Dismantling the rural health workforce pipeline

For the past 27 years, a statewide network of Area Health Education Centers (OKAHEC) has worked to increase the supply of primary care providers and improve access to health care in Oklahoma’s rural and underserved communities. Now this program is going away, another victim of the state fiscal crisis and of our failure to provide adequate funding of services that help make us a healthier, better educated, and more prosperous state.

OKAHEC is a community-state-federal partnership that was established in 1984 at the OSU College of Osteopathic Medicine. The program’s central office is part of the OSU Center for Rural Health and its regional centers are located at Cameron University in Lawton, Carl Albert College in Poteau, Tulsa Community College, and Rural Health Projects in Enid.  Nationally there are 56 AHEC programs with more than 235 centers operating in almost every state. Approximately 120 medical schools and 600 nursing and allied health schools work collaboratively with AHECs to improve health for underserved and under-represented populations.

OKAHEC is intended as a comprehensive health workforce development pipeline focused on growing and nurturing the pool of health professionals serving rural and underserved communities. The program has three principal components,  summarized as “get ’em, train ’em and keep ’em”:

1. Get ’em – Building awareness of health care careers for rural and minority students  from grade school through high school. Career awareness and exploration programs include job shadowing, career counseling,  ‘Medical Mystery Tours’, M*A*S*H summer camps and ‘A Day in the Life of a Community Health Center’, providing students with first-hand glimpses into a range of health care jobs and settings.
2. Train ’em – Assisting health professional students with training in rural areas;
3. Keep ’em – Supporting rural communities and providers by offering continuing education and consumer education training throughout the state.

OKAHEC’s career exploration programming has enjoyed proven success in encouraging rural and minority students to train in health care professions, especially at the OSU College of Osteopathic Medicine, and eventually to practice in rural and underserved urban areas.

Oklahoma suffers from a serious shortage of health care professionals in rural and underserved areas, along with disturbing health disparities affecting the state’s rural and minority populations. OKAHEC is widely praised by former participants, health care providers, training facilities, and communities. Why then is it set to cease operating?

The answer is all about money, and, specifically, state appropriations. OKAHEC receives a $400,000 annual federal grant, which requires at least a 1:1 state match. For years, OKAHEC received a line-item appropriation of state funds through the Oklahoma State Department of Health, which was used both to match the federal grant and leverage additional dollars from the four centers’ host institutions, communities, and various grants. State funding reached its peak of $750,000 in 2010.  In 2011, however, as the Health Department absorbed a second straight year of stiff budget cuts, AHEC lost its funding entirely, as did numerous other programs that aimed to promote public health and improve access to care. This year, the legislature again failed to fund OKAHEC.

Over these past two years, staff was cut by 25 percent and the state match has been picked up temporarily by the four regional centers’ host institutions and by the OSU Health Science Center, with the expectation that state funding would be restored. Once it became clear that the legislature was unwilling to restore state funds in 2013, the decision was reluctantly made in late February not to apply for the next five-year round of federal grants. Without state and federal funding, OKAHEC is not expected to survive past the end of the current fiscal year, and unless other funders are found to step in, most of its education, training and retention programs will quickly wind down.

The end of Oklahoma’s Area Health Education Centers is unlikely to be much noted by most Oklahomans in their daily lives. But it will mean that over the coming years, thousands of students in small towns and rural areas will not participate in programs that might have led them to careers as doctors, nurses, lab technicians or epidemiologists, and perhaps back toward jobs in the communities where they grew up.  This will weaken the infrastructure of our rural health care system and aggravate the shortage of health care providers ready to serve rural and minority communities.  It is one more example showing that as we continue to shrink state government, opportunities for our students and communities shrink along with it.