Volume 6 Number 3
©Minnesota Office of Tourism Photo
Q U A R T E R LY
Summer 2004
The mission of the Office of Rural Health & Primary Care is to promote access to
quality health care for rural and underserved urban Minnesotans. From our unique position
within state government, we work as partners with communities, providers, policy makers and
other organizations. Together, we develop innovative approaches and tailor our tools and
resources to the diverse populations we serve.
Minnesota Rural Health Advisory Committee
Member Profile: ORHPC Talks with Dr.
Raymond Christensen
Home: Duluth Township, a rural township outside of Duluth
Family: Daughters Kari, Anna, and Heather and wife Coleen
Hobbies: Walking, biking, visiting the farm, and occasionally golfing and fishing
Dr. Raymond Christensen, Rural
Health Advisory Committee
Member
Dr. Raymond Christensen is an assistant dean and associate professor of family medicine at
the University of Minnesota School of Medicine in Duluth. As a member of the faculty, Dr.
Christensen’s focus is on rural medicine. He trains rural physicians and advocates the rural
mission and vision of the medical schools in both the Twin Cities and Duluth. Dr. Christensen
also keeps in touch with rural medicine by practicing one day a week at Gateway Family Health
Clinic and spending one night a week on call in the emergency room at Mercy Hospital, both of
which are in Moose Lake, Minnesota.
A commitment to rural health and helping rural people access quality health care is very
important to Dr. Christensen. As he says, “I have always been concerned about how people in
rural America were treated.” His desire to help rural America is rooted in his rural upbringing.
Growing up on a farm in northwest Wisconsin, Dr. Christensen’s family and many of the other
families around him did not have health insurance; it was either unavailable or unaffordable.
The lack of health insurance combined with concern for family and friends who dealt with the
devastation of premature death or ongoing health problems reinforced his desire to practice
rural medicine.
Dr. Christensen is a champion for rural health and his list of accomplishments is a testament
to his dedication. He has been a partner in a rural practice, helped establish an emergency
medical system for northeast Minnesota and northwest Wisconsin, helped form the Minnesota
Center for Rural Health, and served as the medical advisor to the Minnesota Commissioner of
Health. The Office of Rural Health and Primary Care appreciates his role in helping to establish
the Office as the federally designated state office of rural health. He was appointed to the Rural
Health Advisory Committee in 2003 and serves as the committee’s higher education
representative. His connection to the University and practice as a rural physician make him a
natural fit for the committee.
What do you think are the most important issues facing rural health today?
RC: I think the most important issue is ensuring access to health care for everyone no matter
where they live or what their financial status. In order to provide access, some basic questions
need to be answered first, such as:
• What is the best way to handle health care in rural areas?
• How can access to health care be ensured without barriers such as cost and transportation?
Estelle Brouwer, Director
Karen Welle, Assistant Director
Stefani Kloiber, Editor
• Should there be a doctor, nurse practitioner, or physician assistant in every town or should
there be a sub-regional or regional health care system where a doctor visits the local clinic on
a regular basis?
These questions are still resolving themselves. On an encouraging note, I am beginning to see
physicians coming together and realizing that we can do a better job as providers when we
work together. This type of collaboration helps all of us give better care to our patients.
What one or two changes do you think would make the most difference for rural
health?
RC: First, we need to be very careful how we spend the limited resources we receive in rural
See “Dr. Raymond Christensen”
2
(back page)
Imagine being one of the nearly 5,000 Hmong refugees who will be immigrating to Minnesota this year, filled with excitement
and perhaps a little trepidation to build a new life in America. For most immigrants, coming to America opens up a world
of opportunity, but it also presents some challenges. Accessing health care is one of those challenges. Confronting our
health care system can be a daunting task for anyone, but even more difficult when language barriers and cultural
differences exist. Challenges exist on both sides of the health care relationship. The immigrant is faced with explaining
their health concern to a provider either on their own or through an interpreter, if available. The provider is faced with
trying to understand the health concern as well as provide culturally appropriate care. But where does a health care
provider, especially in a rural or remote area, go to learn more about providing culturally appropriate care?
One course at the University of Minnesota is trying to help providers and policy makers better understand our newest
populace. The course, Immigrant Health Issues, is taught by Katherine Fennelly, a professor of public affairs at the
University of Minnesota’s Hubert H. Humphrey Institute. The concept for the course came from Katherine’s experiences
in talking and working with educators and providers in Greater Minnesota. She explains, “As I was working with
educators and providers, I started to recognize the tremendous change in diversity that has been occurring in small towns
around Minnesota.” She continues, “I realized that there were few resources available for providers to better understand
and to learn about the different aspects of providing culturally appropriate services to their clients, students, and/or
patients.” This lack of resources inspired Katherine to create a resource for providers on immigrant health issues.
Immigrant Health Issues is a graduate level, 14-week distance education course. The opportunity to complete the
course online makes it especially appealing for those who don’t have the flexibility to participate in a traditional classroom
setting. The course can be taken for four credits or no credit and is equivalent to 60 contact hours. It has also been
approved for 50 CMEs, 50 nursing CEUs, or 6 U of M general CEU credits.
ORHPC Quarterly recently spoke with Katherine Fennelly about the Immigrant Health Issues course.
What is the course about?
The demography of American communities is changing
dramatically, but many of our institutions have not kept pace with
the needs of new African, Asian, Eastern European and Latino
residents. Health care and social service providers used to treating
European-origin families and some Latino residents are suddenly
seeing refugees from Somalia, Ethiopia, Laos, Bosnia, Cambodia
and the Sudan. In order to meet the needs of these new residents,
it is imperative for providers and policy makers to understand the
context and motives for immigration as well as the characteristics
and belief systems of their clients.
What types of students generally take the course?
Students come from a variety of fields. Health care providers,
policymakers, community agency professionals, and students in
public health, medicine, nursing, social work, public affairs,
education, and the social sciences have completed the course.
Photo courtesy of Bill Cameron
PROGRAM FOCUS
An Online Course in Immigrant Health Issues
What are the course goals and objectives?
The goal of the course is to help students gain an understanding
of the characteristics of immigrants and their families in the
United States, major health needs, principles of cultural
competence in service provision, and tools for effective advocacy.
The objectives of the course are to:
In 2001, 14.4% of Hispanic children in
Minnesota were uninsured.
(Populations of Color in Minnesota: Health Status Report,
MDH)
See “Immigrant Health Issues”
(page 7)
3
PARTNER PAGE
Minnesota Health Care Workforce Partnership Launches New Round of Forums, Creates Data Innovations
New Partnership Offers Easy Access to Data on Minnesota’s Health Workforce
By Stefani Kloiber and Karen Welle
Minnesota Health Workforce Forums – Revisited
“Over the last 15 years, Minnesota has experienced an unprecedented economic expansion. Since the
late 1980s, the number of new jobs created in Minnesota has gradually outpaced the growth of the
available workforce, creating a shortage of workers. Employment growth in the health care industry has
remained robust, well above the average job growth for the state. At present, the demand for workers,
especially by health care employers, remains strong.
Overall, this trend in the state’s economy is expected to continue well into the future. In fact, the gap
between the number of all new jobs and available workers is expected to widen. Compounding the
absence of an available workforce to fill new jobs is the aging of the state’s population.”
Excerpt taken from: Critical Resources: Forums Addressing Minnesota’s Health Care Worker Shortage, An Overview of Regional Findings, March 2001
identify what else is needed to address the health
Remarkably, this narrative was written nearly four years
workforce shortages, and look at long term planning.
ago and it remains true today. While many new initiatives
have been developed to address Minnesota’s health
Health workforce data and graphics from the new
workforce shortage, there is still a lot more to be done.
interactive Web site described
Four years ago the
on page 5 will be featured at the
Healthcare Educationregional forums.
Industry Partnership,
Minnesota Center for Rural
The following health
Health and the Office of
workforce facts from the
Rural Health and Primary
Minnesota Department of
Care partnered with several
Employment and Economic
other health care
Development help illustrate the
organizations to sponsor a
need to continue working on
series of regional forums on
strategies that will impact the
the health workforce
health workforce shortage.
shortage. The purpose of
the forums was to provide
Since 2000:
health workforce data,
• Unemployment rates have
discuss local health
A workforce forum participant takes notes at a
risen in the past three years
workforce issues, strategize
forum in Proctor on June 25.
and are only now declining.
potential solutions, and offer
input for a statewide report.
• The health care industry has
Health care professionals, elected officials, economic
had above average job growth; health care grew by
developers, business leaders, educators, community
38,000 jobs in the last four years.
resource directors, and consumers all offered their
• Minnesota’s population is growing older. The
suggestions for easing the shortage. The forums also laid
number of Minnesotans 65 years of age and older is
the groundwork for a coordinated effort to address
expected to increase by 14% from 2000 to 2010.
Minnesota’s health workforce shortage.
• Health care openings declined in 2003; however,
vacancy rates remained high and are increasing,
Jumping forward to 2004, the Minnesota Health Care
with nearly 5,000 openings in the health care
Workforce Partnership has decided it is time to revisit the
field in 2004.
health workforce shortage issue. The Partnership,
composed of statewide organizations concerned about
• The number of vacancies for nurses, certified nursing
health workforce issues, is hosting a series of six forums in
assistants, and home health aides is increasing rapidly
the summer and fall. The 2004 regional forums are
after a decline in 2003.
intended to build upon the initial strategies from 2000,
4
See “Workforce Forums - Revisited”
Good data on health workforce issues is critical to
understanding shortages and creating both regional and statewide
approaches for resolving them. While there are many sources for
good data on the Web, they are not always easily accessible and
may not offer the ability to graphically represent the data. But the
Minnesota Health Care Workforce Partnership has found a
solution. The Partnership has teamed up with the Rural Policy
Research Institute to share data and create visuals of the data.
Beginning in Spring 2004, the Minnesota Health Care
Workforce Partnership began working on ways to use available
data to understand the trends in health workforce in Minnesota
and share them at the regional workforce forums. At the same
time the Rural Policy Research Institute (RUPRI), a federallyfunded rural policy research group out of the University of
Missouri, was interested in enriching its Community Informatics
Resource Center (CIRC) health workforce data to help states
understand their workforce needs. The CIRC is a Web-based tool
available to the public, and contains a remarkable amount of data
from a number of national sources such as the U.S. Census
Bureau, the Health Resources and Services Administration, and
the Centers for Medicare and Medicaid Services. An exciting
partnership between RUPRI and the Minnesota Health Care
Workforce Partnership was born. RUPRI and the Partnership
agreed to bring Minnesota’s data on health care workforce, health
care education, and health care industry together to create a
Minnesota-specific health workforce interactive database site.
The Minnesota-specific site, a pilot for possible projects in other
states, brings health workforce data from the Office of Rural
Health and Primary Care and the Rural Health Resource Center,
health care graduation data from Minnesota’s post-secondary
educational institutions, and data on Minnesota’s hospitals and
long term care facilities together with already-existing geographic,
population, economic/employment, and transportation data. It is
a powerful tool offering the potential for cities, counties, and
regions to see graphically what is going on in their area in health
workforce and beyond. Viewing the data over time is also
possible. The Minnesota Web site demonstrates an accessible way
to obtain data for educational purposes, business planning, grant
writing, and other uses.
Figure 1 shows the number of RN graduates by institution and
licensed RNs by practice site1 in the Northeast region in 2002.
This map, presented at the first regional forum in Proctor on June
25, is just one example of the types of data that can be selected
and viewed simultaneously.
To learn more about the capabilities of the Web site, visit the
site at www.circ.rupri.org, and try the tutorial located on the
home page and plan to attend a regional health workforce forum.
(See page 7 for dates)
1
Office of Rural Health & Primary Care. Data collected represents an approximate
60% response rate to a biennial survey of licensed registered nurses.
Figure 1
(page 7)
5
PARTNER PAGE
Minnesota Health Care Workforce Partnership Launches New Round of Forums, Creates Data Innovations
New Partnership Offers Easy Access to Data on Minnesota’s Health Workforce
By Stefani Kloiber and Karen Welle
Minnesota Health Workforce Forums – Revisited
“Over the last 15 years, Minnesota has experienced an unprecedented economic expansion. Since the
late 1980s, the number of new jobs created in Minnesota has gradually outpaced the growth of the
available workforce, creating a shortage of workers. Employment growth in the health care industry has
remained robust, well above the average job growth for the state. At present, the demand for workers,
especially by health care employers, remains strong.
Overall, this trend in the state’s economy is expected to continue well into the future. In fact, the gap
between the number of all new jobs and available workers is expected to widen. Compounding the
absence of an available workforce to fill new jobs is the aging of the state’s population.”
Excerpt taken from: Critical Resources: Forums Addressing Minnesota’s Health Care Worker Shortage, An Overview of Regional Findings, March 2001
identify what else is needed to address the health
Remarkably, this narrative was written nearly four years
workforce shortages, and look at long term planning.
ago and it remains true today. While many new initiatives
have been developed to address Minnesota’s health
Health workforce data and graphics from the new
workforce shortage, there is still a lot more to be done.
interactive Web site described
Four years ago the
on page 5 will be featured at the
Healthcare Educationregional forums.
Industry Partnership,
Minnesota Center for Rural
The following health
Health and the Office of
workforce facts from the
Rural Health and Primary
Minnesota Department of
Care partnered with several
Employment and Economic
other health care
Development help illustrate the
organizations to sponsor a
need to continue working on
series of regional forums on
strategies that will impact the
the health workforce
health workforce shortage.
shortage. The purpose of
the forums was to provide
Since 2000:
health workforce data,
• Unemployment rates have
discuss local health
A workforce forum participant takes notes at a
risen in the past three years
workforce issues, strategize
forum in Proctor on June 25.
and are only now declining.
potential solutions, and offer
input for a statewide report.
• The health care industry has
Health care professionals, elected officials, economic
had above average job growth; health care grew by
developers, business leaders, educators, community
38,000 jobs in the last four years.
resource directors, and consumers all offered their
• Minnesota’s population is growing older. The
suggestions for easing the shortage. The forums also laid
number of Minnesotans 65 years of age and older is
the groundwork for a coordinated effort to address
expected to increase by 14% from 2000 to 2010.
Minnesota’s health workforce shortage.
• Health care openings declined in 2003; however,
vacancy rates remained high and are increasing,
Jumping forward to 2004, the Minnesota Health Care
with nearly 5,000 openings in the health care
Workforce Partnership has decided it is time to revisit the
field in 2004.
health workforce shortage issue. The Partnership,
composed of statewide organizations concerned about
• The number of vacancies for nurses, certified nursing
health workforce issues, is hosting a series of six forums in
assistants, and home health aides is increasing rapidly
the summer and fall. The 2004 regional forums are
after a decline in 2003.
intended to build upon the initial strategies from 2000,
4
See “Workforce Forums - Revisited”
Good data on health workforce issues is critical to
understanding shortages and creating both regional and statewide
approaches for resolving them. While there are many sources for
good data on the Web, they are not always easily accessible and
may not offer the ability to graphically represent the data. But the
Minnesota Health Care Workforce Partnership has found a
solution. The Partnership has teamed up with the Rural Policy
Research Institute to share data and create visuals of the data.
Beginning in Spring 2004, the Minnesota Health Care
Workforce Partnership began working on ways to use available
data to understand the trends in health workforce in Minnesota
and share them at the regional workforce forums. At the same
time the Rural Policy Research Institute (RUPRI), a federallyfunded rural policy research group out of the University of
Missouri, was interested in enriching its Community Informatics
Resource Center (CIRC) health workforce data to help states
understand their workforce needs. The CIRC is a Web-based tool
available to the public, and contains a remarkable amount of data
from a number of national sources such as the U.S. Census
Bureau, the Health Resources and Services Administration, and
the Centers for Medicare and Medicaid Services. An exciting
partnership between RUPRI and the Minnesota Health Care
Workforce Partnership was born. RUPRI and the Partnership
agreed to bring Minnesota’s data on health care workforce, health
care education, and health care industry together to create a
Minnesota-specific health workforce interactive database site.
The Minnesota-specific site, a pilot for possible projects in other
states, brings health workforce data from the Office of Rural
Health and Primary Care and the Rural Health Resource Center,
health care graduation data from Minnesota’s post-secondary
educational institutions, and data on Minnesota’s hospitals and
long term care facilities together with already-existing geographic,
population, economic/employment, and transportation data. It is
a powerful tool offering the potential for cities, counties, and
regions to see graphically what is going on in their area in health
workforce and beyond. Viewing the data over time is also
possible. The Minnesota Web site demonstrates an accessible way
to obtain data for educational purposes, business planning, grant
writing, and other uses.
Figure 1 shows the number of RN graduates by institution and
licensed RNs by practice site1 in the Northeast region in 2002.
This map, presented at the first regional forum in Proctor on June
25, is just one example of the types of data that can be selected
and viewed simultaneously.
To learn more about the capabilities of the Web site, visit the
site at www.circ.rupri.org, and try the tutorial located on the
home page and plan to attend a regional health workforce forum.
(See page 7 for dates)
1
Office of Rural Health & Primary Care. Data collected represents an approximate
60% response rate to a biennial survey of licensed registered nurses.
Figure 1
(page 7)
5
What Rural Health Means to Me Now:
A Personal Story
By Estelle Brouwer
DIRECTOR’S CORNER
I’d like to share with you a very personal story about the importance of rural health care
and the state and federal programs that support it.
On June 15 of this year, I lost my mother, Esther Brouwer, to a rare progressive
neurological disorder called corticobasal ganglionic degeneration. Mom lived and died in
Tyler, a town of about 1,200 on the southwestern Minnesota prairie. She lived with my
dad, in the house I grew up in on the western edge of town. For the last few months of
her life, Mom was a Medicare hospice patient, although she lived at home and my dad was
her primary caregiver. Hospice volunteers from the local community visited regularly,
usually bearing hot dishes or desserts. She received therapy and other services from the
local home health agency. Her excellent primary care physician is a participant in
Minnesota’s J-1 visa waiver program. For the last several days of Mom’s life, she received
compassionate, professional care from the nursing staff at our hometown Critical Access
Hospital, where she eventually passed away.
I have known for many years that the programs our office supports – and the rural health
care system many of you are a part of – are fragile but essential. But there is nothing like
personal experience to refresh one’s perspective and renew one’s sense of gratitude.
Critical Access Hospitals, hospice programs, home care, the J-1 visa waiver program,
education loan forgiveness and other supports for rural nurses – all these programs and
services have taken on new and personal meaning for me over the past few months.
Most important are the caregivers that make the system go. I extend a heartfelt thanks
to those of you who are involved in one way or another with caregiving in our rural health
care system. Whether you are a hospice or ambulance volunteer, a nurse or nursing
assistant, physician, pharmacist, lab tech, housekeeper, dietary specialist, home health aide,
X-ray tech, or involved in some other way, your work is essential to maintaining quality
health care in rural Minnesota and to ensuring quality of life for rural Minnesotans.
Finally, I would like to offer a special tribute to my mom. She was a talented, witty,
lovely lady who, even while suffering many losses and setbacks over the past several years,
never lost her big smile and hearty laugh. She took enormous pleasure in her children,
grandchildren and great-grandchildren, and we all miss her a great deal. It is a comfort,
though, to know that during her final months and days, she was surrounded by competent
health care professionals and a caring community.
You may recognize the picture featured with this column as the same old photo of me
that we’ve been using for years. What you wouldn’t have known before was that my mom
was always right there with me in that picture, even though you couldn’t see her. She
always has been and always will be … right there with me.
For more information on corticobasal ganglionic degeneration (CBGD), see an article by
Dr. Bradley Boeve of Rochester, MN, at www.tornadodesign.com/cbgd/boeve_updateoncbgd.htm
Dr.Boeve was one of Esther Brouwer’s physicians.
Estelle Brouwer is director of the Office of Rural Health and Primary Care. She can be
reached at [email protected] or (651) 282-6348.
6
Workforce Forums - Revisited
(continued from page 4)
Look for an upcoming regional workforce forum in your region. Forums are currently planned for:
•
•
•
•
•
•
Willmar, September 14th
Rochester, September 17th
Mankato, October 1st
East Grand Forks, TBD
St. Cloud, TBD
Twin Cities, TBD
For more information, go to www.heip.org
Members of the Minnesota Health Care Workforce Partnership include the Healthcare Education-Industry Partnership/Minnesota
State Colleges and Universities; Care Providers of Minnesota; Minnesota Area Health Education Centers and Academic Health
Center/University of Minnesota; Minnesota Colleagues in Caring Collaborative; Minnesota Department of Education; Minnesota
Department of Employment and Economic Development; Minnesota Health and Housing Alliance; Minnesota Healthcare Initiative;
Minnesota Hospital Association; Minnesota Nurses Association; Minnesota Rural Health Association; Minnesota Rural Partners; Office
of Rural Health and Primary Care; Rural Health Resource Center, Minnesota Center for Rural Health; and the Rural Policy Research
Institute.
Stefani Kloiber is the editor of this publication, and can be reached at (651) 282-6338 or [email protected]
Karen Welle is assistant director of the Office of Rural Health and Primary Care. She can be reached at (651) 282-6336 or
[email protected]
Immigrant Health Issues
(continued from page 3)
• Acquire research skills to access demographic, health, and background information on immigrants in the U.S.
• Understand the major characteristics and health needs of new immigrants.
• Design “culturally competent” health programs.
• Learn to advocate for needed changes to promote immigrant health.
• Interact with other professionals and policymakers.
What’s Next?
As more immigrants come to the United States and settle around the country in both metropolitan and rural areas, the need for a course
such as this will only increase. To help meet this need, Katherine Fennelly is currently working with the University of Minnesota’s
medical school to develop a shorter version of the course for fourth year medical students.
For information on registering, please follow this link http://register.cce.umn.edu/Course.pl?sect_key=176692&web_sec=&cmp_cd=
If you have problems or questions about registering, please contact Stacey Grimes at (612) 626-1329/[email protected]
For more information on the Immigrant Health Issues course go to www.tc.umn.edu/%7Efenne007/ or contact Katherine Fennelly at
(612) 362-7889/[email protected]
7
To learn more about the
Office of Rural Health & Primary
Care programs, visit our Web site:
www.health.state.mn.us/divs/chs/
orh_home.htm
Dr. Raymond Christensen
(continued from page 2)
Minnesota. It is important that we utilize these resources appropriately and collaboratively in
order to provide the most access for every dollar spent.
Second, we need to determine what our rural health care delivery system should look like.
One suggestion is to embrace the use of allied health professionals into rural practice and work
together to provide broad access across the state.
And third, we need to attract and educate more physicians to practice in rural Minnesota.
The Rural Health Advisory Committee advises the Commissioner of Health and other state
agencies on rural health issues, provides a systematic and cohesive approach toward rural
health issues, and encourages cooperation among rural communities and among providers.
Meetings are regularly held at the Snelling Office Park at the corner of Energy Park Drive and
Snelling Avenue in St. Paul and are open to the public. For dates, times, and directions, visit
the Web site at www.health.state.mn.us/divs/chs/rhac/meetings.htm or contact Tamie
Rogers at (651) 282-3856/[email protected]
This information will be made
available in alternative format –
large print, Braille, or audio tape
– upon request.
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minimum of 20% post-consumer waste.
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