Mountain Area Health Education Center (MAHEC) Rural Fellowship

Description

Mountain Area Health Education Center (MAHEC), located in Asheville, serves a primarily rural, 16-county region in western North Carolina (WNC). Every county in the MAHEC service area is a designated Health Professional Shortage Area (HPSA) in primary care, dental care, and mental health. In 2017, MAHEC piloted a Rural Fellowship to help address the region's longstanding struggle to recruit and retain a new generation of health professionals. The program is supported by University of North Carolina (UNC) Health Sciences at MAHEC, an academic health center, and receives additional funding from state appropriations.

The MAHEC Rural Fellowship is designed to offer mentorship, education, research support, and community-building opportunities to providers in their first year of practice. Previous fellows have included family medicine physicians, pharmacists, obstetricians, and family nurse practitioners.

The program is based on the six essential elements of their fellowship model, or the "6 Ps":

• Partnership: Fellows participate in the program as part of a cohort, which provides connection and opportunities for peer support as they navigate their first year of rural practice. Fellows are also connected with other health organizations and key individuals in their communities as part of the fellowship.
• Rural Placement: In order to be eligible for participation, fellows must secure employment, either individually or with assistance from MAHEC, in a rural western North Carolina (WNC) county.
• Protected Time: MAHEC pays 20% of each fellow's salary for the duration of the program while the employer pays the remaining 80%. In exchange for the salary support, employers give each fellow 20% of their clinical time to participate in fellowship activities, work on clinical or engagement projects, and engage in activities that promote well-being.
• Preceptor Development: During in-person fellowship events, fellows explore the key components of precepting and are offered opportunities to engage with learners during their fellowship year.
• Community Engagement Project: Each fellow completes a community or clinically focused project during the program. Projects are self-directed and are intended to help the fellows connect with their community and improve clinical processes or community health.
• Enhanced Clinical Practice: Fellows have opportunities throughout the year to continue enhancing their clinical skills through workshops at MAHEC, such as the Point of Care Ultrasound (POCUS) course, or through a variety of CME offerings. MAHEC reimburses fellows up to $3,000 annually for approved CME expenses.

The Rural Fellowship is one component of the broader MAHEC Rural Health Initiative (RHI), which includes educational initiatives, community collaborations, and the development of new models to improve population health and healthcare access in WNC. The RHI team "supports learners throughout the pathway to rural healthcare careers," from high school students to early-career professionals.

Services offered

The MAHEC Rural Fellowship offers the following opportunities to each cohort:

• In-person retreats
• Monthly virtual didactics
• Leadership and preceptor training
• Resiliency and well-being training
• Clinical and project-based skill development
• Support from current and former fellows
• Research support
• Continuing medical education (CME) funds
• Fellows and friends social outings
• Personal and professional mentorship

Results

Of the 30 fellows who have completed the MAHEC Rural Fellowship since 2017, 97% are still practicing in rural areas; 87% are still practicing in rural western North Carolina.

Testimonials from former fellows include:

• "It was good to have the opportunities to stay connected to a small cohort of colleagues who were doing similar work, trying to get established in a rural setting, facing similar challenges."
• "…it was interesting to all get together and talk about our trials and tribulations… [about] trying to build out a full-scope practice. And it was helpful to talk to them about what their issues were and to help them."
• "I think that physicians by nature are educators. We're educating our patients every day and I was really excited to extend that to teaching future physicians as well."
• "...I'm going to continue to have longitudinal medical students ... It just helped to be a Rural Fellow and have that preceptor part of it be baked into the Rural Fellowship."
• "But as time went on, the [community engagement] project actually became really dominant in my Fellowship and has grown into something that has actually changed our practice and affected all of our practitioners."

Challenges

While the program has been successful in increasing the number of new providers in rural WNC clinics, there remain challenges with ensuring they have the support necessary to stay in the community long-term. MAHEC's RHI team is exploring how to best support fellows longitudinally, after completion of their fellowship year, and how to keep them connected with their cohort to ensure they have the necessary social support.

MAHEC has been very fortunate to receive funding from the state to support these workforce development efforts, but funding diversity and sustainability continues to be a challenge. The RHI team is continually looking for additional funding streams to support RHI efforts in rural WNC. MAHEC has also engaged in conversations with other organizations across the state with an interest in replicating the rural fellowship in their communities. There is strong interest in duplicating this program in other areas due to its success in the western region of the state, but funding continues to be a barrier for program replication.

Replication

The RHI team believes that, with the right financial support and stakeholders, the Rural Fellowship framework could easily translate into most rural communities. Interested organizations are advised to identify key stakeholders in their rural communities, such as the CEOs and CMOs of rural hospitals and clinics. The clinics that would be eligible to hire rural fellows need to fully support the model, including the 20% non-clinical time that fellows receive as part of their participation. This component is essential to ensuring fellows can smoothly transition into their first year of practice and avoid feelings of burnout. Stakeholders also need to involve legislators and local, regional, or statewide foundations that fund workforce development efforts. With financial commitment and buy-in from rural hospitals and clinics, the Rural Fellowship can come to life anywhere.

It's also important to be deliberate in the content design of the program so that it suits the fellows, the needs of the patients they serve, and the communities they live in. For example, the monthly didactics hosted by MAHEC's RHI team might not cover topics suited for all rural communities. Understanding how to best support fellows in their unique clinical settings is essential to retain them.

Contact Information

Kylie Agee, MPA, Rural Health Initiative Program Manager
Mountain Area Health Education Center
kylie.agee@mahec.net