNP Program Number of Clinical Sites FHSU Program 18 PSU Program 91 KU Program 142 WU Program 35 WSU Program 7 Total (29-21) 356 ARNP Program Number of Preceptors Utilized in Clinical Sites by Type MD DO PhD MSN Prgm Totals FHSU Program 15 1 25 PSU Program 42 9 4 65 12 KU Program 85 13 4 158 26 WU Program 29 3 1 46 79 WSU Program 4 7 65 112 Type Totals (29-21) 211 32 9 344 596 SUPPLY AND DEMAND Supply ARNP - Nurse Practitioners (Source KS State Board of Nursing 21) 1,885 in Family Practice Specialty* 1,79 ARNP - Clinical Nurse Specialists (Source KS State Board of Nursing 21) 66 in Family Practice Specialty* 379 ARNP - Nurse Midwife (Source KS State Board of Nursing 21) 69 Total (21) 2,56 2,88 *Individual ARNP s may have more than one specialty Total number of active primary care ARNP s in Kansas (Source KDHE Office of Health Assessment 29) Statewide population to FTE ARNP ratio See Attachment R (Source KDHE Office of Health Assessment 29) 27 1 primary care ARNP per each 1,58 population group Health Care Planning Symposium 2 ARNP

Demand The ratio of the number of persons in a population group to the number of primary care physicians practicing in the geographic area and serving the population group per Public Health Service (42 CFR). NOTE: The law only addresses physician demand. 1 primary care physician to each 3, population group Identified Gap Counties designated as Primary Care Health Professional Shortage Areas (HPSA) See Attachment D Shortage based on county s low income or Medicaid population to physician ratio Shortage based on entire population and area Governor designated shortage areas of less than 37.1 physicians per 1, population in rural counties See Attachment F 85 counties 58 counties plus 3 cities 27 counties 8 counties Outlook KS DOL short-term RN projections (29 to 211) NOTE: ARNP s are combined into RN category KS DOL long-term RN projections (28 to 218) NOTE: ARNP s are combined into RN category 1,587 1,64 Kansas Data (statewide, per KHPA) AGE Number 5 years of age or older Percent over 5 years of age Nurse Practitioners 646 34% Clinical Nurse Specialists 395 65% Nurse Midwife 25 36% Health Care Planning Symposium 3 ARNP

BARRIERS Unable to get detailed labor projections because ARNP numbers are included with RN SOC codes. Inconsistent naming conventions for ARNP s makes skill set difficult to understand. Six different national specialty certifications for ARNPs are recognized in Kansas, making it difficult to understand the necessary qualifications beyond the original Registered Nurse licensure. ARNP s are educated using the nursing model other physicians and physician assistants are educated using the medical model. ARNP programs permit part-time and full-time enrollments and do not have a lockstep training model, like the physician and physician assistant models. This makes forecasting supply difficult due to the uncertainty in numbers of graduates. There is a shortage of faculty available to teach the Masters or Doctorate ARNP courses. Those trained at this level are able to earn more practicing than educating. Earning potential in primary care is lower than other specialties. Hard to determine actual need for ARNP s because HRSA s underserved areas do not currently include data for ARNP s. There are a limited number of clinical sites and preceptors available for training as part of the educational requirements. Health Care Planning Symposium 4 ARNP

RECRUITMENT AND RETENTION FOR INDIVIDUALS Source Name Amount Summary Kansas State Loan Repayment Program (SLPR) National Health Service Corp Loan Repayment (HRSA) National Health Service Corp Scholarship (HRSA) Scholarship for Disadvantaged Students (HRSA) $25, annually for a two year period of service; eligible to renew on a yearly basis thereafter $6, for 2 years of service. $17, for up to 5 years of service. One year of service at designated facility for each year of scholarship. Compete for employment at designated HRSA sites. Award amounts vary depending on the funding levels each year. Health professionals must commit to provide health care services at an eligible site located in a federally designated Health Professional Service Area (HPSA) for a minimum of 2 years. The NHSC Loan Repayment Program offers fully trained primary care physicians (MD or DO), family nurse practitioners, certified nurse midwives, physician assistants, dentists, dental hygienists, and certain mental health clinicians $6, to repay student loans in exchange for 2 years serving in a communitybased site in a high-need HPSA that has applied to and been approved by the NHSC as a service site. After completing their 2 years of service, loan repayors may apply for additional years of support. The loan repayment program recruits both clinicians just completing training and seasoned professionals to meet the immediate need for care throughout the Nation. The National Health Service Corps scholarship pays tuition, required fees, and some other education costs, tax free, for as many as four years. Education costs may include books, clinical supplies, laboratory expenses, instruments, two sets of uniforms and travel for one clinical rotation. Recipients also receive a monthly living stipend ($1,289 in 21-211). This scholarship is awarded to students who come from an economic or environmentally disadvantaged background. Health Care Planning Symposium 5 ARNP

Source Name Amount Summary Nursing Scholarship Program (HRSA) National Education Loan Repayment Program (HRSA) Faculty Loan Repayment Program (HRSA) Nursing Student Loans (HRSA) Award varies and includes monthly stipend ($1,326 for 21-211 school year). Covers 6% of total qualifying nursing education loan balance for two years of service; additional 25% of original total qualifying nursing education loan balance for the third year of service. $4, of the participant's student loans and provides funds to offset the tax burden. Participating schools are responsible for selecting loan recipients and for determining the amount of assistance a student requires. In exchange for the scholarship, upon graduation, the newly minted nurses work at The purpose of the Nursing Scholarship Program (NSP or Nursing Scholarship) is to provide scholarships to nursing students in exchange for a minimum 2 year full time service commitment (or part time equivalent), at an eligible health care facility with a critical shortage of nurses. Covers tuition, fees, supplies, books, and provides monthly stipend. Registered nurses working at non-profit health centers, hospitals, nursing homes, and other facilities facing a critical shortage of nurses. Full-time nurse faculty at public or private, nonprofit accredited schools of nursing are also eligible. Degree-trained health professionals from disadvantaged backgrounds serving on the faculty at accredited health professions college or university for 2 years of service preparing the clinicians of the future. Need-based, competitive program. Must pursue diploma, associate, baccalaureate or graduate degree in nursing and apply for aid to participating school. Health Care Planning Symposium 6 ARNP

Source Name Amount Summary Kansas State Nurses Association Nursing Education Loan Repayment Program (NELRP) In 211 will award a $5 scholarship to three applicants using the general scholarship criteria. There are 15 endowed scholarships available: four at $1, each, eight at $5 each, three at $3 each. One managed scholarship is $3 and one managed scholarship is $5. For a 2-year service commitment, will pay 6% of the participant's total qualifying educational loan balances up to $3,. Participants may qualify for an additional 25% if meet the extension requirements for a 3rd year. Within 3 years, participants can effectively pay off 85% of their original educational loan balance. All subject to availability of funds. In 211, the Kansas Nurses Foundation scholarships will be awarded to applicants meeting specific criteria established through the funds. Applicants must have a cumulative grade point average of 3. on a 4. scale, be a Kansas resident, and be enrolled in six credit hours or more per semester in a nursing program. Priorities are RNs pursuing a BSN, graduate and postgraduate nursing study, ARNP, or other certificate nursing programs and students enrolled in undergraduate registered nurse programs. Applicants not awarded endowed or managed scholarships will automatically be considered for the general KNF scholarship. The mission of the Nursing Education Loan Repayment Program (NELRP) is to assist in the recruitment and retention of professional nurses who are dedicated to providing health care to underserved populations. The NELRP provides an economic incentive to nurses to start and/or continue practice in rural or urban communities with a shortage of nurses. Nurses who are selected to participate in the NELRP must enter into a contractual agreement to provide full-time clinical care in an approved facility located in a shortage county. Health Care Planning Symposium 7 ARNP

Source Name Amount Summary Kanas Nursing Services Scholarships Kansas Nurse Education Service Scholarship Kansas Career Pipeline Licensed Practical Nurse program enrollees are eligible for $2,5 each school year. Registered Nurse program enrollees are eligible for $3,5 each school year. Scholarship amounts vary by institution. Recipients will teach one year for each year of assistance after receiving a graduate degree. The Kansas Nursing Service Scholarship requires an obligation to practice as a LPN or RN in Kansas and work for a sponsor. A sponsor means any adult care home, psychiatric hospital, medical care facility, home health agency, local health department or any state agency, which employs LPNs or RNs, licensed by the State of Kansas. The sponsor will provide partial scholarship funding and provide employment upon licensure of the recipient. Recipients must sign an agreement to practice nursing for a sponsor one year for each year of scholarship support. Sponsors pay from $1, to one-half of the scholarship and the State of Kansas pays the remaining amount. Each scholarship amount is divided one half awarded in the fall semester and the second half awarded in the spring semester. Designed to encourage graduate level nursing students who agree to teach in a nurse education program at a Kansas postsecondary educational institution. The nursing programs that are currently participating are: Fort Hays State University, Pittsburg State University, University of Kansas Medical Center, Washburn University and Wichita State University. http://www.kansascareerpipeline.org/ The Kansas Career Pipeline system, a webbased tool, allows Kansans to measure their career interests, skills and work values, explore occupations, establish educational strategies, and ultimately connect with Kansas employers who need their talents. Health Care Planning Symposium 8 ARNP

Source Name Amount Summary CareerZoom Kansas KANSASWORKS.com My Skills My Future http://www.careerzoom-kansas.org/ CareerZoom Kansas, a web-based tool, helps prospective students find affordable career training. The site helps people find satisfying careers in fields where they have an interest, and the Kansas public colleges that offer the training to prepare them to work in those careers. They choose what and where they want to study, and CareerZoom gives them direct links to great colleges that fit their needs. Kansas public workforce system s job bank (post and find jobs in the state of Kansas). https://www.kansasworks.com/ada/ http://myskillsmyfuture.org/ US DOL Employment and Training web portal that allows job seekers to match their current skills with new careers and find out what training is needed to transition from one job to another. Visitors to the site can also view local job postings and locate training and education providers. Users can also select a career and identify local businesses likely to employ selected occupation. Includes private businesses, government, and non-profits. FOR COMMUNITIES Source Name Summary USDA Rural Development Loans, Grants and Initiatives Available for communities less than 2, in size. Community Programs can make and guarantee loans to develop essential community facilities in rural areas and towns. Loans and grants are available to public entities such as municipalities, counties, and special-purpose districts, as well as to non-profit corporations and tribal governments. http://www.rurdev.usda.gov/hcf_cf.html Health Care Planning Symposium 9 ARNP

Source Name Summary Community Service Tax Credit Program Rural Assistance Center Kansas Rural Health Information Services Kansas Recruitment Center Kansas Connections Kansas Medical Resource 4 State Health Resource Partners Kansas Clinicians Network The Kansas Community Service Program (CSP) has given nonprofit organizations a way to improve their ability to undertake major capital fund-raising drives for various projects. This year, $4.1 million of tax credit has been allocated and will be awarded to selected nonprofit organizations to offer Kansas tax credits for contributions made to approved http://www.kansascommerce.com/index.aspx?nid=117 Information and resources to support rural health and rural human services delivery funded by HRSA located in North Dakota http://www.raconline.org/ Announces grant opportunities available for rural communities funded by KDH&E. http://www.kdheks.gov/olrh/krhis.htm The University of Kansas Medical Center, Rural Health Education and Services supports the Kansas Recruitment Center, whose mission is to assist Kansas rural communities in recruiting and retaining physicians and other health care professionals. http://ruralhealth.kumc.edu/krc/ Kansas Connections is an online newsletter provided by the University of Kansas Rural Health Education and Services. http://ruralhealth.kumc.edu/kc/ Kansas Medical Resource provides temporary medical coverage to physicians in rural communities for general surgery, psychiatry, radiation oncology, anesthesiology, obstetrics/gynecology, family medicine, general internal medicine, general pediatrics, and other health care specialties. http://ruralhealth.kumc.edu/kmr/index.html To provide sufficient number of qualified healthcare professionals and support personnel to meet the current and future workforce demands of the four state region including SW Missouri, SE Kansas, NE Oklahoma, and NW Arkansas. http://www.fourstatehealthconsortium.com/ The mission of Kansas Clinicians Network (KCN) is to enable practitioners across the state of Kansas, regardless of clinical setting, to access resources, information, and other assets so that patient care is enhanced and disparities diminished. KAMU has supported KCN since its inception in 1998. http://www.kspca.org/index.php?option=com_content&view=article &id=64&itemid=66 Health Care Planning Symposium 1 ARNP

Source Name Summary MD & DDS Resources Inc. - National Association of Community Health Center Job Boards National Rural Recruitment and Retention Network (3RNet) KDHE Website (scroll down to Fundi ng Sources) Health Workforce Information Center Funding Opportunities Fierce Healthcare job listings KANSASWORKS MD & DDS Resources is the preferred physician and dental recruiting agency of the National Association of Community Health Centers MD Resources is a recruitment agency that specializes in finding jobs for physicians, nurse practitioners. http://www.mdr-inc.com/ 3RNet members are not-for-profit organizations helping health professionals find jobs in rural and underserved areas throughout the country. https://www.3rnet.org/default.aspx http://www.kdheks.gov/olrh/olrh_links.htm#funding http://www.hwic.org/funding/ http://www.fiercehealthcare.com/jobs/ The Kansas public workforce system consisting of 26 workforce centers, 2 mobile centers, 22 virtual service sites, an Internet job bank, and services for both job seekers and employers. See Attachments N & O KANSASWORKS.com Kansas public workforce system s job bank (post and find jobs in the state of Kansas). https://www.kansasworks.com/ada/ Health Care Hiring Universe.jobs http://www.healthcarehiring.com/general-hospitals/kansas// Search or post medical jobs. http://universe.jobs/ The.jobs Universe is a brand new launch of a Top Level Domain (TLD) that provides an interactive, community-driven network of job related sites. Health Care Planning Symposium 11 ARNP

Kansas Health Care Workforce Partnership Symposium DENTISTS Photo courtesy of George Jerkovich

Dentists OVERVIEW Data still to come (3/28/11). Health Care Planning Symposium 1 DENTISTS

Kansas Health Care Workforce Partnership Symposium ATTACHMENTS Photo courtesy of George Jerkovich

Urban County Peer Group (n=6) KANSAS POPULATION DENSITY PEER GROUPS, 29 CENSUS ESTIMATES Population/ Square Mile Semi-Urban County Peer Group (n=1) Population/ Square Mile Densely- Settled Rural County Peer Group (n=19) Population/ Square Mile Rural County Peer Group (n=33) Population/ Square Mile Frontier County Peer Group (n=37) Population/ Square Mile Douglas 254.7 Butler 44.9 Allen 26.2 Anderson 13.5 Barber 4. Johnson 1138.3 Crawford 65.6 Atchison 38. Brown 17.4 Chase 3.6 Leavenworth 162.4 Franklin 46.1 Barton 3.7 Clay 13.5 Chautauqua 5.8 Sedgwick 491.2 Geary 82.5 Bourbon 23.4 Cloud 12.9 Cheyenne 2.6 Shawnee 32.6 Harvey 63.5 Cherokee 35.9 Coffey 13.4 Clark 2.1 Wyandotte 124.4 Miami 53.7 Cowley 29.9 Doniphan 19.4 Comanche 2.4 Montgomery 53.1 Dickinson 22.4 Ellsworth 8.6 Decatur 3.2 Reno 5.5 Ellis 3.8 Grant 12.8 Edwards 4.9 Riley 117. Finney 32.3 Gray 6.9 Elk 4.6 Saline 75.5 Ford 3.7 Harper 7.1 Gove 2.3 Jackson 2.5 Haskell 6.9 Graham 2.7 Jefferson 34. Kingman 8.8 Greeley 1.6 Population Density Census Estimates Labette 33.6 Linn 15.6 Greenwood 5.8 Lyon 39.5 Marion 1.7 Hamilton 2.6 Population Density Peer Group Count Urban 6 Semi-Urban 1 Dense Rural 19 Rural 33 Frontier 37 All Kansas Counties 15 Peer Group Definitions (Per sq. mi.) Population Estimate (29) Percent of Population (29) 15 or more persons 1,556,551 55.22% 4.-149.9 persons 449,677 15.95% 2.-39.9 persons 44,199 15.62% 6.-19.9 persons 256,413 9.1% Less than 6. persons 115,97 4.11% State Average: 34.3 persons 2,818,747 1.% Marshall 32. McPherson 13.3 Hodgeman 2.2 Neosho 28.1 Mitchell 9.1 Jewell 3.4 Osage 22.9 Morris 8.6 Kearny 4.8 Pottawatomie 23.7 Nemaha 13.9 Kiowa 3.2 Seward 36. Norton 6.1 Lane 2.4 Ottawa 8.3 Lincoln 4.3 Pawnee 8.2 Logan 2.4 Pratt 12.7 Meade 4.5 Republic 6.7 Morton 4.2 Rice 13.9 Ness 2.6 Russell 7.5 Osborne 4.3 Scott 6.4 Phillips 5.9 Stevens 7. Rawlins 2.3 Sumner 19.9 Rooks 5.6 Thomas 6.8 Rush 4.4 Wabaunsee 8.6 Sheridan 2.7 Washington 6.3 Sherman 5.6 Wilson 16.5 Smith 4.2 Woodson 6.5 Stafford 5.5 Stanton 3.1 Trego 3.3 Wallace 1.5 Wichita 2.9 Kansas Department of Health and Environment Bureau of Local and Rural Health Page 8 211

POPULATION DENSITY PEER GROUPS 29 CENSUS ESTIMATES KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT Bureau of Local and Rural Health CHEYENNE 2,7 RAW LINS 2,425 DECATUR 2,855 NORTON 5,33 PHILLIPS 5,272 SMITH 3,753 JEW ELL 3,59 REPUBLIC 4,88 W ASHINGTON 5,683 MAR- SHALL NEMAHA 9,968 BROW N 9,927 DONIPHAN 7,624 SHERMAN 5,86 W ALLACE 1,48 GREELEY 1,234 HAMIILTON KEARNEY 2,625 4,169 FINNEY 42, 74 STANTON 2,17 MORTON 3,31 W ICHITA 2,19 GRANT 7,353 STEVENS 5,129 THOMAS 7,343 LOGAN 2,549 SCOTT 4,56 HASKELL 4,6 SEW ARD 23, 13 SHERIDAN 2,435 GOVE 2,48 LANE 1,742 GRAY 6,5 MEADE 4,47 GRAHAM 2,435 TREGO 2,92 NESS 2,835 HODGEMAN 1,96 FORD 33, 692 CLARK 2,81 ROOKS 4,984 ELLIS 27, 739 RUSH 3,143 PAW NEE 6,26 EDW ARDS 3,71 KIOW A 2,322 COMANCHE 1,873 OSBORNE 3,849 RUSSELL 6,596 BARTON 27, 464 STAF- FORD 4,342 PRATT 9,34 BARBER 4,593 MITCHELL 6,344 LINCOLN 3,123 ELLSW ORTH 6,179 RICE 1, 79 RENO 63, 357 KINGMAN 7,571 HARPER 5,667 CLOUD 9,263 OTTAW A 5,974 SALINE 54, 364 MCPHERSON 11, 982 HARVEY 34, 247 SEDGW ICK 49,864 SUMNER 23, 488 CLAY 8,74 DICKINSON 19, 15 MARION 1, 123 BUTLER 64, 84 COWLEY 33, 634 POTTAW ATOMIE 19, 994 Riley 71, 341 GEARY 31, 751 MORRIS 5,994 CHASE 2,798 W ABAUNSEE 6,846 LYON 33, 61 GREENW OOD 6,666 ELK 3,1 CHAUTAUQUA 3,745 JACKSON 13, 412 SHAW NEE 176,255 OSAGE 16, 14 COFFEY 8,436 W OODSON 3,24 W ILSON 9,474 MONT- GOMERY 34, 254 ATCHISON 16, 411 JEFFER- SON 18, 27 DOUGLAS 116,383 FRANKLIN 26, 441 ANDERSON 7,872 ALLEN 13, 23 LEAVEN- W ORTH 75, 227 W YAN- DOTTE 155,85 JOHNSON 542,737 MIAMI 3, 969 LINN 9,335 BOURBON 14, 884 NEOSHO 16, 46 CRAW FORD 38, 869 LABETTE 21, 776 CHEROKEE 21, 64 Frontier Fewer than 6. persons/sq. mi. Rural 6.-19.9 persons/sq. mi. Dense Rural 2.-39.9 persons/sq. Semi-Urban 4.-149.9 persons/sq. Urban 15. persons or more/sq. mi. Kansas Department of Health and Environment Bureau of Local and Rural Health 211 Page 9

Plac e your mes sage here. F or maximum i mpact, us e two or thr ee sentences. Kansas Department of Health and Environment Bureau of Local and Rural Health Primary Care HPSAs as of February 211 CHEYENNE RAWLINS DECATUR NORTON PHILLIPS SMITH JEWELL REPUBLIC WASHINGTON MARSHALL NEMAHA BROWN DONIPHAN SHERMAN THOMAS SHERIDAN GRAHAM ROOKS OSBORNE MITCHELL CLOUD CLAY RILEY POTTAWA- TOMIE JACKSON ATCHISON OTTAWA JEFFER- SON LEAVEN- WORTH WALLACE LOGAN GOVE TREGO ELLIS RUSSELL LINCOLN ELLSWORTH SALINE DICKINSON GEARY MORRIS WABAUNSEE SHAWNEE Topeka Topeka OSAGE DOUGLAS USP WYAN DOTTE JOHNSON GREELEY WICHITA SCOTT Scott City LANE NESS RUSH BARTON RICE MCPHERSON MARION CHASE LYON FRANKLIN MIAMI HAMIILTON KEARNEY FINNEY HODGEMAN PAWNEE STAF- FORD RENO HARVEY COFFEY ANDERSON LINN STANTON GRANT HASKELL GRAY FORD EDWARDS KIOWA PRATT KINGMAN SEDGWICK Wichita BUTLER GREENWOOD ELK WOODSON ALLEN BOURBON WILSON NEOSHO CRAWFORD MORTON STEVENS SEWARD MEADE CLARK COMANCHE BARBER HARPER SUMNER COWLEY CHAUTAUQUA MONT- GOMERY LABETTE CHEROKEE Whole County Designation City Designation State Correctional Facility Designation Low Income Population Designation Partial City Designations Designated but Proposed for Withdrawal Medicaid-Eligible Population Designation US Penitentiary Designated- Not Eligible for Designation

Kansas Medically Underserved Areas and Populations

GOVERNOR-DESIGNATED MEDICALLY UNDERSERVED AREAS KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT Bureau of Local and Rural Health Use only for the establishment or continued operation of Rural Health Clinics (RHCs) CHEYENNE 1.34 RAWLINS.85 DECATUR 1.7 NORTON 2.15 PHILLI PS 1.79 SMITH 2.68 JEWELL.3 REPUBLIC 1.86 WASHINGTON 3. MARSHALL 5.7 NEMAHA 7.25 BROWN 6.59 DONIPHAN 1.2 SHERMAN 3.1 WALLACE.45 GREELEY 2.25 HAMIILTON.84 STANTON 1.88 MORTON 4.46 WICHITA 1.69 THOMAS 4.47 LOGAN 2.68 SCOTT 3. KEARNEY 1.95 FINNEY 18. 22 GRANT 4.3 STEVENS 2. HASKELL.83 SEWARD 13. 12 SHERIDAN.2 GOVE 5. LANE 1. MEADE 2.81 GRAHAM 1.39 TREGO 1.88 NESS 3. HODGEMAN.8 GRAY.93 FORD 14. 6 CLARK 2.15 ROOKS 2.8 ELLI S 2. 45 RUSH 2. PAWNEE 1.86 EDWARDS 1.64 KIOWA 1.3 COMANCHE.8 OSBORNE.5 RUSSELL 4.7 BARTON 22. 8 STAF- FORD 1.71 PRATT 4.22 BARBER 2.95 MITCHELL 4.79 LINCOLN 1. ELLSWORTH 2.38 RICE 4. RENO 39. 4 KINGMAN 2.79 HARPER 3.84 CLOUD 4.97 OTTAWA 3. SALINE 47. 2 MCPHERSON 17. 32 HARVEY 28. 14 SEDGWIC K 297.78 SUMNER 1. 98 CLAY 4.33 DICKINSON 11. 2 MARION 3.1 RILEY 38. 38 BUTLER 29. 32 COWLEY 17. 96 GEARY 7.43 MORRIS 3.78 CHASE.35 POTTAWA- TOMIE 1. 55 WABAUNSEE 1.7 LYON 17. 96 GREENWOOD 3.55 ELK.63 CHAUTAUQUA 1. JACKSON 7.4 SHAWNEE 94. 12 OSAGE 3.88 COFFEY 5.3 WOODSON.33 WILSON 7.94 MONT- GOMERY 19. 4 ATCHISON 5.9 JEFFER- SON 4.17 DOUGLAS 5. 13 FRANKLIN 9.34 ANDERSON 3.8 ALLEN 6.9 LEAVEN- WORTH 25. 77 WYAN- DOTTE 114.76 JOHNSON 352.35 MIAMI 9.48 LINN 4. BOURBON 7.28 NEOSHO 8.53 CRAWFORD 21. 92 LABETT E 1. 98 CHEROKEE 3.53 *The values in each county represent the total FTE for that county based on 29 data. Governor-Designated Medically Underserved Area Ratio equal to or greater than 2,695 persons per primary care physician Not eligible for certification as a Governor-Designated Medically Underserved Area Kansas Department of Health and Environment Bureau of Local and Rural Health 211 Page 23

NATIONAL HEALTH SERVICE CORPS FIELD STRENGTH KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT Bureau of Local and Rural Health January 211 CHEYENNE RAWLINS DECATUR NORTON 2 1 PHILLI PS.3* SMITH JEWELL REPUBLIC WASHINGTON MARSHALL NEMAHA BROWN 1 DONIPHAN ROOKS SHERMAN THOMAS SHERIDAN GRAHAM 1 1 WALLACE LOGAN GOVE TREGO ELLI S 1 6 OSBORNE.7* RUSSELL MITCHEL LINCOLN ELLSWORTH CLOUD 2 OTTAWA SALINE 5 CLAY DICKINSON RILEY GEARY 2 POTTAWA- TOMIE 5 MORRIS 2.8* WABAUNSEE JACKSON 2.2* SHAWNEE 7 OSAGE ATCHISON 1 DOUGLAS JEFFER- LEAVEN- WORTH 3 WYAN- DOTTE 4 JOHNSON GREELEY WICHITA SCOTT 1 HAMIILTON KEARNEY FINNEY 1 STANTON GRANT HASKELL 1 LANE 1 GRAY NESS HODGEMAN FORD RUSH 1 PAWNEE EDWARDS KIOWA BARTON 4 STAF- FORD PRATT 1.1* RICE RENO 5.8* KINGMAN MCPHERSON 1 HARVEY SEDGWIC K 1 MARION BUTLER 4 CHASE LYON 4 GREENWOOD ELK COFFEY FRANKLIN ANDERSON.8* 1 MIAMI LINN 2 2.5* WOODSON ALLEN BOURBON WILSON.25* 1 1.2* NEOSHO 3.5* CRAWFORD MORTON STEVENS SEWARD MEADE CLARK 1 COMANCHE BARBER 1.1* HARPER 1 SUMNER 1 COWLEY CHAUTAUQUA MONT- GOMERY 1.75* LABETT E CHEROKEE 1 None <1 NHSC Provider 1-2 NHSC Providers 3-4 NHSC Providers 5-6 NHSC Providers 7 NHSC Providers *Counties with a partial FTE have a provider who serves in more than one county. Kansas Department of Health and Environment Bureau of Local and Rural Health 211 Page 39 Primary Care Professionals Physicians 1 Physician Assistants 22 Nurse Practitioners 15 Dental Professionals Dentists 14 Dental Hygienists 4 Mental Health Professional Psychiatrists 4 Clinical Psychologists 11 Clinical Social Workers 7 Clinical Licensed Prof. Counselors 1 Marriage and Family Therapists 4 Total NHSC Professionals: 92

DISTrIBUTION OF KANSAS COmmUNITy HOSPITALS OCTOBER 21 Of the 15 counties in Kansas, 26 contain more than one community hospital, 73 contain only one community hospital, and nine are without any community hospitals. The following counties do not have a hospital: Chase, Doniphan, Elk, Gray, Linn, Osage, Wabaunsee, Wallace and Woodson. As of October 21, Kansas has 128 community hospitals. Of these 128, there are 82 hospitals certified for swing-beds. A swing-bed is a licensed acute bed that has been designated by a hospital to provide either acute or long-term care services. The beds must meet the following conditions under section 1883, b1 of the Social Security Act: 1) The hospital must be located in a rural area. 2) The hospital must have less than 1 acute beds. Community Hospital Acute Licensed Bed Size 25 and Under 5-99 26-49 1 and Over SOURCE: Kansas Department of Health and Environment, Bureau of Child Care and Health Facilities HOSPITAL CHARACTERISTICS 13

CrITICAL ACCESS HOSPITALS AND KANSAS medicare RURAL HOSPITAL flexibility PROGRAm The Kansas Medicare rural Hospital Flexibility Program is the successor to the Kansas EACH/rPCH Program. Small rural hospitals are designated by the State as Critical Access Hospitals, formerly rural Primary Care Hospitals, which are linked with larger full service hospitals known as either Essential Access Community Hospitals or Supporting Hospitals. This relationship is called a rural Health Network. Certified CAHs are eligible for Medicare cost-based reimbursement. A federal grant program is administered by the Kansas rural Health Options Project, promoting network development and the integration of emergency medical services. Requirements (KSA65-468): A CAH must... be located in a rural area (outside a metropolitan statistical area) no closer than 35 miles to another hospital unless certified by the State as a Necessary Provider; comply with Medicare Conditions of Participation at the time of application; provide emergency medical services; participate in a network communication and data-sharing system; provide for patient referral and transfer and emergency and non-emergency transportation; and participate with the Supporting Hospital or EACH in joint credentialing and quality assurance. How it works: The local CAH applicant creates a linkage with a larger secondary care hospital to develop network services support and agrees to... limit inpatient and swing-bed care to 25 acute-care beds not to exceed an annual average 96 hours length-of-stay; make available 24-hour emergency care; have a physician, physician s assistant, or nurse practitioner available to provide services; and provide routine diagnostic and clinical lab services. KANSAS CAHs: There are 83 Critical Access Hospitals in the State of Kansas as of October 21. A list of these hospitals and the rural Health Networks can be found on pages 22-23. Alma, NE Lincoln, NE Denver, CO St. Francis Goodland Atwood Colby Oberlin Hoxie Norton Hill City Phillipsburg Plainville Smith Center Osborne Mankato Beloit Belleville Concordia Hanover Washington Clay Center Marysville Sabetha Seneca Onaga Wamego Holton Hiawatha Horton Atchison Winchester St. Joseph, MO Oakley Quinter WaKeeney Russell Lincoln Minneapolis Abilene Salina Herington Topeka Overland Park Tribune Syracuse Johnson City Leoti Lakin Hugoton Scott City Satanta Dighton Garden City Meade Ransom Ness City Jetmore Minneola Ashland LaCrosse Larned Kinsley Greensburg Coldwater Hoisington Stafford Elinwood Kiowa Pratt Medicine Lodge Ellsworth Lyons Hutchinson Kingman Harper Anthony Lindsborg Wichita Caldwell Hillsboro Marion Council Grove Winfield Eureka Sedan Fredonia Neodesha Garnett Iola Chanute Oswego Girard Columbus Pittsburg Joplin, MO Bartlesville, OK Supporting Hospital Critical Access Hospital NOTE: Supporting hospitals are not required to be certified. SOURCE: Kansas Department of Health and Environment, Office of Local and rural Health HOSPITAL CHARACTERISTICS 21

KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT Bureau of Local & Rural Health Rural Health Clinics Provider-Based and Free Standing as of 1/1/1 Total: 175 Facilities Certified RHCs CHEYENNE RAWLINS DECATUR NORTON PHILLIPS SMITH JEWELL REPUBLIC WASHINGTON MARSHALL NEMAHA BROWN DONIPHAN SHERMAN THOMAS SHERIDAN GRAHAM ROOKS OSBORNE MITCHEL CLOUD CLAY POTTAWA- TOMIE JACKSON ATCHISON OTTAWA RILEY JEFFER- SON LEAVEN- WORTH WALLACE LOGAN GOVE TREGO ELLIS RUSSELL LINCOLN DICKINSON GEARY WABAUNSEE SHAWNEE WYAN- DOTTE SALINE JOHNSON ELLSWORTH MORRIS OSAGE DOUGLAS GREELEY WICHITA SCOTT LANE NESS RUSH BARTON MCPHERSON MARION LYON FRANKLIN MIAMI RICE CHASE COFFEY ANDERSON LINN PAWNEE HAMIILTON KEARNEY FINNEY HODGEMAN STAF- FORD RENO HARVEY GRAY FORD EDWARDS SEDGWICK BUTLER GREENWOOD WOODSON ALLEN BOURBON STANTON GRANT HASKELL KIOWA PRATT KINGMAN WILSON NEOSHO CRAWFORD ELK MORTON STEVENS SEWARD MEADE CLARK COMANCHE BARBER HARPER SUMNER COWLEY CHAUTAUQUA MONT- GOMERY LABETTE CHEROKEE Eligible areas with Urbanized Areas, Rural Health Clinics Not Eligible for Rural Health Clinics Eligible areas without Not Underserved, Ineligible Rural Health Clinics for Rural Health Clinics

State Funded Primary Care Clinic Grant Programs: SFY 211 CHEYENNE RAWLINS DECATUR NORTON PHILLIPS SMITH JEWELL REPUBLIC WASHINGTON MARSHALL NEMAHA BROWN DONIPHAN SHERMAN THOMAS SHERIDAN GRAHAM ROOKS OSBORNE MITCHEL CLOUD OTTAWA CLAY RILEY POTTAWA- TOMIE JACKSON ATCHISON JEFFER- SON LEAVEN- WORTH WALLACE LOGAN GOVE TREGO ELLIS RUSSELL LINCOLN ELLSWORTH SALINE DICKINSON GEARY MORRIS WABAUNSEE SHAWNEE OSAGE DOUGLAS WYANDOTTE JOHNSON GREELEY WICHITA SCOTT LANE NESS RUSH BARTON RICE MCPHERSON MARION CHASE LYON FRANKLIN MIAMI HAMIILTON KEARNEY FINNEY HODGEMAN PAWNEE STAF- FORD RENO HARVEY COFFEY ANDERSON LINN GRAY FORD EDWARDS SEDGWICK BUTLER GREENWOOD WOODSON ALLEN BOURBON STANTON GRANT HASKELL KIOWA PRATT KINGMAN ELK WILSON NEOSHO CRAWFORD MORTON STEVENS SEWARD MEADE CLARK COMANCHE BARBER HARPER SUMNER COWLEY CHAUTAUQUA MONT- GOMERY LABETTE CHEROKEE Allen: Community Health Center of Southeast Kansas (Dental Only) Atchison: Atchison Community Health Clinic Barton: Heart of Kansas Family Health Care Cherokee: Community Health Center of Southeast Kansas Cheyenne: Cheyenne County Hospital Clinics Crawford: Community Health Center of Southeast Kansas Mercy Health System Douglas: Douglas County Dental Clinic Health Care Access Heartland Clinic Ellis: First Care Clinic Finney: United Methodist Mexican-American Ministries Ford: United Methodist Mexican-American Ministries Geary: Konza Prairie Community Health Center Grant: United Methodist Mexican-American Ministries Greeley: Greeley County Family Practice Hamilton: Hamilton County Family Practice Harvey: Health Ministries Clinic Johnson: Health Partnership Clinic of Johnson County Mercy and Truth Medical Missions Kingman: St. Gianna Health Care Clinic Leavenworth: St. Vincent Clinic (Caritas) Linn: Mercy Health System Lyon: Flint Hills Community Health Center Montgomery: Mercy Health System Montgomery County Community Clinic Pottawatomie: Community Health Ministry Rawlins: Rawlins County Health Department Rawlins County Dental Clinic Reno: PrairieStar Community Health Center Riley: Riley County-Manhattan Health Department Konza Prairie Community Health Center (Dental Only) Saline: Salina Family Healthcare Sedgwick: Center for Health and Wellness E.C. Tyree Health and Dental Clinic GraceMed Health and Dental Clinic Guadalupe Clinic Hunter Health Clinic Seward: United Methodist Mexican-American Ministries Shawnee: Marian Clinics Shawnee County Health Agency Wallace: Wallace County Family Practice Wyandotte: Duchesne Clinic (Caritas) Mercy and Truth Medical Missions Silver City Health Center Southwest Blvd. Family Health Care Swope Health Services Turner House Children s Clinic Statewide: Kansas Statewide Farmworker Health Program

Kansas Federally Qualified Health Centers: SFY 211 CHEYENNE RAWLINS DECATUR NORTON PHILLIPS SMITH JEWELL REPUBLIC WASHINGTON MARSHALL NEMAHA BROWN DONIPHAN SHERMAN THOMAS SHERIDAN GRAHAM ROOKS OSBORNE MITCHEL CLOUD CLAY POTTAWA- TOMIE JACKSON ATCHISON OTTAWA RILEY JEFFER- SON LEAVEN- WORTH WALLACE LOGAN GOVE TREGO ELLIS RUSSELL LINCOLN ELLSWORTH SALINE DICKINSON GEARY MORRIS WABAUNSEE SHAWNEE OSAGE DOUGLAS WYANDOTTE JOHNSON GREELEY WICHITA SCOTT LANE NESS RUSH BARTON RICE MCPHERSON MARION CHASE LYON FRANKLIN MIAMI HAMIILTON KEARNEY FINNEY HODGEMAN PAWNEE STAF- FORD RENO HARVEY COFFEY ANDERSON LINN GRAY FORD EDWARDS SEDGWICK BUTLER GREENWOOD WOODSON ALLEN BOURBON STANTON GRANT HASKELL KIOWA PRATT KINGMAN ELK WILSON NEOSHO CRAWFORD MORTON STEVENS SEWARD MEADE CLARK COMANCHE BARBER HARPER SUMNER COWLEY CHAUTAUQUA MONT- GOMERY LABETTE CHEROKEE Allen: Community Health Center of Southeast Kansas Barton: Heart of Kansas Family Health Care Cherokee: Community Health Center of Southeast Kansas Crawford: Community Health Center of Southeast Kansas Ellis: First Care Clinic Finney: United Methodist Mexican-American Ministries Ford: United Methodist Mexican-American Ministries Geary: Konza Prairie Community Health Center Grant: United Methodist Mexican-American Ministries Harvey: Health Ministries Clinic (Look-Alike) Lyon: Flint Hills Community Health Center Reno: PrairieStar Community Health Center Riley: Konza Prarie Community Health Center (Dental Only) Saline: Salina Family Healthcare Sedgwick: Center for Health and Wellness GraceMed Health and Dental Clinic Hunter Health Clinic Seward: United Methodist Mexican-American Ministries Shawnee: Shawnee County Health Agency Wyandotte: Swope Health Services *Statewide: Kansas Statewide Farmworker Health Program

Distribution of Kansas Primary Care Physician FTEs Adjusted by Hours by County, 29 * CHEYENNE RAWLINS DECATUR NORTON PHILLIPS SMITH JEWELL SHERMAN THOMAS SHERIDAN GRAHAM ROOKS OSBORNE WALLACE LOGAN GOVE TREGO ELLIS RUSSELL GREELEY WICHITA SCOTT LANE NESS RUSH BARTON HAMILTON KEARNY FINNEY HODGEMAN STANTON 1.3.9 1.7 2.2 1.8 2.7 3.1 4.5.2 1.4 2.8.5.5 2.7 5 1.9 2.5 4.7 2.3 1.7 3 1 3 2 22.8.8 2 18.2 1.9 GRANT 4 MORTON STEVENS SEWARD 4.5 2 13.1 PAWNEE GRAY EDWARDS.9.8 FORD STAFFORD MITCHELL LINCOLN RICE REPUBLIC WASHINGTON MARSHALL NEMAHA DICKINSON GEARY WABAUNSEE CHAUTAUQUA SHAWNEE SALINE MORRIS OSAGE ELLSWORTH 47 LYON 2.4 3.8 3.9 RENO HARVEY SEDGWICK COWLEY MEADE CLARK BARBER SUMNER COMANCHE HARPER JACKSON BROWN BUTLER GREENWOOD WOODSON PRATT WILSON HASKELL 14.6 KIOWA KINGMAN 4.2 297.8 ELK.8 7.9 2.8 2.2 1.9 1.6 1.8 1.7 3 1.9 3 5.1 7.3 4.8 1 4 39 2.8 3.8 CLOUD 5 OTTAWA 3 MCPHERSON 17.3 28.1 11 CLAY RILEY POTTAWATOMIE 4.3 1.6 38.4 11.2 7.4 MARION CHASE 3.1.4 29.3 18 1.1 18 3.6.6 1 7.4 94.1 6.6 COFFEY 5.3 ATCHISON 5.9 DONIPHAN JEFFERSON LEAVEN- WORTH 4.2 1.2 DOUGLAS FRANKLIN 9.3 ANDERSON 3.8 ALLEN 6.1 NEOSHO 8.5 25.8114.8 WYANDOTTE JOHNSON 5.1 352.3 MIAMI 9.5 LINN 4 BOURBON 7.3 CRAWFORD 21.9 MONTGOMERY LABETTE CHEROKEE 19.4 11 3.5 * Shaded by Ratio of 29 Adjusted Population to Primary Care Physician FTEs R <= 2,999 3, - 3,499 3,5-3,999 4, - 4,999 No Physican or R >= 5, Published by: Kansas Department of Health and Environment Bureau of Epidemiology and Public Health Informatics Information Technology, GeoSpatial Services Date of Publication: June 21 Data Source: Kansas Cartographic Dataset Public Health Informatics

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Distribution of Kansas Primary Care Physician Assistant FTEs Adjusted by Hours by County, 28 * CHEYENNE RAWLINS DECATUR NORTON PHILLIPS SMITH JEWELL SHERMAN THOMAS SHERIDAN GRAHAM ROOKS OSBORNE WALLACE LOGAN GOVE TREGO ELLIS RUSSELL.8 2.6.8 GREELEY WICHITA SCOTT LANE NESS RUSH BARTON.2 1 1 1 3.9 HAMILTON KEARNY FINNEY HODGEMAN STANTON 1.9 1 1 2.7 1 1.4 GRANT 1.2 MORTON STEVENS SEWARD 1.7 PAWNEE GRAY EDWARDS FORD STAFFORD 1 MITCHELL LINCOLN ELLSWORTH RICE REPUBLIC SALINE RENO HARVEY WASHINGTON MARSHALL NEMAHA 1 1.1 1 CLOUD RILEY JACKSON CLAY POTTAWATOMIE.7 1.8 OTTAWA MCPHERSON DICKINSON GEARY MARION CHASE COWLEY MEADE CLARK BARBER SUMNER COMANCHE HARPER WABAUNSEE LYON CHAUTAUQUA SHAWNEE BROWN MORRIS OSAGE GREENWOOD WOODSON PRATT WILSON HASKELL 1.1 KIOWA KINGMAN 1.9 29.3 ELK.7.8.8 1.4 1.8 1 2.8 4 4.4 3.2 COFFEY BUTLER 3.1 2.2 SEDGWICK.9 6.4 1.9.8 6.1 1.4.9 1 1.9.8.2.9 1.7 7.3 2.9 1.4 ATCHISON 2.7 DONIPHAN JEFFERSON LEAVEN- WORTH.9.9 DOUGLAS 4 FRANKLIN ANDERSON ALLEN 1.9 NEOSHO 2 4.2 4.9 WYANDOTTE JOHNSON 21.4 MIAMI 1.8 LINN BOURBON CRAWFORD MONTGOMERY LABETTE CHEROKEE 1.3 3.4 2 * Shaded by Ratio of 28 Adjusted Population to Primary Care Physician Assistant FTEs R <= 2,999 3, - 3,499 3,5-3,999 4, - 4,999 No Physician Assistant or R >= 5, Published by: Kansas Department of Health and Environment Bureau of Epidemiology and Public Health Informatics Information Technology, GeoSpatial Services Date of Publication: March 29 Data Source: Kansas Cartographic Dataset Public Health Informatics