**FTS-HRSA-OA**

**December 21, 2005**

**1:00 p.m. CST**

Coordinator At the request of the company today's call is being
recorded. If anyone has objections, you may disconnect at this time.
Please proceed.

Beverly Okay. I think, Susan, I'm going to go back, we've had several
more people come on the line, and start your introduction all over
again. So our speakers today are Susan Salter with the National Health
Service Corps; Tim Skinner with the National Rural Recruitment and
Retention Network; and Lou Coccodrilli with the AHEC Program out of
HRSA. So I'm going to introduce them all three and they're going to have
15 minutes apiece to present. You should have all received their
overhead presentations on the listserve. After all three have presented
we'll take questions and answers.

So we're going to start with Susan Salter, and like I said she is with
the National Health Service Corps. She has assisted communities with
recruiting primary providers through the NHSC program for over 12 years.
She coordinates the NHSC recruitment and outreach activities as well as
the process for identifying and approving new sites to participate with
the NHSC. She's going to be speaking on how clinics can maximize their
recruitment efforts by utilizing NHSC programs. Susan, why don't you go
ahead.

S. Salter Okay. Well, I hope everybody has the presentation because I am
going to go through very quickly. There's a lot of information on the
National Health Service Corps and the different programs and it's hard
to do it in 15 minutes, but I just want to give you a flavor for what we
do and encourage you to follow-up with your state primary care office or
directly with the National Service Health Corps for more information.
We're always happy to do these type of calls and we have a lot of topics
we can talk on, recruitment or developing discount B policies and
schedules and things like that. So we're happy to do that in the future,
so if something sounds interesting to you and you have a group that
you'd like us to talk to, we're happy to do that.

My first slide, after the title slide, is the mission of the National
Health Service Corps. I always like to start any presentation with our
mission, which is to improve the health of the nation's underserved.
Because as you'll hear, if you're not familiar with the Corps, we have
programs that assist clinicians and students, and a lot of times people
think that we're a financial aid program for students or clinicians.
We're really not. It's how we do some of the things. The reason is to
really help communities recruit health professionals.

So moving to the next slide, what does the NHSC do? We help underserved
communities recruit health professionals, and we have an array of
marketing and recruitment activities that we do. The theme for that is,
are you committed to serving the underserved? So we're not just looking
for anyone, we're really looking for those clinicians who want to do
this type of work, who are committed to doing it, and trying to let them
know that we have programs that can help them do that.

Moving to the next slide, is just a list of our programs that I'm going
to be talking about, our scholarship program, our loan repayment
program, ...responder program. I'll briefly touch on that, as well as
state loan repayment programs, search programs, which are student
...experiences, and then a little bit on our campus based ambassador
programs.

So our scholarship program, if you're not familiar with it, is a program
that provides scholarship support to students while they're in school.
It does provide for tuition, fees for books, educational expenses, they
get a stipend for living allowances. In exchange for that scholarship
support they agree to serve in the neediest areas in the country upon
completion of their training. They do choose their practice site, but
they choose it from a list of sites that we provide for them that are
located in the highest need areas of all the sites that are asking for
our assistance. The disciplines that we offer scholarships for, which
means these are disciplines that we will have available for placement,
would be certified nurse-midwife, dentist, family nurse practitioners,
physician assistants, primary care physicians in family medicine,
internal medicine, pediatrics and ob-gyn, and we also offer scholarships
for psychiatrists.

Then we have our loan repayment program. The loan repayment program
repays educational loans for clinicians in exchange for their agreement
to serve for at least two years in an underserved area. For the initial
two year service requirement they'll get up to \$50,000 to repay their
student loans. With the loan repayment program they obtain employment
first, and then they apply to the National Health Service Corps. So
there's a lot more flexibility \... with scholars, we have a list of
scholars we need to place. We can tell you who they are. With loan
repayers it's really a tool that communities use to make their practice
sites more attractive because they qualify for loan repayment.

> The disciplines that we offer loan repayment include those disciplines
> that we offer scholarships for but it's also expanding to include all
> primary care nurse practitioners, so not just family nurse
> practitioners, but also adult or women's health. Physician assistants,
> certified nurse-midwifes, dentists, again just like the scholarship
> program, but we also offer loan repayment to dental hygienists, in our
> loan repayment.

We, also, in the next slide will list the mental behavior health
disciplines that we offer loan repayment for. On the scholarship program
we offer scholarships for psychiatrists but we have about five other
disciplines that we'll offer loan repayment to.

A couple of things that you need to know if you're interested in the
National Health Service Corps, that all of our sites must be located in
providing service to federally designated health professional shortage
area or HPSA. HPSAs are not designated by the National Health Service
Corps, they are designated by the shortage designation branch in the
bureau of health professions, and I have provided their Web site on this
slide where you can get a lot of information on criteria for HPSAs. They
have a database you can search to see if your county is in a HPSA. But
if you have any questions, if you can't find whether you're in a HPSA or
you'd like to apply for a HPSA, the best person to contact would be your
state primary care office first to find out how they can help you with
that.

Next are things called automatic HPSAs, and all federally qualified
health centers, or FQHC look-alikes, are eligible for automatic HPSA.
They automatically are designated as being a shortage area. Certified
rural health clinics are also eligible for an automatic HPSA, but they
must apply and they must meet NHSC charges for services requirements,
which I am going to talk a little bit about. Native American populations
and sites also have automatic HPSA opportunities.

Now as I said in the scholarship program, scholars have to go to areas
of greatest need. So how do we determine which areas have the greatest
needs? The way that we do that is, HPSAs are scored. The lower the score
the lower the need, the higher the higher the need. They go from zero to
about twenty-five. So the higher you HPSA score is the higher your need
is if you would qualify for priority funding through the National Health
Service Corps which means you would be eligible for a National Health
Service Corps scholar.

The next slide actually talks about what the minimum score would be if
you wanted to recruit or if a site wanted to recruit a National Health
Service Corps scholar. Now HPSAs come in three types; primary care which
is a shortage of primary care professionals; mental health, a shortage
of mental health; and dental HPSAs, which are a shortage of dental
providers. So depending on who you're recruiting would depend on which
HPSA you're looking at.

> But if you wanted to recruit a primary care physician who received a
> scholarship from the National Health Service Corps you would have to
> be in a primary care HPSA of 14 or above. Physician assistant and
> nurse practitioners have to be in a primary care HPSA of 13 or above.
> Certified nurse-midwives would have to be in a primary care HPSA of a
> score 8 or above, dentists, in the dental score of 20 and above, and
> psychiatrists, a mental health HPSA of 20 and above.

There are also limits to the number of new scholars that you can get and
they are listed on the next slide, which I hope you have. That is not
affected by the number of scholars you may have gotten last year or loan
repayers you have serving. It's really new every year, you can get new
scholars.

Talking about the loan repayment program, we give a priority for sites
that are in the higher scoring areas but there's no minimum HPSA score
to be eligible for the loan repayment program. However, if you're in a
site that has a score of 14 or above that means that you get a priority,
which means we can review loan repayment applications from clinicians
who are serving in either primary care, mental health or dental HPSA
that scores 14 or above, as soon as it's received. If it's eligible and
complete we can approve it at that time.

> Applications from clinicians who are in HPSAs with a score of 13 or
> below would be funded after our deadline, which is the last Friday in
> March, by decreasing HPSA score until our funds are depleted. But I
> can tell you that in fiscal years 2003, 2004 and in 2005 we were able
> to fund all eligible loan repayment applications regardless of score.
> So it is dependent on our funding and there is no guarantee, but we
> have been fortunate to have funding levels that have allowed us to
> award all loan repayment requests that we've gotten that were eligible
> and who submitted complete applications.

There are also maximums to the numbers of new loan repayers you can get
each year. Again, that's not affected by the number of new scholars you
get or the number you may have already serving. Those are listed on the
slide.

When we talked about site eligibility, again, you have to be in a HPSA
and there are other requirements. One of the big requirements, which is
also a requirement for rural health clinics who want to apply for the
automatic HPSA, is our charges for services. National Health Service
Corps sites have to agree that they will eliminate financial barriers to
care, which means they have to have fees that are consistent with the
prevailing rates in the area, and they have to discount or waive those
fees for individuals who are at or below 200% of the poverty level. They
have to accept assignments for Medicare and have agreements with
Medicaid and the state children's health insurance program. They also
have to post a sign in a prominent place in the practice advising
patients that no one will be turned away because of their inability to
pay and they can apply for discounts at the desk, etc.

Sites of the National Health Service Corps do have to provide
comprehensive primary care, primary mental health service or dental
services. They have to be ambulatory in nature. We don't do in-patient
or hospital \... The have to ensure access to ancillary in-patient and
specialty referrals.

> Now if you're interested in the program how would you...On the next
> slide I have our Web site and that's where our Recruitment and
> Retention Assistance application, or our R&R application, can be
> found. On our Web site we have a list of tabs on the left and one of
> them says Applications and if you click on that you'll see the
> Recruitment and Retention Assistance application. You can download it,
> fill it out, submit it to us, you can fax it to us, the instructions
> are there. We ask that you do keep your vacancies current and notify
> us if there's any changes. So once you apply you'll be notified that
> your site was approved, and you have to remember that sites can be
> approved for primary care but not dental and vice versa. So you'll
> want to know what HPSAs you have and what those scores are.
>
> Once you're approved, then you can request vacancies to be posted any
> time. Even if you don't have a vacancy right now, a site can apply and
> be approved and then when they do a have vacancy they can call our
> 1-800 number. All of that contact information is on my last slide, and
> just request to post a vacancy. But we do ask when the vacancy has
> been filled that you let us know so we can take it off. If you have
> someone at your site who wants loan repayment, you still need to call
> and request a vacancy for them. We would indicate that's a filled
> vacancy, it wouldn't go our Web site, but we would still need to know
> about that.

So it's important to apply to the National Health Service Corps to post
your vacancies on our Web site. We are doing a lot of recruitment
efforts, like I talked about. We have posters in residency programs, we
do print ads, we do presentations and residency visits, and so we are
constantly reaching out to folks who want to work in underserved areas
and bringing them to our Web site as the place to find those jobs. A lot
of people will maybe get a lead from that who is not a scholar who
doesn't want loan repayment. So it's not an exclusive list for
individuals who want loan repayment or who are a scholar, but it's
certainly used by those individuals who either participate or want to
participate in this program. We also provide an opportunity to fill out
a site profile where you can add additional information to try to get
folks to call.

Then my last couple of slides, we have a ready responder program. Those
individuals are commissioned officers in the U.S. Public Health Service,
which means the Corps would pay their salary. They do serve in the
neediest areas; the minimum HPSA score for those folks is 15. They serve
up to three years but they also receive training to respond to national
and regional emergencies. So sites have to be prepared to provide
coverage for their training as well as if they're deployed, which this
year, of course, they were deployed quite a bit with Katrina and all the
other hurricanes.

A number of states have state loan repayment programs. The National
Health Service Corps does provide grant funds to states to operate their
own state loan repayment programs; benefits and requirements do vary.
Some states have state loan repayment programs that aren't tied to the
National Health Service Corps, and their placement can be sometimes in
state HPSAs and not federally designated HPSAs. So for information on
that you can contact your primary care office or look at the NHSC Web
site for contact information.

We also started a campus based ambassador program who are volunteer
faculty on campus' across the country who work with the National Health
Service Corps to really recruit students into the mission of the Corps,
into thinking about ... in underserved areas. So we have probably 600
folks who volunteered for that program, and there is a list there if
you'd like to try to hook up to see if there is an individual ambassador
in, I guess all of you all are from Georgia, I'm thinking, and try to
hook up and develop some community academic linkages at those type of
...

We offer a search program, which provides opportunities to students and
residents to get some experience. We have about 23 to 25 contracts with
states to do that and their contact information is on the...

Lastly, we also provide technical assistance to sites, to help them to
apply and become National Health Service Corps sites or help them
develop recruitment plans or develop academic linkages. We have a number
of areas that we can provide technical assistance to sites. We're always
happy to do that.

> Some sites already have Corps clinicians and they may be struggling,
> and of course, it's to our benefit that we help them with certain
> things. Sometimes they may need some billing and coding assistance, so
> we're able to provide that for sites that have Corps clinicians, to
> make sure that they are able to stay viable. So if you're interested
> in that you would call our 1-800 number or visit our Web site. My last
> slide has all of that information on it. I look forward to answering
> any questions at the end of the presentation.

Beverly Thank you, Susan. That was very informative.

S. Salter I think I kept within my 15 minutes, more or less.

Beverly You did a real good job. I could tell you were hardly coming up
for breath. If you would all save your questions for Susan until after
the other two presenters, then we'll have a fairly long question and
answer session. So thanks again, Susan, we'll be back to you.

Our next presenter is Tim Skinner. Tim is the Executive Director of the
National Rural Recruitment and Retention Network, which is called 3R
Net. Prior to joining 3R Net he was involved in medical staff
development and physician recruitment and retention for more than 20
years. He has experience in rural recruitment in communities of 800 to
8,000 people in the tri-state area of Wisconsin, Minnesota and Iowa.
Community involvement is essential to recruitment and retention of
medical staff in rural areas and Tim's experience echoes that. He is
also the past president of the Association of Staff Physician
Recruiters, and has presented around the country on topics related to
physician recruitment and retention. Tim, I'm going to let you tell your
story about your favorite sign in La Crosse.

T. Skinner Okay. Thanks, Beverly. What Beverly's referring to, actually
about 50 miles from my house in the hill country of Wisconsin, is a nice
blue sign on the highway that says, and I think I can almost quote the
sign. The sign says, "For cell phone emergencies, please dial 911."
Every cell phone that you have available says "No service." I mention
that as an example of some of the kind of thinking that comes from, in
this case, some office somewhere that said let's put this sign here and
help these folks out. It's well intentioned, but in reality it doesn't
really help because the cell phones don't work. I think we have that
kind of thing going on in rural practices, in trying to support some of
our underserved populations. The sign just cracks me up. I know that
some day I'm going to drive by that sign and this cell phone is actually
going to work.

But what I want to do is to first of all thank Susan and try to do what
Susan did, and try to keep this fairly short. I want to talk about 3R
Net, how it works, the member benefits, community benefits, and how the
3R Net works with communities. I also need to tell you that the 3R Net
is supported by a grant from HRSA's Office of Rural Health Policy, and I
feel badly that I did not include that on one of the slides.

> But the PowerPoint presentation I hope you all have in front of you
> will offer a variety of information, and you'll have that as a
> reference. I'm going to try to group some of the slides together to
> squeeze things in and stay on track. I also warn those of you who have
> headsets on I'm trying real hard not to sneeze, so if you hear this...
> remove those headsets.

First of all if you look at slides one and two, the 3R Net is a
not-for-profit organization. It works with state members and helps
communities recruit and retain physician, dentists, nurse practitioners,
PAs and other medical professionals. In late 2005 we started working on
pharmacy, and you'll see more of that in 2006. The other thing is that
we really strongly endorse the tie between physician recruitment and
community development. In fact it's our premise that the two have to go
together if you're going to be successful. The members are available to
consult and assist rural communities and to help with workshops and
forums. That's our approach to technical assistance, along with we have
an online recruitment and retention manual.

The other thing that 3R Net does is we really recognize that rural and
underserved populations just aren't the same across the country. We have
43 member states currently. Those states have diverse needs, they have
diverse populations, and our members are diverse. They all use the 3R
Net differently. It's pretty apparent that just by looking at the map,
that Wisconsin and Georgia are just not the same and they do have
different needs. We think that's important and we don't take a cookie
cutter approach to how we do things. Our state members have different
budgets and they have different levels of staffing, so each state really
does decide how the 3R Net works best for their state.

> Our members are all not-for-profit state-based agencies and they all
> have a relationship to HRSA. Some of the state members are offices of
> rural health, some are PCAs, PCOs, we've got AHEC members, we've
> got...based members, and we have some states that combine the
> resources of several of those agencies to form a member. We've also
> got, I think probably most of you are familiar with the bi-state
> project, that's Vermont and New Hampshire that have gone together and
> they form a membership. So we've got different kinds of members. But
> the key, and what we want, are 3R Net members who'll really be
> responsive to candidates and communities.

So if you look at that grouping of slides like three through six there,
I want to talk a little bit about the members, what we do and our
principles and our benefits. Probably one of the biggest things that our
members have is the advantage of a national presence that would really
be too expensive to do it alone as a single state-based agency. I'll
tell you a quick little story, a funny story.

> Last year in 2005, 3R Net had ten booths at the National Congress
> Family Practice Residency meetings. We had people from about eight
> states, we had our 3R Net staff all there representing 43 states and
> 3,500 communities. We had 200 family practice residents and medical
> students registered on the 3R Net during that meeting. I can tell, you
> I've attended that meeting since 1987. I've missed a few years here
> and there, but there were times when I really felt pretty darn good to
> go home with one candidate. By representing 43 member states and 3,500
> communities, the residents really quickly figured out what the
> advantage to the 3R Net was. It was fun because they would come up and
> say, "You mean I can look at Minnesota, South Carolina and Colorado in
> one place and I won't be bothered by recruitment firms?" The answer
> was yes. They were bringing their friends and their colleagues and
> their faculty.
>
> So what we do is pool our resources so we can do things like that,
> have a much bigger presence. I can also tell you we've worked with
> Susan, and in 2006 we'll be combining some of our exhibits with the
> National Health Service Corps and I think that's going to be a pretty
> potent combination and a lot more fun, both for us and for the
> candidates, because they can find information right there.
>
> We pool our funds, our members pool funds and share the knowledge, and
> then we can develop this national presence on ads and Web sites, and
> use the database which, again, would be really way too expensive for a
> single agency to do. So the 3R Net really does provide that national
> exposure. Our basic premise that we operate on is the people in your
> state know more about what's going on than those in distant
> recruitment firms. Those folks are going to be more responsive to
> community needs.

So to kind of wrap up the member benefits section, you'll see a lot of
sharing of information, access to database list serves, access to
candidates, national presence, journal ads, Web sites, recruitment fairs
and so on.

If you look at slides seven and ten, this is kind of fun because you can
see in 2004 we had 753 matches or placements. Four hundred fifty nine of
those were physicians, eighty were dentists and the rest were other
medical professionals, either mental health; RNs, PAs, NPs, social
workers, clinical psychologists and so on. As you look at those matches
you can see right away that they took place in 611 communities and 541
of them were medically underserved areas. Just think for a minute, 459
physician placements, if we just talk about that, and if there was a
recruitment fee of \$20,000 per physician for half of those,
collectively we saved communities \$4.5 million. And quite frankly, we'd
rather see a community and practice keep a \$20,000 recruitment fee
because it means a lot to small towns. So that's one of the other
advantages that members have.

As you can see from slides nine and ten, our members do recruit from a
variety of underserved areas, and you can look at the list there.
Probably more interesting, and maybe surprising for some people, is we
recruit for a variety of health care facilities, everything from
community clinics to very large integrated delivery systems...

If you look at slides 11 and 12, I'm going to talk about cost for a
little bit, it's kind of fun. The annual dues to 3R Net is \$3,000 a
year, and I just think it's kind of interesting to compare that to the
cost of a \$30,000 pickup truck, which I can't afford. But we look at
the annual dues as \$3,000 a year. More important on slide number 12, if
you look at how much it costs to advertise in one of the national
journals for a year, you can see that that \$3,000 will get you a lot
more, because all the members contribute and then we advertise on behalf
of 3R Net. It's very, very expensive to do appropriate, targeted journal
ads for a year.

As we move on to slide 13, we get into what we're really talking about,
and that is that recruitment and retention in rural communities really
has to include community development and all the resources in the
community be successful. In other words, the agencies, the clinics, the
hospitals, the businesses, need to collaborate to work together.
Everybody knows here on this call that the entire country is looking for
physicians. This isn't rocket science. I've been doing physician
recruitment in small communities for about 20 years. I'm certainly not a
rocket scientist. But it's all about how you bring people together and
collaborate and prepare and plan and be persistent. That's really what
it's about.

Then...recruit pension. That doesn't exactly roll off the tongue, it's
not real easy to say. But what we really want to emphasize is that
physician recruitment is not an isolated event. It's part of a process,
and we need to pull all those things and more together. Actually there's
a very short list on that slide. That's a full days' workshop, at least.
But we need to think of physician recruitment or practitioner
recruitment as including the community needs assessment. You need to be
prepared with a strategic plan that leads to a recruitment plan.
Orientation and retention needs to be addressed up front, and we
certainly should be paying attention to retaining our existing staff. So
physician recruitment, practitioner recruitment really doesn't work very
well in a vacuum; it's really part of a process. Again, I just can't
emphasize enough that in rural communities there has to be an
interaction and a partnership between the community and the medical
practice. We have to do our homework up front.

For rural communities, our goal is to find a match between the
practitioner and the community and not just make a placement. I've been
there, I know what it's like to lay in bed at night and have trouble
falling asleep because you think, man, is that guy going to be nuts? Is
he going to make it, fit in? That's a terrible feeling, and I think as
we're better prepared up front we think about the actual match rather
than the placement, we'll be much better off.

On slides 15 and 16, to find your 3R Net member. I think most of you are
in Georgia, but I'm not sure about that, but it's very, very easy to
find your 3R Net member. You go to
[www.3RNet.org](http://www.3RNet.org/), click on the map of the United
States, and up will pop the list of members. Click on the state of
interest and there will be the contact information for that person's
phone number, e-mail address, and so on. They'd be happy to work with
you. Now if there's not a 3R Net member, if somebody is out there
listening and they don't have a member in their state, please get a hold
of us, because if you have ideas about who would be a good, responsive
member in the state, we'd certainly like to work with them.

On the last slide is the 3R Net, if you want more information. There is
a toll free number, there's the e-mail info at 3RNet.org, that will get
you to Nicki Kennedy Cafer, who's the administrator, who is very, very
knowledgeable. My contact information is there also. Like Susan, I think
I tried to stay under 15 minutes.

Beverly You did a very good job, Tim. We actually have folks on the line
from all over the country. I'm sure that's very helpful, and many of
them must be in states where you have memberships. I'd like to ask at
this time, too, if you have the capability to put your phones on mute so
that you can just listen and we don't hear what's going on in your area,
that would be very helpful for the speakers. So if you save your
questions for Tim, we have one more speaker and then we'll get into our
question and answer session.

Our next speaker is Lou Coccodrilli. He is the AHEC branch chief in the
division of the state, community and public health in the Bureau of
Health Professionals at HRSA. He has provided leadership and guidance in
the nationwide expansion of AHEC programs, overseeing growth from 18
AHEC programs and 40 AHEC centers in 18 states, to a nationwide network
of 51 AHEC programs and 200 AHEC centers in 46 states. His focus has
been on increasing access to care for rural and underserved populations
by working to establish federal, state and local partnerships that
improves the distribution network to the equality of the health care
workforce. Lou, I think you said you have Dr. David Hanny with you
today.

L. Coccodrilli Yes, David is on the line, also. He has assisted me in
daily work as well as with regard to this presentation. Thanks for that
wonderful introduction. It just shows you what perseverance, the other
gentleman mentioned perseverance, results in, in terms of the growth of
the AHEC program. I've been at it awhile. Started out with creating
community health centers in rural Pennsylvania, and ended up in the
Bureau of Health Professions because I was attempting to improve how
these federal programs impact on the recruitment of health professionals
into rural health centers.

Okay, given that brief introduction, let me just say it's good to be
here with all of you. I know we're all challenged with regard to this
issue in terms of recruiting health professionals and meeting the needs
of underserved populations in rural and other underserved areas. So it's
good to be with you.

The legislation for the AHEC program started in 1972. We had 11 AHEC
contracts at the time. Those were awards directly to schools or academic
health centers; there were no AHEC centers. I'll get back to that a
little later. These awards are cooperative agreements. The AHEC programs
have to compete about every three years to get renewed, and they do it
through a peer review system with outside reviewers, non-federal
reviewers involved. So they are challenged each about every three years
to get more dollars or to maintain what they have.

The purpose of the AHEC program on the second slide there, one of our
challenges is the breadth of our purpose; improve recruitment,
distribution, diversity, quality of personnel, providing services in
underserved areas. We do focus on primary care. It's been a part of our
agenda for some time now in terms of focusing on exposing students to
primary care providers and to primary care settings, in terms of
training settings in underserved areas.

With regard to students, the next slide, through these AHEC programs and
AHEC centers, we do a lot of placements in community based settings.
Hopefully many of them are in your communities in rural areas. Our AHEC
programs, when they start, and they oftentimes start in the rural areas
because that's where the needs are most obvious, and then gradually
establish AHEC standards in the rural areas, with training programs
there, and then eventually come back and create an AHEC center in the
urban area, the university area.

Let me go to the next slide. I've talked a little bit about students who
will receive in underserved areas. Those are the students at the
schools, i.e. medicine, nursing, etc. We also have a very strong health
career recruitment program. We've been in the communities over the
years. It's one of those things I've emphasized. We carry out recruit
activities for students in grades nine through twelve in summer health
careers programs of 20 hours or more. We also through our AHEC centers
do presentations in rural underserved areas or entire school
populations, i.e. K through 12. But our summer programs' emphasis for
those students who are in grades nine through twelve and are likely to
begin choosing health careers training. We also try to provide field
placements and mentorships for these young students. Some of those are
in rural hospitals, community health centers, federally qualified health
centers, etc.

Let me go onto the next slide, if you're still with me. We now have 51
AHEC programs. The basic programs are one that are in a developmental
mode. They're generally getting more money. Associated with the programs
are these AHEC centers, about 200 of which are contracted with these
AHEC programs. These are more than affiliation agreements; these are
contracts. All of our AHEC program awards from this office, the awardees
have to provide 75% of that money has to go out to the AHEC centers
under contract to provide training for either health profession
students, health career students, primary care residents, as well as
local providers for continuing education.

We do not have AHEC programs in Iowa, Kansas, North Dakota, South
Dakota, and Puerto Rico. Part of that is because we don't have the
money. But part of it is we're very open in terms of bringing on new
programs, because as I introduced early we've generally expanded this
program with minimal growth in funding. So we are interested in any
program that is leadership in rural areas who want to get a program
going. Some of these states the leadership has elected not to commend
for an AHEC program award. Some we've worked with and we are still
working with. Some we need more money. I guess the point I want to make
is we're not a program from the federal level where they say we must be
in every state. So it's a collaborative agreement in terms of how we
setup new AHEC programs and AHEC centers. I might mention, oftentimes
rural people and rural leaders become the stimulus for many of our AHEC
programs that have been initiated.

Let me go on past the map as you can see where we are not, but you can
also see where we are. I'm going to talk a little bit now about the
students, to help profession students. If we were to tally the students
on this chart: medicine, dentistry, nursing, etc. there are about 40,000
that we are reaching with community based training each year. Exposing
them to rural and underserved area sites population, cultures, values,
needs in these areas. So we're proud of the fact that we are getting
students out there. Our figures are staying about the same at this
point. You might imagine that medicine and nursing would be large
numbers. Physician assistants, advance practice nurses, and pharmacists
in terms of students, so they're getting out there -- and allied health.

Our next slide is one that we did as it relates to the community health
centers. We're continually working with the CHC program. I might mention
Susan mentioned that we're also working with the National Service Corps,
several of our AHEC program staff members in these various universities,
as well as at the AHEC center level our serving as NHCS ambassadors.

Let me go back now to the community health centers. David has done some
data collection and analysis for us. As you can see, we have a student
range of students at the CAC sites. Medicine is a large number as well
as undergraduate nursing.

Let's go to the next slide. We're going to talk about the health careers
component. That is the students nine through twelve who are involved in
community-based health careers recruitment programs. As you can see, the
breakout is by race and ethnicity. Black or African American and
Hispanic have the largest numbers. However, White disadvantaged is very
large. This would include rural White disadvantaged students. So those
are three major groups. Our AHEC centers through their advisory boards
or policy boards are oftentimes influential in working with the local
schools to get students into these health careers programs.

Our next slide deals with continuing education. We feel that this CE
portion of what we do contributes....Okay, thank you so much. I don't
know where that's coming from but I'll continue....

Beverly Again, if you have the ability to put your phones mute will you
please do that? Thank you. It sounds like somebody is in a car on a cell
phone maybe.

L. Coccodrilli Okay. I'll try to continue through that. Our CE activity
is one that we provide to local providers in all of the areas that we
serve. Hopefully, this is a CE that's responsive at the local level.
We're continually challenged because the federal office sometimes the
leaders here would like to promote certain CE courses. But they may not
be the most relevant to local providers, so we hope that through our
AHEC the CE that they provide is relevant to rural providers.

The next slide talks about our CE that we're providing at CHC sites.
Again, medicine and nursing have the highest number of participants.

The next slide relates to AHEC program training sites. In some cases,
these are duplicative but nonetheless they're reported this way and we
thought we'd share this with you. Our training sites for CHC is about
almost a thousand. HIP is, as you know, sometimes we're talking about
one in the same. But anyhow, the reported HIP sites are for 5,600; rural
health center sites are 585; federally qualified sites about 400; and
AHEC urban sites are 2,500. These other AHEC sites are pretty much going
to be mostly rural. We've changed our data collection system so that in
the coming year we're going to have AHEC urban and AHEC rural sites and
then AHEC other sites because we're always trying to get our arms around
number of sites, urban and rural.

Our next slide deals with residents. All of our programs have to be
involved with at least one primary care residency program. The total
cohort of residents participating in our AHEC programs is 51 AHEC
programs or about 5,000. And it looks like about 10% of those residents
are also participating in training sites. So that's a nice marriage that
we have there in terms of what we're trying to achieve. Our greatest
numbers are, of course, in family medicine. General internal medicine
the numbers are similar. General pediatrics and general internal
medicine are similar.

The last slide is one that allows you to reach any one of us. David, I
thank you for what you have done regarding this presentation. David is
on the line with me. Norma Haytott is also our program ... She is not
present. Each of those individuals, plus I will be able to refer you to
various AHEC program awardees or AHEC centers. I do want to mention the
funding right now, we are a steady state. Everyone knows the funding
issues for '06 are up in the air. But we are pretty much a steady state.
We do have our awards completed for '05. One thing about our AHEC
centers, in our older programs, our model programs, they're receiving
about \$85,000 total federal dollars at the AHEC center level. Then we
have 38 model AHEC programs; they're the older programs. At the basic
programs, which are in the developmental or growth mode, they receive
between \$200,000 and \$300,000 from the awardee school as they go
through a growth phase. So in some cases our AHEC centers are truly
dependent on state and local funds. They all are asked to do that. But
in our early stages of development they get more federal dollars per
center than they do later. That's pretty much it for me. I'll give folks
a chance to ask some questions. Thank you.

Beverly Lou, I was wondering if you could tell the folks on the call how
community can reach their local AHEC program and how local AHEC programs
can help them in their recruitment.

L. Coccodrilli Many of the awardees are familiar with the AHEC programs
in their state. We can provide that via e-mail to any of the individuals
on the phone with an e-mail to us or a phone call to David Norma or me.
Recruitment in the purest sense with regard to the 3Rs program and with
regard to NHCS I think is an area where the AHECs attempt to help
various provider institutions and organizations. But it varies with
various AHEC centers. I don't really have -- each of our AHEC centers
are, I think, in concert with, as the gentlemen mentioned from 3Rs, some
of our AHECs are a part of that network. Some of the AHECs are involved
in assisting organizations or rural areas to get their applications
together for various recruitment efforts. I think it just varies. We're
very open to inquiries that we may receive in that regard.

Beverly Okay. Thank you, Lou. We'd like to open it up for questions now.
So if any of you have questions for any of the panelists. If it's for
one particular panelist, you can direct it directly to that person or if
it's just a general question, whoever thinks they might have an answer
to your question can just jump in and answer it. Any questions? You'll
have to remember to take your phones off mute to ask questions. I've
been known to sit here and think Ed is talking into a phone that was on
mute.

W I have a question. I would like to ask a question for Susan Salter. I
would like to know how can you raise your HPSA score.

S. Salter How can you raise your HPSA score? The HPSA scores are done
based on information that's provided, in most cases, with the
designation. The primary care office is generally the office that
submits the designation requests. Now, for automatic HPSAs that we were
talking about for health centers, those are scored based on national
sets of data. If you have more accurate data of that better represents
what's going on in the community, you can submit that to the Shortage
Designation Branch and they will look at that and see if that will
increase the score as opposed to using the national data sets that they
use to develop those scores for all the automatic HPSAs.

The place to start is really your primary care office. I know this is
national so that's what I would recommend. I'm not sure in Georgia --
it's still a PCO. It's the PCO in every office is the place you want to
start talking to them because they, in most cases and as far as I know
all cases, submitted that data that got the score. So they'll be able to
look at it and say this is what happened and this is why it is what it
is. Or look at it and say what has changed. Has something changed? Have
providers retired? Have the moved out of the area? Perhaps there is
something they can do. But that's the place you would go to start. If
you don't know who your primary care office or PCO contact is you can
call our 800 number and ask or our Web site under our links tab, those
have a list of all the primary care offices. If there are any PCOs on
the line that want to chime in.

W I have a question for Susan Salter. I deal with all mental health and
behavioral health grantees. Two of mine need neuropsychologists. They're
having a hard time finding and recruiting them. Is that covered under
mental health or what?

S. Salter It can be. But it depends. The National Service Corps is
really looking to recruit primary care mental health services, which to
a large extent provide the treatment. If you had a neurophysiologist
that was only going to be doing testing, for example, that would be a
problem. But if they were going to be doing testing and then also
following up with appropriate treatment -- many of them do -- then we
can work with them. They would really look at their job description and
talk with the National Service Corps to make sure it is in line with
what we're doing. So yes, we can do it as long as they're not just
doing....

W They would be doing both.

S. Salter Yes.

W On the same issue of mental health I have another question about
specialists within that field. I think for Susan that other may have
comments on....I'm working with an outreach grantee who is looking
specifically not just for a psychiatrist, for a psychiatrist with
specific geriatric experience in the field. Is that something that any
of you who are out in the recruitment area are familiar with? Is there a
particular place they need to go if they look for such a person? They
can find a psychiatrist; they can find folks with geriatric experience.
But finding some within training in both fields is pretty difficult.

S. Salter This is Susan. For the National Service Corps they would not
be eligible for a program if we had a psychiatrist who specialized in
that. One of the issues would be that we'd have to...understood was that
many of our sites are requesting general psychiatrists. So if for some
reason it didn't work out at the site that recruited them they would be
expected to fulfill their NHCS site at an alternative location. We may
not have something that specialized in geriatrics, so they would have to
be prepared to provide services generally I guess. We could do it, but
they would have to know that going in before they committed to the
National Service Corps. That's the same with pediatric child
psychiatrists. Although, we tend to have more requests for them now than
we did a few years ago when they were requested loan repayments. I don't
know if Tim can speak to whether the 3R net members recruit
psychiatrists, specialists.

T. Skinner Thank you, Susan. I was just going to add to that. Yes, they
do. We have a lot of states that are looking for psychiatrists. Now,
whether you're talking adult general psychiatrists or child and
adolescent psychiatrists or another subspecialty of psychiatry, they're
hard to find, particularly those who want to go to rural areas. So what
some communities have done, instead of your case where you're looking
for somebody who is trained in both those areas, might back that up a
little bit and search for an adult psychiatrist or general psychiatrist
who has a real interest and some evidence of background and knowledge in
geriatrics. It opens up the pool a little bit. I'll leave it at that.

Beverly Thank you. Further questions?

W I have another one. Several of the outreach grantees with whom I'm
working are working on a variety of aging issues, self-management
issues, and chronic disease self-management. But there's an overlay of
depression and psychiatric disorders that a company chronic diseases,
particularly in rural isolation. Is there, from any of you, a specialty
or a training area that we need to be looking at to try to help them get
the professionals in are even special training opportunities for people
our age within their provider community?

T. Skinner I'll take a shot at that one. This is Tim. The American
Academy of Family Physicians and the AOA (American Osteopathic
Association) both have programs to support ongoing continuing education
for primary care physicians in a variety of areas. So there are
continuing education opportunities available. We've also seen a growth
in the last couple of years of nurse practitioner programs where the
nurse practitioners really specialize in behavioral health issues.

Now unfortunately, the supply of those folks is very low and the demand
is high. But that's at least another alternative. I've also worked with
physician assistants over the years who have -- and physician assistants
and nurse practitioners are unique, because they have the ability to
specialize in different areas even at different times in their careers.
I've worked with PAs who have gone on and worked and picked up training
also in behavioral health -- and I say behavioral health to include some
of the issues you're talking about. But also they've worked in
behavioral health units; they've worked in outpatient behavioral health.
So they've picked those things up. Some of those folks are pretty good.
Some of them also have an interest in it. If you can open your situation
up to hiring family nurse practitioners or family-oriented PAs you can
train those folks to work with that too. So that's another potential for
you.

W I have a question for Susan. Susan, in your presentation you have a
page on recruitment and you mention recruitment tools. Can you talk a
little bit about exactly what those are? Are these generic videos and
posters or do you customize them?

S. Salter We actually customize them. We have a recruitment video that
is done is segments by discipline. So we're expecting that that will be
used when folks are talking to residents, students and they're able to
show them based whether they're primary care, mental health, or oral
health. That has been done and it is being printed and we will have that
available. It's about 30 minutes. But you can show it by segment, so we
don't have to show the whole thing. We also have a CD-ROM that we send
out with our loan repayment application that talks a lot about that
program. We'd like to get those on our Web site. We haven't been able to
figure out how we would do that. But that's something we'd like to do in
the future.

Our posters, they're all geared towards serving the underserved in the
National Service Corps and they all talk about our loan repayment
programs. They really talk about, though -- we have jobs in underserved
areas which qualify for the loan repayment program. So first and
foremost, if you want to do this we can help you find a job on our list
and they also qualify for loan repayment if that's something you're
looking for. We do print ads for posters, we do have the videos, but
they are all geared toward the National Health Service Corps. There are
posters and ads, but it's really about serving in community
health...rural health clinics, or underserved areas, things like that.
Did that answer your question?

W Yes. Thank you.

T. Skinner May I follow-up a little bit on that? One of the things that
Susan said that's fun to talk about: the members of the 3R net are
working more and more closely with National Health Service Corps. One of
the things that Susan volunteered at our national meeting is the
opportunity for our members to contact the corps office and say, look,
I'm making a residency visit. I'll let Susan talk about what kinds of
things are available. But maybe somebody the National Health Service
Corps would go with that person. That may be materials, it may be
handouts, it maybe a little assistance to help with a lunch. But that's
another resource where we're seeing our two agencies working together to
help develop some of those things and get the word out a little bit
more.

S. Salter We do have brochures -- this is Susan -- we do have brochures.
We're happy to provide those to anyone who may be going out to either
talk to communities. Brochures for...and how they can join and what the
requirements are as well as on the loan repayment program. So people can
request those through the National Health Service Corps. We can send
them out if you're going to make a presentation and you want to have
something to leave them with on our program.

W Lou, I have a question for you. I know in Georgia we have a program
that places medical students from the Medical College of Georgia into
rural areas to work in clinics and places like that. I know those must
be short-term placements. But I was wondering if you could have a
permanent position there that these students rotate in and out that the
AHECs can help.

L. Coccodrilli I think there are both kinds. There are certain sites
where students are rotated in and out of their routine. Some of the
preceptors in those areas and some of those sites will take students
routinely. Where there is even more stability is where there might be a
primary care resident that we're supporting that is part of an AHEC
program, but also is staffing a particular site and students are
rotating out of there.

I'm just thinking also about -- they're many long-standing rotations now
for some the AHEC programs that have been in place for some time. I
think if there's a need on the part of a rural site among the awardees
on this call, if there's a need or an interest in establishing a
training site I think that should be explored. We're a steady state
funding right now, but I think our programs are continually looking for
good training sites in rural areas and other underserved areas. So it's
oftentimes a combination of interest on the part of the rural site and
maybe one of our ORHP awardees if they're interested.

> I feel like I punted a little bit on your earlier question on
> recruitment. I just want to explain that a little bit. I think the
> more direct recruitment efforts are through the 3R network, through
> the NHSC, also through HRSA's state loan repayment program (SLRP). But
> AHEC what we're trying to do is establish a training relationship in
> these rural and underserved areas and exposing students, exposing
> residents, and helping out preceptors in those areas with regard to a
> training agenda. So I think our payoff is one that's oftentimes not
> articulated, because some of these students, and residents, and
> providers who participate in our programs may not identify themselves
> as having had an AHEC experience. But nonetheless, they probably will
> locate back in a rural or underserved area.
>
> So I feel we're a part of the agenda with regard to this, but we're
> not the direct, you know, I need someone, my key person has left, I'm
> very dependent on a couple of key providers and I need help in a
> hurry. Or a hurry could be very short-term: I need help within the
> coming year. I think that oftentimes other resources such as 3R, such
> as NHSC, and, of course, other recruitment efforts that individual
> entities use on their own.

Beverly Right. Thanks, Lou. Susan, I have a couple of just short
questions for you. One is, is the loan repayment program complete
repayment or is it just partial payment repayment for the health
professionals?

S. Salter It can be complete. There's no limit to the number of years an
individual can serve as long as they continue to serve in HPSA, they use
the money we gave them toward their educational loans. And they will
check that. They will make the applicant show that prior money they got
went to their loan. So you get \$50,000 the first two years. If you
don't owe \$50,000 you'll get whatever you owe. If you owe more than
\$50,000 you'll get the \$50,000 and you'll have an opportunity to
amend. The third year is at \$35,000; the fourth year is at \$35,000;
the fifth year goes back to \$25,000; the sixth year goes back to the
\$20,000; and then seven years and beyond is \$15,000. Graduated amounts
a little more for that third and fourth year because our information has
shown that if we can keep them there longer there's a good chance of
retention. So that third and fourth year would have to be at the same
site.

> So we only provide amendments if they're at the same site. Or
> sometimes within an organization they may move them to another
> satellite and that would be okay. But if they're going to physically
> another organization or another site then they would have to do a new
> two-year contract. And they could do loan repayment, come back later,
> and do it again. They would have to show the money they got before.
> Two years initially and then one year extension.

Beverly Okay. The second question I had for you is about how long does
it take for a site to be approved to get a placement there?

S. Salter Our application process can take anywhere up to six weeks. It
all depends when you apply. We have a lot of sites applying around the
deadline, which is the last Friday in March, so it can take quite
awhile. I would say when you generally...receive it, it does go through
our state primary care office and they will...usually talk to the
site...policy. They understand what they're agreeing to do. We have to
check to make sure they're in HPSA, those types of things.

W Just from my personal knowledge, Susan, do you ever have positions
that go in these underserved communities in state?

S. Salter Yes. We actually had a 15-year retention study that said, I
think it was 52% of the folks...in that we're still in that site that
they originally went to. Now we do a retention study a year out. A year
out, what were they doing? And our...are like 75% to 80% of the folks
are still there a year later. But the only long-term study we did was a
few years ago. It had the number of 52 at the same site.

W That's wonderful.

S. Salter It's like Tim said, you've got to make the right match. So
that's why we just don't go out and say come for a loan repayment,
because those folks might not stay. It's really you have to know what
you're signing and what you're agreeing to do. It's really important
that sites have the...and that's important for retention.

Beverly Anymore questions?

W One further one, Beverly. The Native American populations I believe
you said had an automatic HPSA opportunity.

S. Salter Correct. And the PCO can probably help you with that or the
Shortage Designation Branch. They're in the process of assigning all of
these automatic HPSAs and not all of them have been put in the system.
They might not show up when you go to the Web site for the Shortage
Designation to search the HPSAs.

But if you have a Native American population the
federal...69.28\...sites we put scholars there, but we haven't been loan
repayers there. One of the requirements for the Corps is they agree to
treat everyone. Some of the federals that are...meeting that requirement
because members of the tribe are Native Americans. But the tribal sites
that have agreed to treat anyone that may present, its clinic are
eligible for both scholars and loan repayers depending on the HPSA
score. So if there's a question, someone wants to use it, they don't
know if they have it, you can call your PCO or they can send in the
application or call us and we can try to find out for them. It may be a
matter of us working with Shortage Designation just to get it assigned.
Because the ones that are requesting it, obviously, we can get those
right away. The others will be done as they progress through this
process of assigning the numbers.

Beverly Anybody else with a question? Charles Owens, are you on the
line? Charles is director of our state office of rural health. I was
wondering if he was going to be on the line if he had something to add
about how the offices of rural health might help in this....He may have
hung up already. Last call for questions. All right. Susan and Tim and
Lou, I think you've been very helpful. I really appreciate you taking
the time to join us on the call today. I hope everybody has a wonderful
holiday season. Take care. Good-bye.