PROVIDENCE – It was a busy week for the future workforce in health care and life sciences within Rhode Island’s innovation ecosystem: a new university master’s program for physician assistants was inaugurated; a new report defined the workforce needs through 2020, projecting double-digit growth in the health care sector; current efforts to pump up the biotech education pipeline were scrutinized; and a legislative hearing delved into a proposal to shove the University of Rhode Island and Rhode Island College nursing programs into a shared space as part of a proposed $206 million redevelopment.

All are these efforts are very much joined at the hip – even if news coverage was limited, non-existent, done in silos, and disjointed. All professed to have a common message, proselytizing on behalf of collaboration, partnership and teamwork.

But, under closer examination, the flurry of activities also revealed strong, persistent resistance to change – and how difficult it is to break down existing silos that are embedded in the current way of doing business – and the way that the R.I. General Assembly thinks about health care.

• On Thursday, May 29, Johnson & Wales University officially opened its newly renovated $13.3 million Center for Physician Assistant Studies, introducing its first class of 24 students – 19 women and 5 men – chosen from more than 1,000 applicants. The students will earn their master’s degree in the two-year program, graduating in 2016, with the opportunity to compete for jobs that offer an entry wage of about $93,000. How many will choose to stay and practice in Rhode Island is unknown.

The opening of the new facility on 35 Claverick St., a rehabbed former jewelry manufacturing site turned into a LEED gold-certified building, was replete with a ribbon-cutting ceremony, opening remarks by Gov. Lincoln Chafee, who invoked his “meds and eds” mantra, wry comments by Johnson & Wales Chancellor John J. Bowen, who said that the school had now opened both a new parking garage and a morgue [the cadaver-based anatomy lab at the Center] this year, a plea from Marie Ghazal, CEO from Rhode Island’s Free Clinic, concerning the continued lack of equity in health care, an informal parade of the new students in their sparkling white coats, and gift-wrapped boxes of chocolates to mark the occasion.

• On Wednesday, May 28, The Tech Collective sponsored its latest forum on the bioscience skills gap in Rhode Island, drawing a sparse crowd of about 20 at Save The Bay. The forum was part of a follow-on series to the 2013 Rhode Island Bioscience Industry Skill Study that identified 4,602 jobs in the sector and another 11,847 workers in supporting roles.

The panel attempted to put the spotlight on building the biotech education pipeline; it featured Ed Bozzi, co-founder of the Rhode Island BioScience Leaders and coordinator of the Biomanufacturing Program at the University of Rhode Island, Avelina Espinosa, associate professor of Biology at Roger Williams University, and Tim Pelletier, coordinator of the R.I. Outreach Center for Biotechnology at the Community College of Rhode Island.

Surprisingly, one of the biggest gaps identified by companies, the panel members all agreed, was not in scientific know-how and technology training. Rather, it was in the soft skills – written and oral communications, the ability to work well with others as members of a team, the creative drive, as described in the clichéd term, “to think outside the box.”

Equally surprising, it took a question from ConvergenceRI about “STEAM,” the integration of “art” into the Science, Technology, Engineering and Mathematics, or STEM curriculum, to prompt a shout-out to be given for the statewide conference on STEAM that was happening on May 30 at Rhode Island College, by Charles McLaughlin, coordinator of Technology Education at RIC, who was attending the forum.

• On Friday, May 30, a new report, “Rhode Island’s Healthcare Workforce: Assessing the skills gap and providing recommendations to meet the industry needs,” was released. The 32-page report, prepared by the R.I. Governor’s Workforce Board’s industry partners, Healthcentric Advisors, Stepping Up, and the Hospital Association of Rhode Island, documented the projected future workforce needs in the state in health care.

As Rhode Island’s largest private sector employer, the workforce is projected to grow by 16.2 percent between 2010 and 2020 for the health care and social assistance industry, the report said. One of the trends driving this are the aging Baby Boomers – who make up about 40 percent of the current health care workforce and are retiring – and the increasing need for services from an aging population.

More trained nurses and caregivers are needed, but many will find jobs outside of hospitals, where care is moving from inpatient to outpatient facilities.

The report states: “Of the anticipated new jobs added to the health care workforce, 11,001 are expected to be due to industry growth while 12,662 are expected to be replacements. The highest growth positions include RNs, home health aides, medical assistants, medical secretaries, and nursing aides.”

• Finally, on Thursday, May 29, there was a two-hour hearing before the R.I. House Finance Committee concerning the proposed development of the Dynamo House. The $206 million project – in addition to allowing Brown University to relocate much of its administrative staff from the cramped College Hill campus, create residential space for students [but for which students from what colleges and universities is unclear], build a parking garage, and create a shared space facility for the nursing programs at the University of Rhode Island and Rhode Island College. [See link to ConvergenceRI story, “Developer’s dream, or nursing students’ nightmare?”]

“It took more than two hours of testimony before a lawmaker, Rep. Agostinho F. Silva, D-Central Falls, asked the overarching philosophical question posed by the project,” opined reporter Paul Grimaldi in the Providence Journal. That question was posed to the college presidents from RIC and URI: “Why don’t we have just one nursing program in the state of Rhode Island?” [In Grimaldi’s opinion, that may have been the overarching philosophical question, but for many of the nursing faculty leaders, the overarching question was: why were two nursing programs being forced into a marriage of convenience neither wanted? Who benefits?]

URI President David M. Dooley responded, according to the story, by saying that the proposal would allow the two nursing schools to share the most-expensive portions of their programs at a savings to the state while maintaining the separate identities. “It’s an advantage to Rhode Island to have these distinctive programs.”

The questions not being asked
The morning after the hearing, the phone rang at Convergence RI, and a source close to the negotiations regarding the proposed shared space for the nursing programs vented her frustration over the questions not being asked.

“Where’s the needs assessment?” the source wanted to know. None had ever been done for the project, she claimed.

The nursing faculty has had absolutely no input into the development of the plans, according to the source. The original plans had the two schools on different floors, the source continued. Now, the floor plans have been changed in just the last week, with offices for the both schools on the same floor. Why the changes?

The workforce analysis of future nursing needs flies in the face of the proposed shared space facility, the source continued. “More positions will be created outside of hospitals, rather than inside,” she said.

The source also challenged Dooley’s response about the idea that sharing space would create cost-savings by creating a shared simulation lab. “One year’s rent for space in this building is $6 million – paid for by the state for a temporary space to an outside vendor, “ she said.

Instead, she continued, what about using the $6 million already appropriated by Rhode Island voters and dedicated to expand the existing facilities at Rhode Island College, including a simulation lab.

More complicated is the problem in how the affiliation of the two nursing programs is being talked about. “It is shared space, not a joint program,” the source emphasized. Any attempt to change the curriculum at either school, which are both independently accredited, with different missions, would require approval from the national nursing accreditation association.

The new white coats at Johnson & Wales
The decision to expand its curriculum to include a master’s program in physician assistant studies in Rhode Island was made based on research analyzing where the good-paying jobs of the future would be, according to George Bottomley, the director of the new Center for Physician Assistant Studies at Johnson & Wales University. [See link to ConvergenceRI story on the endeavor below.]

As Chafee told Convergence in an interview before the festivities began, “The physician assistant program is Johnson & Wales branching out to do for the health care industry what they [had previously done] with business administration, hospitality and culinary arts.” For Chafee, it was “the realization of the dream of meds and eds coming together on this 195 real estate.”

Bowen told Bottomley that he “had exceeded expectations” 100-fold. He also praised the collaboration with the medical school at Brown University and the ongoing partnership with Brown. After his first luncheon meeting with Christina Paxson, the president of Brown, Bowen said he came home and told his wife: “Honey, I’m an Irish Catholic. I need to go to confession; I’ve in love with another woman.”

Bowen projected his own experience as a first generation college graduate onto the ceremony, saying that it was very symbolic that the university had bought an old dilapidated factory building built in 1948 and breathed new life into it.

“For many of the people who worked here, that walked through this building, their lives never got any better,” he said. The lives of the new students, he continued, will be a little better when they leave. “And they’ll make sure that other people’s lives get better along the way.”

For the students, a major attraction of the new program was the focus on humanistic education, explained Ashley Stoltenburg, who had come to Providence from South Dakota. “The mission statement, focused on humanistic medicine, that’s what drew me to the school,” she said. Not many PA programs that I’d looked into focused on humanistic medicine. “I took a road trip last weekend, and each time I went past a road sign, I tried pronouncing it. Paw-Tuck-It,” she said with a laugh.

Workforce needs
There were important nuggets buried in the 32-page report underwritten by the R.I. Governor’s Workforce Board. “The most significant gaps that employers identified include communications, critical thinking, clinical skills, professionalism and customer service,” the report said, in congruence with what industry executives had told the biotech panel. “Employers overwhelmingly comment that new graduates/job seekers lack ‘soft skills’ such as conflict resolution, accepting feedback and correcting actions, listening, and teamwork.”

Further, while there is a negligible amount of labor shortage anticipated for jobs requiring only a high school degree, the report found that it was harder to fill jobs that required at least an associate’s degree in the Rhode Island market.

Further, the report found that nursing jobs are trending away from acute care facilities and into community-based, non-hospital settings, as the continuum of care moves toward being more patient-centric. As a result, nursing schools have begun to change their clinical placements to include more nursing homes, schools and senior centers, reflecting the shift from in-patient to out-patient care.

Internships become key
Placing students in internships becomes a key component of success in the educational pipeline, though the needs of students are often a matter of age groupings, according to Bozzi. Younger college students – 18-19 years of age – often look for an internship during the summer months. Other students in their early 20s often look for an internship that will be for a semester at a time. Older students – whom Bozzi characterized as being in their 30s, 40s and 50s – are looking to transition to a job.

Bozzi cited the new Innovate Rhode Island program of internships, funded through new legislation enacted following concerted lobbying by his organization, R.I. BioScience Leaders, and administered by the R.I. Science and Technology Advisory Council. He told ConvergenceRI that he was unaware that there had been a two-month glitch on the website promoting grant assistance for the internships, and speculated that may have been one of the reasons why he hadn’t yet heard from Neurotech about internships for his students.

Take-aways
The Johnson & Wales’ new physician assistant center has no direct links with the nursing programs at RIC or URI or the proposed new shared-space facility. It also has no direct links with R.I. Nurses Institute Middle College Charter High School – a charter school that runs from 10th grade through the freshman year of college, focused on nursing. It has built a series of partnerships to place its physician assistant students in clinical settings – but not as part of an ongoing educational partnership with nursing programs. 

When asked, Bottomley appeared unfamiliar with the with the Providence-based Middle College Charter High School, even though it is only a few blocks away from the new center.

The R.I. General Assembly – and in particular, the House and Senate Finance Committees, are being asked to make judgments about the new $206 million Dynamo House development and the proposed shared-space rental agreement to house a portion of the URI and RIC nursing schools, but they have never heard directly from the nursing school deans or faculty, only the two college presidents. The fact that $6 million was already approved by Rhode Island voters to expand the nursing school capability at the RIC campus – which was to have included a new simulation lab – appears to be unknown to legislators and to reporters, alike.

The R.I. Governor’s Workforce Board, under the leadership of Rick Brooks, has completed two comprehensive reports about the projected demand for health care workers in Rhode Island and the educational needs to grow the biotech sector.

The fact that there was a two-month glitch on the website to promote the modest internship program through the Innovate Rhode Island Small Business Fund, administered by the R.I. Science and Technology Advisory Council, points to the need to create a comprehensive, cross-sector internship program for Rhode Island, perhaps managed by the Governor’s Workshop Board itself, modeled on the current statewide internship program now underway in Massachusetts, targeting STEM/STEAM students.

Comprehensive coverage connecting the conversation between all these activities can only be found in ConvergenceRI.