Keeping it local: Apprenticeship program helps Inchelium clinic keep, promote staff

INCHELIUM, Wash. – The community health center here, on the eastern edge of one of the state’s largest tribal reservations, used to serve only members of the Colville Confederated Tribes.

But the Lake Roosevelt Community Health Center has come to serve anyone who arrives at its doors in this isolated part of northeast Washington, including people from Kettle Falls and Republic and elsewhere in Stevens and Ferry counties.

The extent of the clinic’s draw can be seen in the numbers: Inchelium has a population of about 400 people, but last year the Lake Roosevelt clinic and the smaller Keller clinic attached to it saw 2,772 tribal and non-tribal patients.

The reason it brings in people from so far and wide can be seen in the clinic’s offerings, which include optometry, dentistry, general medical care, labs and, as of recently, behavioral and mental health outpatient services.

While the clinic has no trouble attracting patients, health care workforce recruitment here is still a challenge, as is common in most rural regions in the state and country.

“It is difficult, not just for tribes, but for any part of rural America. That’s becoming a very emerging problem: really looking at recruiting professional staff to a rural area,” Rodney Cawston, chairman of the Confederated Tribes’ council, said.

And while recruitment of medical professionals is a challenge, Stefanie Lelone, the human resources manager at the clinic, points out that medical assistants are on the front lines of health care, interacting with patients. To boost the ranks of those workers, leaders here turned to an apprenticeship model to help keep and promote their own workers to become medical and dental assistants through a Washington Association for Community Health program.

“When you’re from here and committed to the community, and we have something like this we’re able to offer, it works for us and it works for them,” Lelone said. “And you have people who care about the people they’re serving from the beginning.”

Becoming a medical assistant requires courses at a community college and taking a certification exam. Until recently, that meant a more than two-hour commute for those living on the reservation. But while online classes have reduced some of the required drive time, state law requires future medical assistants to complete a 160-hour, in-person externship.

Dayna Seymour, the operations manager at the Lake Roosevelt clinic, said the tribe’s apprenticeship program allows people to do that externship closer to home.

The apprenticeship program “gives these people the opportunity to get this training and the stuff they need, the certifications, without having to go to Spokane to get that done,” Seymour said. “So it’s really awesome, because I think some of the people that have gone through, I don’t know that they would have wanted to go to Spokane to do this.”

Six employees at the Lake Roosevelt center have gone through the program since it began in 2014, and four still work there as medical assistants. Les Lahr, the health center’s longtime medical assistant, is a big reason for this, as she has coached and trained everyone who has gone through the program. Lahr went to community college in Spokane to get her MA certification but said the center had a real need for more assistants in 2014.

“There was an incentive to train more staff members and get our own staff to do it,” Lahr said.

Brenda C. Starkey is currently an apprentice in the program. Starkey, who lives in Kettle Falls, makes the commute every day and has been working for the tribes for well over a decade.

She worked at the clinic as a certified nursing assistant before beginning in the apprenticeship program last year to become a medical assistant.

The program requires about 10 hours a week of work for those in it, outside of normal work hours. Starkey will finish up the coursework component of the program this summer and then take a few months to study and prepare for the test, which she will take in October or November.

The Washington Association for Community Health facilitates the apprenticeship program at centers and outpatient programs in hospitals around the state.

The program is run like a traditional apprenticeship, with full pay and benefits for employees on day one, Katherine Lechner, workforce development manager at the association, said.

“This is really meant for people who are placebound, or they need to maintain full-time employment in order to keep living their lives, but they need to or want to continue their education,” Lechner said.

The program costs $3,750, which Lake Roosevelt covers for its employees.

That cost is not too burdensome for employers, Lechner said, especially when the time and cost of recruiting critical staff is considered.

“What we hear from (employers) is that the cost to recruit a new MA is so much higher than that tuition cost that they see it as a good investment, and oftentimes it helps with retention too, because that person has some loyalty,” Lechner said.

Those who go through the apprenticeship program also receive community college credits for their time in the program, which they can use towards a degree. Starkey plans to continue her education after completing the program and pursue a college degree. The program has four cohorts per year, with about 25 people per cohort.

Using apprenticeship programs as a way to recruit medical assistants is relatively new nationally, a study from the Center for Health Workforce Studies found.

Apprenticeship programs have helped staffing levels in Inchelium, Lelone said.

“When you can train people locally from your community, you have a higher chance of them staying,” Lelone said. “And even though I agree that these MDs, physicians and dentists are really challenging positions to fill, so are MAs. They were really hard to find, especially because we are so rural.”

So far, hundreds of apprentices have gone through the program in both community health centers and hospital outpatient departments in Washington. Starting this fall, health centers will be able to apply for an apprenticeship for substance use disorder professionals, Lechner said.

Lelone and tribal council leaders expressed the need for similar programs to provide other health care staff, like nurses, new avenues to train in rural settings.

“If we can’t have trained staff and personnel, that can take away some of those services we find so difficult to provide here,” Cawston said. “You know, we really need to create good programs that are more responsive to the communities they serve.”