The fifth season of the STAR² Center Talks Workforce Success podcast highlights Primary Care Organizations (PCAs), Community Health Centers (CHCs), and National Training and Technical Assistant Partners (NTTAPs) who successfully used, disseminated, and/or implemented practices, strategies, tools, and more gathered from the STAR² Center’s training opportunities, technical assistance, or original resources. In this episode, Michelle Fernández Gabilondo speaks with Judd Mellinger-Blouch, director of the Pennsylvania Primary Care Career Center at the Pennsylvania Association of Community Health Centers about some of the challenges facing the health center workforce today and what tools and strategies can be employed by health centers with the support of PCAs to work toward workforce success.

Transcript by Rev.com

Michelle Fernández Gabilondo: Welcome everybody. My name is Michelle Fernández Gabilondo. I’m the Associate Director of Workforce Development at the Association of Clinicians for the Underserved. We’re here today for season five of STAR² Center Talks Workforce Success. We’re really excited to have Judd Mellinger-Blouch. He is the director of Pennsylvania Primary Care Career Center at the Pennsylvania Association of Community Health Centers. Welcome, Judd. How are you doing?

Judd Mellinger-Blouch: I’m doing fine, Michelle. Thanks for having me.

Michelle Fernández Gabilondo: Yeah, we’re very excited to have you here today. So just to go ahead and jump in and get started, could you introduce yourself, tell us a little bit more about your professional journey, your role, and then also your organization?

Judd Mellinger-Blouch: My background actually is in journalism. I graduated from Penn State long time ago with a degree in journalism, but I got into healthcare, public relations and marketing recruitment. I’ve been in that for almost 37 years now, so I’ve been around a while. Before joining the Pennsylvania Association of Community Health Centers, I was director of Marketing Communications at the Pennsylvania Medical Society, which is the Statewide Physicians Association here in Pennsylvania. I joined PACHC in 2014 as you said, the director of the Pennsylvania Primary Care Career Center. The Pennsylvania Primary Care Career Center is a little bit unusual for a PCA. It’s a state funded career center. Grant has been around for about 10 years. I just celebrated my ninth anniversary here, and the career center was formed solely actually to increase access in rural and underserved areas by helping health centers recruit and retain really essential providers. At that point, it was really focused on providers, physicians, dentists, nurse practitioners and so on. Really, we’ve expanded that to also focus somewhat on frontline employees like medical assistants, dental assistants, and community health workers.

Michelle Fernández Gabilondo: Excellent. And it’s always so great to work with you all. So learning more about the organization, it’s always great to hear that. We’re going to jump in. As you know, we’re going to be talking about workforce and STAR² Center resources. So the first question that I have is, could you share with our listeners today some of those workforce challenges that are front of mind for the health centers that you work with in Pennsylvania?

Judd Mellinger-Blouch: There’s so many, Michelle, it’s really hard to… This is a list that’s hard to keep short. And one of the things that I’ve discovered as I look around at other industries is that if there’s a workforce challenge in this big world of ours, it’s probably faced by community health centers. They run into just about every workforce problem that’s out there, but just to name a few, first, I think, and maybe foremost it’s hard to pick one that’s the worst problem they face. We’ll just say significant challenge is the competition for talent. The talent pool is very shallow in a lot of areas and there’s a lot of people wading around in that pool looking for talent. So there’s a lot of competition for talent and there are organizations out there with deeper pockets than community health centers as we all know. And they can do things like offer some benefits and so forth that really make it very attractive for people to work there.

One of the keys for community health centers as they face that competition is to find out where their competitive edge is. And so, we’re trying to help them discover their competitive edge and they do have one. I’d say the next workforce challenge is training the next generation of caregivers and providers. As you know, HRSA through the Bureau of Health Workforce is very big on health profession, education, training and getting community health centers to be more involved in this. And it’s a real challenge. They want them to do this, but honestly, they haven’t given your regular old health center any money to help them do this. And it can be a strain on our health centers to do this. And when I say regular old, I mean those that are not teaching health centers that are not funded as teaching health centers and most of them do not have any of that kind of funding. So that’s a challenge.

And really looking around your area, say your rural health center or even an urban health center, looking around your neighborhood or looking around your region and trying to reach out and find people in your area who would make good employees and then training them and bringing them in. And then the next challenge is then retaining those, that personnel. Sometimes I think retention is even harder than recruitment because as we mentioned earlier, there’s so much competition for talent that it’s really difficult to keep those personnel on board when there’s so many opportunities out there. And honestly, we know that there are health systems in Philadelphia for instance, are targeting providers at community health centers because they can go to them and say, we’re going to pay you 30, $40,000 more a year to come over here and it’s money that’s hard to resist.

But also, one of the other big challenges of retaining personnel is retaining those frontline workers, those people who are making 17, $18 an hour being a medical assistant at community health center. And then the health system down the street offers them 21, $22 an hour and it’s hard to retain those folks. I think a couple of others real quickly is there’s a lot of myths surrounding health centers such as low pay, poor benefits, long work hours and so forth that really are not true. That’s a challenge for us. And then last and one of the big ones that doesn’t get talked around probably nearly enough, is adapting to new generations. The younger generations of workers who are doing the awful thing of insisting on a work-life balance, Michelle. And one of the real challenges there is that, for instance, physicians want to work a 40-hour week, but they want to make the same money that doctors are were making when they were working 50 and 60 hour weeks and more.
You talk to a family physician who’s been at it for say, 30 years, and you ask them how much they made when they started in relation to how much a cardiologist or an orthopedic surgeon or any of the higher paid specialties makes. It was pennies on the dollar to what they made and how hard they worked to make that money. And now you have a new generation of folks coming along who want to make that money and they want to work 40 hours a week. It’s hard to pay people when their productivity is that much lower than their people in previous generations. Of course, I’m a baby boomer and when I say that, probably folks, millennials and Gen Zs would like to bring me up. I think everybody needs to face it. That’s a challenge when you want to make that full salary and you want to work what many of us… I mean, I don’t know many people in our business, Michelle, who work just a 40 hour a week. Anyway, I’ll stop there with the workforce challenges, that’s plenty.

Michelle Fernández Gabilondo: I will say as a millennial, so I want to put that perspective in there that’s okay with you is I think we really need to address those challenges. And one of the things that I hear sort of from that younger generation perspective is, yes, well, we understand some of these arguments, but look at inflation, look at the level of student debt we’re coming out of, look at equity issues that really are only just now being addressed. And I think that’s what makes this problem so complicated because there’s so many layers to it that makes it very hard to address it. But I think it’s something that can definitely be addressed.

We talk a lot about the importance of just having communication. That’s one of the strengths that I think health centers can really capitalize on is the culture they’re building, the mission that they have, which I think a lot of other health networks may not be able to compete with that piece of it, that for people that’s a huge part of their retention. And not to belabor this point, we did not too long ago a webinar on communicating across generations. And really, the perspective we took on this is that every generation is going to look at another generation kind of with a bit of a side eye and be like, “Ugh, I disagree with this or that,” but when you can actually sit down, communicate, build a culture of trust, there is a lot that can come out of that.

Judd Mellinger-Blouch: You’re right, there’s more complexity to it than just hours and wages, that healthcare is changing drastically. You’re right with the loan repayment and the student loan debt. And so, you have a physician coming out and doing that, and then you have a nurse practitioner goes through much less schooling, comes out and could possibly be your competition down the street because they want independent practice. It gets very complicated and I think you’re absolutely right that health centers, that’s what we talk about with the competitive advantage. One of the things is communication. The another thing is purpose, getting at the reason why you got into healthcare to begin with. Focusing on that and helping people remember that’s why they did this.

Michelle Fernández Gabilondo: Moving up to the next question, and I think we kind of discussed this a little bit sort of indirectly with what we were talking about, but given all those challenges, where do you think the focus really should be right now when we’re developing and providing that T&TA?

Judd Mellinger-Blouch: I look at our experience here in Pennsylvania and we’re a little different because we’re doing that direct recruiting and we have funding to do that. At the same time, as the director, my time has been pulled away from doing as much direct recruiting and really working on a lot of policy issues and helping out with programming and so forth. But I think for all PCAs and all NTAPs involved with workforce, one of the needs that we see out there a lot is that there’s a number of community health centers, particularly the smaller ones that really aren’t good at recruiting. They really are not good at it at all. And one of the reasons is that they have either the CEO or the HR manager is doing the recruiting, and I have great respect for folks in the HR profession and I would never want to do that because there’s so much to it and there’s so much detail and you have to handle all those details and put up all those posters and follow those rules and it would drive me nuts.

But many of them are not natural recruiters. And so, how can PCAs and NTTAPs work with these organizations, help them learn recruiting better, help them do a better job of sourcing candidates and contacting local health systems, local residency programs and training programs and so forth, and making inroads and networking and all this sort of thing. That really does not come naturally to a lot of people. A lot of people think, well, you hired an HR manager there and they should be out there doing the recruiting. Well, once you get past posting jobs on Indeed, and a lot of HR people are lost when it comes to that. I think another thing that needs to be done is really recruiting for retention.

The National Rural Recruitment and Retention Network or three 3Rnet really touches on this a lot. That’s something that’s probably a lot more natural to a lot of HR managers, and that’s things like a really favorable experience when you’re interviewing a really good onboarding program that doesn’t just onboard the provider but onboards her whole family because people are moving to new communities and they need to be welcomed and they need to be… If you want them to stay, you’re going to have to… You got to onboard the spouse or the partner and the kids just as much as you do the provider.

And single people, if they’re moving to a rural community in particular, they’re coming in there with no support network at all. I mean, they don’t even have a spouse and kids. What are people doing to welcome them in to make them feel at home? And in a lot of rural areas, if you weren’t born and raised there, you’re an outsider for the rest of your life. So how do you get past that? Frankly, there’s communities within certain cities where it’s like that. You drive from one neighborhood to the next in Wilkes-Barre or Pittsburgh or whatever, just as much of an outsider as if you were moving into a small town somewhere. And we’re doing a lot here in the state Pennsylvania about training frontline workers. And that’s a great way to build pathways for career opportunities.

And I think some of the PCAs, some of the NTTAPs, well one of the NTTAPs is National Institute for Medical Assistant Advancement and others are really doing some great work in this. Some of the PCAs have developed dental assistant training programs and there’s some really good tools out there, and I think that needs to be an area where PCAs and NTTAPs help their health centers work on that. And then last two, better training and more resources for justice, equity, diversity and inclusion. And then also, it kind of goes along with diversity and inclusion issues are self-care training and not just for the providers, but also for administrators like HR directors. We talk to a lot of HR directors here in Pennsylvania who are really at their wits end because it’s such a tough job. And I think sometimes we forget that people in administration have a different kind of stress, but probably the same level of stress as providers.

Michelle Fernández Gabilondo: Some of the trainings we’ve done, we’ve started including a slide that shows some data on how HR professionals, their burnout levels are equal to the providers. When we’re dealing with these things, you can’t look at it isolated to just one part of the workforce. It affects everybody. It’s so important. I’m so glad you mentioned that with the HR professionals because yes, we see that they’re burned out and like you said, recruiting is also a very specific skill. So putting people in positions where they’re like, this is not necessarily the skill that I’ve developed, only breeds more of that burnout. And then when you don’t really have the workforce and the people that you need, it’s a very multi-layered problem.

But I think as you were talking, what it made me think about at the end of the day, so many of these things, and I know this is not a solution, but it’s about how do you bring it back to being people focused and what the people in your health center need, because that also directly impacts how you work with your patients, the services you provide, all of those things, which is something that I’m very happy to see that there just has been more of this honing in on how do we take care of the people that we have, but then you add those complex layers, which is where it gets pretty difficult.

But yeah, everything you said very much is what we hear around the country as well. The NTTAPs and the PCAs, we’re here to provide resources. And us at the STAR² Center, as you know we create a lot of resources, we put it out there. They’re on our website. We really are very intentional in wanting to collaborate with primary care associations. And the question that I have is could you tell me some of the STAR² Center resources that you may have used in the past and found helpful or really any feedback on any of the STAR² Center resources that you may have used?

Judd Mellinger-Blouch: I know one of the big things that we use for STAR² Center I use is just I refer people to your website all the time. I use it, it really is a treasure trove of resources that we can turn to for all kinds of different things. One example is that as we’ve done this health professions education and training, HPET planning for with health centers is using your planning tools and STAR² Center worked with HRSA to come up with a definition of health profession, education and training planning, I believe, something like that. So they wanted everybody to do a comprehensive workforce plan and then they redefined it to do an HPET plan. And so, it’s been a real journey. So it was really helpful to have those resources on hand. You guys make it so easy to find stuff and really saves on time when we do that.

And I know another way we’ve used you is you’ve spoken at our annual conference a number of times. You were there Michelle, last year to co-present at a DEI four-hour session, and then you did a one and a quarter-hour session on Wednesday morning at our conference. We got great feedback from particularly your presentation on that Wednesday morning. That was our highest rated session in the human resources track. So you did a great job and you had great resources to rely on too. It’s not just you as a really good speaker, but also the resources that STAR² Center that you had at your disposal to do the presentation. And then another reason why people should use you guys as speakers is then if we challenge you on a topic that maybe you need to do some research on, then that research is done for all the PCAs and all everybody else that you guys always seem very willing to say, “Hey, we haven’t done much on that, but let’s look into it. We can do that. It’s in our wheelhouse.” So that’s great.

And that kind of leads into the last thing. I have you guys at my disposal whenever I need you, I can call you or Suzanne or whatever and say, “Help me figure this out. What do you guys have on this? Have you talked to any other PCAs that are doing this?” The sessions you hold where we all get together and network are really great. Oftentimes you guys are showing up at the 3Rnet conference or other locations. And honestly, Suzanne Speer seems to be everywhere, but I dearly love her and she’s a great person. So anyway, I would just say to people, if you go on the STAR² Center website and you look for something and it’s not there, give them a call and find out, they may have something in the works.

Michelle Fernández Gabilondo: And I’m so happy to hear that about the session. It was so great presenting there and being with the audience, and they were so engaged too and I remember, I think the session started at eight, you always get a little bit worried with the morning session. So that is very wonderful to hear. And for us, it’s so important to go to these conferences and to present, because a big part of what we get is we’re able to get that feedback of what are the health centers looking for as PCAs, what do you need? And all of us really working together for the end goal of supporting this health center movement that is so fundamentally important.

So I just really thank you for that great feedback and always for inviting us to speak. We’re always happy to do that. And yes, anybody can reach out at any point and we’re here to help. Is there any feedback that you’ve received from your health centers on using some of these resources? And part of the reason that I also ask this is because when we develop our resources, we want to be really intentional of both having a foundation and understanding of the concept that we’re talking about, but then giving people actual tangible tools.

Judd Mellinger-Blouch: Like I said before, the biggest thing was in the feedback I got on your presentation last year, and Suzanne spoke in there before and got really good feedback. I look forward to your newsletter every month that lists all the new stuff because then we do a weekly email newsletter every Friday afternoon, and it is big. It’s a lot of stuff in there. And I always feature the STAR² Center stuff.

Michelle Fernández Gabilondo: Thank you for letting us know about that and at any time we’re here to help, go speak, present. And as you know, Suzanne Speer, so she’s, for those who are listening, our senior director of Workforce Development at the STAR² Center and really just amazing. So as we wrap up again, I just want to say thank you so much. I also want to give you the chance to talk about any resources that you all have as a PCA, that you want to share with the audience. This is your time to share that.

Judd Mellinger-Blouch: Sure. So I wanted to just highlight a couple of things. And we were fortunate here in Pennsylvania that a lot of the vaccine hesitancy money that went to our Department of Health from the federal government, they turned around and said to PACHC, they said, “Hey, we want to give you a bunch of money. What do you want to do with it?” We told them a bunch of projects and they committed $26 million of that to projects we wanted to do. And within that, there’s two projects that really address workforce. Of course, I think every project in some way, shape or form affects workforce. Whether you’re getting new equipment or you’re building new building or you’re doing anything like that, it impacts workforce and people need to remember that. But the two that are really addressed most directly are of that 26 million, 10 million is going to training community health workers and medical assistants onsite at the community health centers in Pennsylvania.

Unfortunately, we had to carve out all the ones in Philadelphia because they’re in a separate HRSA jurisdiction. So they didn’t get the same money we got, they got different funding. So our health centers, about 40 health centers. I think actually the actual number is 36. 36 of the health centers are involved in onsite medical assistant and community health worker training programs. Some of them are using NIMAA, some of them are using a company called Career Steps to do this training. The area health education centers in Pennsylvania have a community health worker curriculum that a lot of our health centers are using, and it’s hopefully going to really address some of these issues with training and obtaining frontline workers.

And then the other project is about $6.5 million is being spent on a statewide workforce marketing campaign. Then most of that money, like the CHW and MA training program is going to be divvied up among our health centers according to their size and their annual billings or annual revenue or something like that. But we developed an overall campaign tagline on it is Earn a Living Where Your Heart Is and we’re really focusing on recruiting people who have that passion for the purpose of community health centers, want a job where they can feel good every day about the work they do and then a job that loves them back. A job they love and a job that loves them back.

And so, we’ve set up a whole Google Drive full of assets and resources. Many of our health centers are using the advertising agency that we used for this, Gavin Advertising out of York, Pennsylvania. And this has just really started in December. Already, we’re getting some really good feedback. Some folks have used the money to fund billboards like in rural areas and these billboards of the talk of the town because they’re featuring people that everybody in town knows, people who work at community health centers and others are just really getting started and getting their projects underway. But we’re very excited to see where that leads. So that’s a couple of things we’re doing. And this is all in addition to all the recruiting and the HPET and the policy stuff we’re doing.

Oh, one last thing in conjunction with HPET, I could keep going I guess, but two projects that we’re involved in. One is we’re just helping University of Pennsylvania or Penn in Ivy League school in Philadelphia. Their school got $125 million gift from Leonard Lauder to do training of nurse practitioners to work in rural and underserved areas. So they’re going to use that. They’re going to have 40 NP students per year who will get a full ride to get their NP at Penn. And then we’ll be required for two years to work in a rural underserved area after that. So we’re working with them to help them find preceptor sites for these students so they could not only train with the idea of going into rural and underserved areas, but actually train in those rural and underserved areas.

And then a much smaller program, but probably one of them just as excited about is we’ve got a one-time $300,000 grant from Pennsylvania to do a nurse practitioner residency pilot. And we’re going to be doing that in the Pittsburgh area with Carlow University and the FQHCs in Pittsburgh over the next year to see how that goes. And see if that’s something the state would want to fund in the future. Those are some projects we’re working on and some things we’re very excited about. And then we’re also doing our regular jobs too.

Michelle Fernández Gabilondo: Never a shortage of work. Well, Judd, I just want to say thank you so much. I’m so glad everything that you all are working on is just so fundamentally important. Again, I am Michelle Fernández Gabilondo. Today, you were listening to STAR² Center Talks Workforce Success. We were interviewing Judd Mellinger-Blouch. He’s the Director of the Pennsylvania Primary Care Career Center with the Pennsylvania Association of Community Health Centers. Please make sure to go check them out. And Judd, tell me if I’m incorrect in this, but I believe your website is pachc.org.

Judd Mellinger-Blouch: pachc.org is the PACHC website. The career center has its own website, and it’s paprimarycarecareers.org, paprimarycarecareers, all one word .org.

Michelle Fernández Gabilondo: Perfect. Thank you for that. And again, thank you so much for being here. This was great. Thank you everyone for listening.