Abstract
North Carolina's health care workforce is evolving quickly as the demographics of the state's broader population change. There are many initiatives aimed at addressing this evolution, but educators, practitioners, policymakers, and the broader health care community must leverage resources to ensure the future workforce reflects the state's population and needs.
North Carolina's demographics are changing rapidly. Between 2010 and 2016, the Hispanic population increased to 9.2% from 8.4%, while the white and black populations stayed approximately the same; as of 2016, the state was 63.5% white and 21.3% black [1]. At the same time, as of 2014, whites were overrepresented in every health profession in the state, while the Hispanic and black populations were still dramatically underrepresented across fields [2].
Since 1984, the North Carolina Area Health Educations Centers (NC AHEC) Program has worked to increase population parity. Much of this work has focused on diversity and development programs and activities. A driving philosophy has been that it takes a village, and much of NC AHEC's work has focused on leveraging our resources in collaboration with that wider village to provide opportunities that seek to promote and enhance diversity in the broadest sense in our health professions workforce.
Statewide Programs
Across the state, there has been a strong push toward more trauma-informed care, interprofessional care, and care focused not only on health behaviors but also the social determinants that underly them. These same considerations should be undertaken as we prepare North Carolina's future health care providers for the workforce. This means addressing health disparities and educational gaps among those who will be providing care, as well as their patients, and implementing efforts to increase the diversity of the health care professions. Our universities, medical providers, and clinicians increasingly recognize these myriad factors that influence health disparities and how a more diverse health workforce will better address them. They are also realizing that this process must start much earlier than it has in the past, reaching out to students as early as middle school to make them aware of what is possible for their future careers and how, if they choose to do so, they can take the right steps to become health care professionals. This includes both formal and informal education, networking, and mentorship, with new innovations being introduced all the time.
At NC AHEC, these efforts have taken several forms, from the NC AHEC Scholars Program, which recruits, trains, and supports a diverse and multidisciplinary group of students from across the state, to precollege pipeline programs such as the NC AHEC Passport to Health Careers and Youth Health Services Corps programs. Additionally, NC AHEC provides information and resources for aspiring health care practitioners to learn more about health professions and career pathways to becoming a health care professional in North Carolina [3].
UNC HAPPI
NC AHEC works with the University of North Carolina at Chapel Hill (UNC) to fund the Health Affairs Partnership Pipeline Initiative (HAPPI) [4]. Through this program, students—from middle school through post-baccalaureate—attend events and preparatory programs that allow them to learn about the health career options available. Students—especially those from rural and underserved demographics and regions—are often only aware of a limited number of health workforce professions, such as physician, nurse, surgeon, and mental health provider. Through programs like HAPPI, they can gain exposure to the wider health care workforce spectrum, learn about the requirements for entering each field, and begin their health care education exploration through programs such as the Science Enrichment Preparation Program and UNC's Summer Bridge.
Since it can be difficult for many students to travel for such programs, HAPPI offers other options as well. Students around the state can use the HAPPI website as an informational portal for information about health affairs degrees and pipeline programs. AHEC has also partnered with HAPPI and the North Carolina Health Careers Access Program (NC-HCAP) to develop HAPPI Roadshows, in which the HAPPI team and participants travel to each of the nine NC AHEC regions to exchange information and experiences. According to UNC, the HAPPI Roadshow helps participants seamlessly transition into high school and undergraduate pipeline programs at the university [5].
The North Carolina Alliance for Health Professions Diversity
A group of faculty, administrators, and students of North Carolina's medical schools, health organizations, and related institutions concerned with increasing overall diversity in the state's health care workforce have joined together to create the North Carolina Alliance for Health Professions Diversity (NCAHPD) [6]. The statewide organization works as a clearinghouse for best practices in Diversity and Inclusion in health professions education (see Table 1). NCAHPD also holds meetings, conferences, and programs and trainings aimed at increasing diversity in the North Carolina health care workforce pipeline.
North Carolina Alliance for Health Professions Diversity Goals
Around the country 46 AHEC programs with 261 centers enroll health professions students in AHEC Scholars Programs to supplement their health professions education with additional experiential learning in rural and urban underserved areas. The AHEC Scholars Programs focus on interprofessional education, behavioral health integration, social determinants of health, cultural competency, practice transformation, and current and emerging health issues [7]. Recently, the Health Resources and Services Administration (HRSA) illustrated that targeting health professions students with opportunities like AHEC Scholars closer to graduation and actual practice results in a shortened workforce pipeline [8], and research from the UNC Cecil G. Sheps Center for Health Services Research has shown that such targeting also increases the probability that students will establish their careers and remain in rural and urban underserved areas [9]. Yet while this current focus in our work at NC AHEC has had positive results, there continues to be a need to begin our pipeline work earlier.
The AHEC Scholars Programs have resulted in increased collaborations and support of health professions education and community practitioner training programs. This shift is significant because it leaves an opportunity for the “village” to identify, enhance, support, and promote opportunities for pre-college students to become health care professionals. There is a growing and continuing need and sense of urgency to produce a diverse health care workforce pipeline that builds on and expands on existing efforts. Our future efforts must account for both anticipated and unanticipated barriers to—and leaks in—the pipeline and allow each “village” partner space to contribute to these efforts.
Opportunities include leveraging budgets by partnering with current and new individuals and agencies who share a similar mission, targeting our historically black colleges and universities (HBCUs) and other minority-serving institutions to enhance the academic skills of students from disadvantaged backgrounds, and supporting them in successfully entering and graduating from health professions training programs.
National Efforts
In addition to the work being done within North Carolina, members of our local health care workforce pipeline also have access to national organizations dedicated to matching the workforce's diversity to that of the wider population.
The National Association of Medical Minority Educators, Inc. (NAMME) facilitates communication and relationships between national, state, and community stakeholders focused on improving racial and ethnic diversity in every health profession [10].
As President of NAMME from 1997 to 1999 and in prior leadership roles, my goal was to work on a national platform to increase the awareness and importance of pipeline programs in medicine as well as all health professions.
The National AHEC Organization (NAO), meanwhile, represents a network of more than 300 AHEC program offices and centers that serve counties around the United States. Its goal is to help its members achieve the AHEC mission—enhancing access to health care by improving the workforce pipeline via strategic partnerships—through advocacy, education, and research [11].
Conclusion
Working in this space is the hallmark of my professional career, and just as Robert Frost wrote in his 1922 poem “Stopping by the Woods on a Snowy Evening”: “I have promises to keep and miles to go before I sleep.” There is work to be done in the development of a diverse workforce that represents North Carolina's changing demographics and we must rise to the occasion to further the goal of providing the highest-quality, culturally competent, culturally appropriate, and culturally sensitive health care for all of our citizens in North Carolina.
Acknowledgments
To the Village, thank you for all that you do and for all the opportunities to strategically work toward increasing population parity in the health professions.
Potential conflicts of interest. J.R.W. and K.U.P. have no relevant conflicts of interest.
- ©2019 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.
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