Autumn-Winter 2007 – Rural Health in America - National AHEC ...

Autumn-Winter 2007 – Rural Health in America - National AHEC ...

A Publication of the National AHEC Organization


Autumn/Winter 2007

Rural Health in America:

The AHEC Role

In This Issue

Alaska: Rural Challenges and Limited Access to ○ Care

Sen. Lisa Murkowski (R-Alaska)

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The Rural Health Workforce and the Essential Role of ○ AHECs

Thomas J. Bacon, PhD; Stephen L. Silberman, DMD,MPH, DrPH; and Kathleen Vasquez, MSEd

Defining the Issues and Principles of Rural Health Professions Workforce ○ Development

Hilda R. Heady, MSW

Partnerships and Collaborations

Partnering for Change: Addressing the Primary Care Workforce ○ Shortage

John Sawyer

Collaboration as a Strategy to Address the Health Workforce ○ Crisis

Mark Loafman, MD, MPH; Linda Kanzleiter, MPsSC, DEd; and Felice Vargo

Partnership for Primary ○ Care:

David Garr, MD; Janice Benson, MD; and Kelley Withy, MD, PhD

Recruitment, Retention and Practice

Preparing Health Professionals for ○ Tomorrow

Mary Amundson, MA

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Wisconsin Academy for Rural Medicine and Wisconsin AHEC: A Team Approach

Byron Crouse, MD; and Alison Klein

Where Can Science Take You?

Kathy Huntley, MS

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Geriatric Assessment Interdisciplinary Team Training:

A Collaboration Among the Maryland AHECs and the University System of Maryland

Donna Wilson, BA, MA; Reba Cornman, MSW, LCSW-C; and Terri Socha, BA

Rural Health and Technology

Improving Senior Care Through Technology: A Collaborative Approach

Gail O. Mazzocco, EdD, RN; and Andrea Novak, MS, RN-BC, FAEN

Northern New York Successes in Healthcare Workforce Development

Richard K. Merchant, MS

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Clear Connections: A Feasibility Study Model to Bring Telemental Health Services to Rural Communities

Catherine Russell, EdD; and Patricia Beckenhaupt, MPH, RN

Web-Based Tools Extend AHEC’s Impact to Support Rural Health in Texas

Shannon Kirkland, MBA; Mouyong Liu; and Paula Winkler, MEd

Laboratory Professionals Are Critical to Health Care

Sue S. Beglinger, MS, MT (ASCP), CLS (NCA); and Mary A. Nelson, MT (ASCP)

Rural Life and AHEC Connections

Amish Health Project: Plain and Simple

Maggie Turnbull, MA/WEd, MT (ASCP)

The Rural/Frontier Women’s Health Coordinating Center in Nevada

Rocio Flores-Zuniga

What the Heck Is an AHEC?

Richard R. Perry, MA

Rural Health in America: The AHEC Role

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Volume XXIV, Number 1

Autumn/Winter 2007

The National Area Health Education Centers Bulletin

A Publication of the National AHEC Organization

Alaska: Rural Challenges

and Limited Access to Care

Sen. Lisa Murkowski (R-Alaska)



is the junior



Senator from


In Alaska the term rural takes on special meaning as nearly one

quarter of the state’s population lives in communities and villages.

Alaska faces healthcare challenges unlike those of any other state.

Our healthcare service area is the largest in nation—in fact, Alaska

is bigger than Texas, California, and Montana combined. Despite

that size, Alaska has fewer roads than Rhode Island, which means

that health delivery often involves air travel and weather delays.

Adding to Alaska’s medical woes is our low ratio of physicians to

patients, the sixth lowest in the nation; but outside of Anchorage,

Alaska’s largest city, it’s the worst in the nation. This problem is

exacerbated by the fact that the senior population in Alaska is the

country’s second fastest growing.

The rapidly expanding group of people needing medical care,

coupled with the scarcity of physicians, make receiving medical

attention very difficult, especially for patients living in

rural areas. A resident of Bethel told me that he would be

willing to fly the 400 miles to Anchorage if only he could find a

primary care doctor who would accept him. He also joked that

he counts himself “lucky” to have a heart condition because that

means he gets to see a specialist sometimes.

The lack of accessible health care for rural residents must be fixed.

Today, because of low Medicare reimbursement rates and high

attrition rates, the shortages of physicians and other healthcare

providers in Alaska are at crisis levels. For example, if you are pregnant

and live on the Aleutian Chain, you must travel 600 miles to

Anchorage to deliver your baby, and many more are forced to go

without care entirely. That is why I have proposed legislation to

alleviate the nation’s rural healthcare crisis.

Unfortunately, it is a problem that is forecast to get worse. In just

20 years, 20% of the nation’s population will be 65 or older, a

percentage larger than at any other time in history. Just as this

aging population places the highest demand on our healthcare

system, some experts predict a national shortage of 200,000

physicians. If that becomes a reality, 84 million patients could

be left without a doctor’s care.

Early in the year I introduced the Rural Physician Relief Act, a bill

that provides tax incentives for physicians to practice in our most

rural and frontier areas throughout the

country. Creating incentives that offset

the high cost of providing care in

the most remote areas of the nation

will go far in recruiting physicians to

the areas that are most in need of their services. This legislation will

bring some much-needed assistance to physicians who provide

primary health services to rural Americans.

I also introduced legislation, the Physician Shortage Elimination

Act, that provides additional investments in programs that have

been successful in attracting and retaining physicians in underserved

areas of the country. Despite increasing demand for physicians,

supply remains stagnant. The number of medical school graduates

has remained virtually flat the past three decades. In addition, half

of all physicians practice medicine within 100 miles of their residency.

The odds of retaining physicians in underserved areas dramatically

increase when medical students serve their residencies in

those communities. Rural and underserved residency programs must

be allowed to flourish. My legislation will prevent residency programs

from being penalized for training in locations where the need

is greatest, and improve and expand current medical residency programs.

In addition, my legislation will reauthorize the Centers for

Excellence and the Health Careers Opportunity Program. It will

also double the funding for the National Health Service Corps, an

excellent program that provides students with scholarships and

loan forgiveness.

A dozen states have already reported significant physician shortages.

The greatest shortages have persistently been in primary care.

In rural areas of the country, where 50 million Americans live in

areas that lack sufficient care, these shortages represent one of the

most intractable health policy problems of the past century.

The legislation I’ve introduced aims to correct this problem before it

gets any worse. Congress cannot sit idly by while potentially millions

of patients go without care and millions more are at risk for

losing access to health care. I look forward to working with my

Senate colleagues to pass legislation that would provide greater

patient access to physicians in our most rural and frontier areas.

Sen. Murkowski is also providing leadership in the effort to reauthorize the Title VII

programs, including AHEC. -eds.

The National AHEC Organization supports and advances the Area Health Education Centers (AHEC) network

in improving the health of individuals and communities by transforming health care through education.

The National AHEC Bulletin is published semi annually by NAO.

Editorial Overview

Thomas J. Bacon, PhD, is

Program Director of the

North Carolina AHEC,

Chapel Hill, NC, and Cochair

of the NAO Editorial


Stephen L. Silberman,

DMD, MPH, DrPH, is

Program Director of the

Mississippi AHEC,

Jackson, MS, and a

member of the NAO

Editorial Board.

Kathleen Vasquez, MSEd,

is Program Director of the

Ohio Statewide AHEC,

Toledo, OH, and a member

of the NAO Editorial


The Rural Health Workforce and

the Essential Role of AHECs

Providing high quality accessible health care to

people living in rural and remote parts of the

United States has been an inherent challenge

for the nation’s health care system. Today, 20%

of Americans live in rural areas, but fewer than

9% of physicians practice there, and similar

shortages exist for nurses, dentists, pharmacists,

allied health professionals, and other

health practitioners. Numerous reports have

noted the challenges in recruiting and retaining

health professionals for rural areas, and the

Bureau of Primary Health Care projects severe

shortages of primary care providers available to

work in federally funded community health

centers in the near future.

The primary mission of the AHEC Program

since its founding in 1972 has been to improve

the supply, distribution, and retention of primary

care practitioners and other health professionals

in rural and other underserved communities.

Since its inception, AHEC was viewed as the

educational arm of a series of safety-net

programs put in place to address the issues of

access to quality health care. Community health

centers and the National Health Service Corps

were established as the primary mechanisms to

deliver care to vulnerable populations, and

AHEC was created to provide health professions

training and practice support.

This issue of the National AHEC Bulletin

focuses on the rural health workforce, including

the role AHECs play in preparing a healthcare

workforce to address the needs of our rural

communities. Senator Lisa Murkowski’s lead

article presents information on the nature and

extent of access issues in rural states, as well as

legislative initiatives she and others are

championing to alleviate the problem. The

AHEC leadership throughout the country

looks forward to working with Senators

Murkowski, Kennedy, and others as they

renew efforts to reauthorize the Title VII

programs, including AHEC, during 2008.

The article by Hilda Heady provides a broad

overview of issues affecting the rural health

workforce. Ms. Heady writes from the

perspective as Director of AHEC and other

rural health initiatives in West Virginia, and from

her experience as the 2006 president of the

National Rural Health Association.

An essential strategy used by AHEC for over 35

years involves creating partnerships with organizations

that have similar missions. Though effectively

using such partnerships at local and state

levels has always been fundamental to AHEC’s

success, their use at national levels is relatively

new. Three articles in this issue highlight new

partnerships between the National AHEC

Organization, the National Association of

Community Health Centers and the Society of

Teachers of Family Medicine. These national

partnerships provide AHECs throughout the

country with access to additional resources and

strengths that we can bring to our collective efforts

in improving the recruitment, preparation, and

placement of rural health professionals.

Other articles in this issue describe creative

approaches at state and regional levels to expand

AHEC services to rural healthcare students and

providers. A series of articles focus on rural health

and technology. The recruitment and retention

section includes articles on the AHEC role in

supporting a new rural track curriculum in a

medical school; an innovative science curriculum

for high school students; and a rural interdisciplinary

experience for health science students. In the

final section, the unique aspects of rural communities

and rural populations and the way AHECs

are creatively adapting their programs to meet the

needs of these special populations are highlighted.

Although life in rural America has changed

significantly over the last three decades, the

need for access to affordable high-quality health

care remains constant. AHECs throughout the

country continue to work collaboratively to

develop innovative programs and services to

train healthcare providers to meet the needs of

rural America. We trust you will find this issue

of the National AHEC Bulletin to be both

informative and stimulating, and welcome your

thoughts and opinions about topics you would

like to see addressed in upcoming issues.


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Defining the Issues and

Principles of Rural Health

Professions Workforce


Hilda R. Heady, MSW

This article provides an overview of the issues faced by policy makers and

professionals concerned with rural healthcare workforce development through

career pipeline programs and outlines the issues endemic to recruitment and

retention in rural areas. In addition, a summary of the ways in which

AHEC and other programs can address these issues is presented.

Two of the most enduring characteristics of

the rural health landscape are the uneven

distribution and relative shortage of

healthcare professionals. This is not

insignificant as nearly 60 million people in

the United States live in areas considered

rural or nonmetropolitan by various definitions.

1 As rural health advocates and

supporters of the culture of rural America

we face a dilemma as Congress tries to

balance the budget while still providing for

all elements of our society. The dilemma is

how to maintain our advocacy for support of

interventions to address the growing

challenges in rural America while balancing

our arguments with a positive perspective on

the strengths within rural America. Some

could say that this dilemma comes at a

tipping point in which rural American

culture is changing today as fast as, if not

faster than, it did with the industrial

revolution. Rural communities that have

seen declines in growth for decades are now

seeing increases in population owning to

immigration and the retirement of the

largest generation in our history.

Leaders and policy makers are taking a new

look at their healthcare systems as they try

to find solutions to both old and new

problems. This look includes rural populations

that traditionally have relatively more

elderly and children, unemployment and

underemployment, and poor, uninsured and

underinsured residents, and a population

that is becoming more diverse. While many

rural communities remain vulnerable to

economic downturns because of their

economic specialization, 2 others are finding

ways to capitalize on new labor markets,

tourism, and alternative living accommodations

for the elderly. Problems unique to

rural healthcare delivery systems include

long travel distances to obtain health care,

low population densities, lack of economies

of scale, and high rates of fixed overheadper-patient

revenue. 3 The nation’s rural

environment is diverse across its economic,

social, environmental, demographic, and

epidemiological dimensions. Local

healthcare systems, with small numbers of

providers and sparse resources, are tenuously

balanced to meet the needs of

residents while providing adequate income

and quality of life to providers. 4

So, faced with socioeconomic difficulties,

many of the 60 million people who have

chosen to live in rural America do so for

significantly positive reasons. These include

low-density population, often a cleaner

environment, low crime rates, and a healthy

nurturing environment in which to raise a

family. Rural people often possess values

that are reflected in their commitment to

family and community. While rural people

are self-reliant and value individualism,

they also engage readily in collaboration and

partnerships to solve problems. 5

Rural areas experience significant problems

in recruiting and retaining a well trained

Hilda R. Heady, MSW, is

Executive Director,


AHEC Program Director,

in Charleston, WV.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 3

Defining the Issues and Principles of Rural Health

Professions Workforce Development

healthcare workforce. These issues for rural

communities are compounded by the disparity

in federal 6 and state reimbursement for rural

providers and facilities in spite of the fact

that these providers clearly serve as the

safety-net. Policies that address the economic

stability of these rural areas and

improve reimbursement for healthcare

services are important components that

might increase the number of individuals in

the rural healthcare workforce.

Providers most likely to serve rural areas

come from rural areas. Aspiring healthcare

providers need to be well educated in

science and math to be competitive in order

to achieve admission to advanced health

professions schools and programs. Rural

schools are usually economically disadvantaged

in recruiting teachers. Strategies that

address economic development, workforce

education and training throughout the

continuum, and education and empowerment

of rural community leaders have the

greatest chance to impact this continuing


Students and health professionals who live,

train, and work in rural areas feel appreciated

by the communities they serve and

believe they make a difference in people’s

lives. Students and residents when trained

in the rural healthcare environment quickly

learn that rural people both respect them

and expect them to be leaders. These

expectations can be great tools for screening

those who can make it in the rural practice

environment versus those who have unrealistic

fantasies about working in such


Information technology resources available

in many rural areas provide “virtual”

opportunities to reduce problems sometimes

associated with professional isolation. In

addition, hospitals and other healthcare

agencies are often willing to assume the

educational expenses of those interested in

rural health through scholarships and other

financial assistance for those willing to work in

underserved areas. Finally, healthcare

workforce wages and salaries can be among the

highest in the community, providing a greater

than average standard of living.

For our purposes here, the rural healthcare

workforce is broadly defined as including all

types and levels of providers needed in rural

areas, most, but not all, in the primary care

fields. Rural health policy makers and leaders

concerned with healthcare workforce supply

have come to understand some “truths” about

the challenges to the rural health workforce

development issue. In terms of strategies, there

is no singular strategy that works. Those that

are effective are combined strategies that

provide rural health education and training,

pipeline programs for trainees from rural areas,

and support for the community efforts to recruit

and retain healthcare providers. Long-term

improvements are needed in methods of

reimbursement for rural providers, and over

time, economic development in rural areas can

improve outcomes.

To deal with these issues, the 2001 Institute of

Medicine report, Crossing the Quality Chasm: A

New Health System for the 21 st Century,

recommended integrating a core set of competencies

that included patient-centered care,

interdisciplinary teams, evidence-based

practice, quality improvement, and informatics

in the education of all health professionals. The

committee proposed that all clinicians should

possess these competencies irrespective of their

discipline. 7

The literature cites predictors of physician

selection of rural practice. The most likely

person to become a rural physician is a male

who grew up in a rural area, has a strong

interest in rural medicine upon admission to

medical school, receives a National Health

Service Corps or similar scholarship, is a

member of an underserved and/or ethnic or

minority group, and chooses a rural family

8,9, 10, 11

practice preceptorship in his senior year.

In order to address the chronic shortage of rural

healthcare workers, states have devised a

variety of educational initiatives primarily

comprised of rural training experiences for

trainees. Among these, AHECs and other


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Defining the Issues and Principles of Rural Health

Professions Workforce Development

community-academic partnerships have a

strong tradition as community-based

educational organizations with firsthand

experience and knowledge of the healthcare

needs within underserved communities.

Pathman observed that residency rotations,

brief preceptorships in rural areas, and

graduation from a residency program that

has an emphasis on rural, underserved area

health care have the most promising effect

in preparing physicians for rural practice and

in lengthening the time that they serve in

rural communities. 12

West Virginia’s publicly funded higher

education system, for example, instituted

degree-required rural rotations for all statesupported

health sciences students in 1996.

From 1995 to 2005, eight full-county federally

designated HPSAs in West Virginia were

dropped from the list, due in part to the 91

health professionals who went into practice in

those counties during that time period. All of

these health professionals had completed

degree-required rural rotations. Also, over the

past eight years, the number of physicians in

practice in rural areas of West Virginia rose by

142% according to 2006 data and by 200%

according to 2007 data. 13 Other states have

found that community-based training with

medically underserved populations and

primary care role models living and practicing

in underserved communities can reinforce and

guide students’ interest in serving rural

communities. 13,14 In this respect we have to

keep in mind that education policy is a state

issue, but both federal and state dollars are

used to fund educational programs.

Evaluations of programs that included rural

curricula for medical students have shown

success. 11 The literature indicates that the

shortage of physicians is directly related to

the educational and career choices of

students. Many policy makers and educators,

therefore, suggest that major curricular

reforms emphasizing primary care 12 and

community-based training will prove most

effective in bolstering the number of

14, 15

physicians serving in rural areas.

AHECs have led national strategies in

curricular reform and community-based

training for over 30 years. Many AHECs

initiated primary care residency programs

and community-based training systems in

states where none existed. The challenge for

AHECs across the country, in this author’s

opinion, is to stay true to the original intent

and major core educational mission of

AHEC as the home for strategies to address

the needs of the underserved. AHECs have

served as the incubators or the development

laboratories for those unique tools needed to

fill the gaps in health professions training

programs. Many rural states have benefited

for years from this innovation. AHECs

provide pipeline

programs that help rural

communities grow their

own health professionals,

which the literature

supports as a highly

successful strategy.

Because AHECs bring

communities and higher

education resources

together, these centers

create strong community-based


experiences for students

in rural areas that cannot be duplicated on

campus. Once the providers are nurtured

through the pipeline and trained in the real

world of rural practice, AHECs provide

support for them to stay in these communities.

AHECs provide continuing education

and the means for providers to stay connected

to an academic environment through

work with students and residents. And

finally, AHECs educate and support

community leaders and groups to improve

the rural practice environments through

advocacy and policy.

An earlier, more detailed version of this article,

coauthored by Ms. Heady, first appeared in the

January 2006 issue of the Journal of Medical

Practice Management. –eds.

AHECs provide pipeline

programs that help rural

communities grow their

own health professionals,

which the literature

supports as a highly

successful strategy.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 5

Defining the Issues and Principles of Rural Health

Professions Workforce Development



Hart, G., Salsberg, E., Phillips, D.M., & Lishner, D.M. (2002). Rural health care providers in the United

States. Journal of Rural Health, Supplement, 18, no. S 211-231.


Ricketts, T.C. III., Johnson-Webb, K.D., & Taylor, R.K. (1999). Populations and places in rural America. In

T.C. Rickets III (Ed.). Rural health in the United States (pp. 7-24). New York: Oxford University Press.


Hassinger, E. W., & Hobbs, D. J. (1992). Rural society—The environment of rural health care. In L.A.

Straub & N. Walser (Eds.). Rural health care: Innovation in a changing environment (pp. 178-190).

Westport, CT: Praeger.


Hart et al., Rural health care providers, p. 212.


Heady, H.R. (2006). Appalachian values: Myths, magic, and the real McCoy. Rural culture: West Virginia’s

Legacy (pp. 3-17). Morgantown, WV: West Virginia University Center on Aging.


Hart, L.G., & Taylor, P. (2001). The emergence of rural health policy at the federal level in the United

States. In J.P. Geyman, T.E. Norris, & L.G. Hart (Eds). Textbook of rural medicine (chap. 6). New York:



Institute of Medicine: Committee on the Quality of Health Care in America. (2001). Crossing the quality

chasm: A new health system for the 21st century. Washington, DC.


Rabinowitz, H.K., Diamond, J.J., Markham, F.W., & Painter, N.P. (2001). Critical factors for designing

programs to increase the supply and retention of rural primary care physicians. JAMA, 286, 1041-1048.


Pathman, D.E., Steiner, B.D., Jones, B.D., & Konrad, T.R. (1999). Preparing and retaining rural physicians

through medical education. Academic Medicine, 74, 810-820.


Rabinowitz, H.K., Diamond, J.J., Markham, F.W., & Hazelwood, C.E. (1999). A program to increase the

number of family physicians in rural and underserved areas: Impact after 22 years. JAMA, 281, 255-260.


Rabinowitz, H.K., Diamond, J.J., Veloski, J.J., & Gayle, J.A. (2000). The impact of multiple predictors on

generalist physicians’ care of underserved populations. American Journal of Public Health, 90, 1225-1228.


Pathman, D.E. (1996). Medical education and physicians’ career choices: Are we taking credit beyond our

due? Academic Medicine, 71, 963-967.


WV Higher Education Policy Commission. West Virginia Health Sciences and Rural Health Report Card.

(2006). Retrieved from


Tippets E, Westpheling, K. The Health Promotion-Disease Prevention Project: Effect on Medical

Students’ Attitudes Toward Practice in Medically Underserved Areas. Family Medicine.1996; 28: 467- 471.


Pathman, D.E., & Riggins, T.A. (1996). Promoting medical careers in underserved areas through training.

Family Medicine, 28, 508-510.


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Partnerships and Collaborations

Partnering for Change:

Addressing the Primary Care

Workforce Shortage

John Sawyer

The relationship between the NACHC and NAO is described and suggests

how this partnership may lead to improvements in recruitment and

retention of the health workforce serving our nation’s most vulnerable


Over the past eight years, the number of medical

residents in primary care disciplines has fallen by

22%, despite the fact that the overall number of

medical residents has risen by 10%. At a time

when the need for primary care physicians in the

United States far exceeds the supply, this

statistic only begins to shed light on the troubled

future of primary care if action is not taken by all

stakeholders. Through expanded partnerships at

the national, state, and local levels, we must take

steps now to ensure that enough young people

seek careers in primary care and serve in those

underserved communities where the need is the


Community Health Centers (CHCs) and

Area Health Education Centers (AHECs)

have long worked hand in hand to try to

address the barriers to primary care access and

the underlying causes of broad-based, regional,

and local shortages of primary care clinicians

willing to serve the underserved. With these

mutual goals in mind, this past spring, the

National Association of Community Health

Centers (NACHC) and the National AHEC

Organization (NAO) signed a Memorandum

of Agreement and committed to mutually

beneficial efforts. This new partnership

includes reciprocal conference education

sessions, identification of collaborative projects,

recruitment of clinical staff for health centers

across the country, career development

activities for AmeriCorps volunteers currently

working at health centers, and collaborative

policy efforts.

Partnerships of this kind have proven to be

successful for both organizations in the past

and show great promise for meeting both

NACHC’s and AHEC’s goals for strengthening

the primary care workforce. Additionally,

NACHC and NAO have participated in early

efforts toward building a dialogue among a

wider group of stakeholders around primary

care workforce development in the context of

broader health reform. These collaborative

efforts are critical now, as the looming shortages

in primary care threaten access for those

populations most in need.

Just last year, the American College of

Physicians warned that the nation’s primary

care workforce—which it called “the backbone

of our health care system”—is on “the verge of

collapse.” Although this crisis has implications

for the health of all Americans, it is not

surprising that the greatest physician shortages

are found in rural and inner-city areas, and at

community, migrant, public housing and

homeless health centers nationwide. Rural

America, home to 60 million Americans, or

20% of the total U.S. population, is home to

only 9% of practicing U.S. primary care

physicians. Similar, and oftentimes more

severe, shortages exist for nurses, dentists,

pharmacists, allied health professionals, and

mental health professionals.

The shortage of primary care physicians is also

very real for health centers that serve medically

underserved, low income, under- and uninsured,

and minority populations in every state

and territory throughout the nation. This past

summer, the Washington Post ran an article

highlighting the dire need for primary care

physicians in health centers, citing agreement

among health center CEOs that recruiting

qualified and committed clinicians is one of the

John Sawyer is Assistant

Director, Federal Affairs, of

the National Association of

Community Health

Centers, Inc., in

Washington, DC.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 7

Partnerships and Collaborations

Partnering for Change: Addressing the Primary Care

Workforce Shortage

most difficult tasks they face. As demonstrated

by a 2006 report in the Journal of the American

Medical Association, the woes of health center

CEOs are far from unfounded—during 2004,

there were more than 1,400 clinical vacancies

at health centers across the country. The report

cited vacancies for more than 760 primary care

physicians; 290 nurse practitioners, physician

assistants, and nurse midwives; and 310

dentists. Not surprisingly, the JAMA report

found the greatest shortages at the most rural

and inner-city health centers.

While the shortage of primary care practitioners

continues to grow, health centers and their

local, state, and national partners have been

successful in addressing and managing this

problem. Between 2000 and 2005, health

centers increased their physician staff by 52%

and their dental staff by 85%, well ahead of

their 47% growth in patients. This success

story mirrors health centers’ history of overcoming

many serious challenges, and their

resilience provides many lessons to other

struggling healthcare and safety-net organizations.

To address health center workforce shortages,

especially in rural and inner-city areas with the

greatest need, NACHC has engaged in key

partnerships to cultivate future generations of

health professionals from diverse backgrounds

to work in medically underserved areas. For

example, five years ago, NACHC partnered

with A.T. Still University in Arizona to create a

dental school with diversity and service in

community-based settings as its core mission.

This program successfully graduated its

inaugural class of 54 students this year, with

most graduates currently serving in a health

center or with other safety providers, many of

which are located in rural areas. A medical

school with the same focus opened this fall and

had 1,300 applicants for its 100-student firstyear


NACHC has also successfully partnered with

the AmeriCorps program to create the

Community HealthCorps program, which now

has young volunteers working at health centers

in 19 states, the District of Columbia, and

Puerto Rico. Eighty percent of HealthCorps

members indicate that they plan to pursue

further education in a career in health care.

Furthermore, NACHC sees this program as an

excellent opportunity to collaborate with

AHECs to help create the next generation of

healthcare leaders for both the AHEC and

Health Centers programs. NACHC further

plans to partner with NAO to study the

relationships between the state AHECs and

health centers to create programs that can meet

the needs of both organizations.

Additionally, NACHC has pledged its

continued support for several programs

specifically designed to mitigate the primary

care workforce shortage in this country.

Operating on the belief that AHECs help to

create a more diverse, culturally proficient

workforce, NACHC pledges to show Congress

its support for continuing and increasing

funding for these vital programs. NACHC has

also called on Congress to reauthorize and

significantly expand the National Health

Service Corps (NHSC), with a clear legislative

preference for NHSC placements at safety-net

providers like health centers. NHSC has

played a huge role in expanding the number of

health centers nationwide as well as expanding

capacity at existing health centers. In order for

NACHC to reach its goal of serving 30 million

patients in health centers by 2015, it is

essential that these programs continue to grow.

While both the individual and combined efforts

NACHC and NAO have resulted in many great

successes, there is much work to be done to bring

AHECs and health centers together to

strengthen healthcare delivery in the nation’s

underserved communities. The partnership

between NACHC and NAO has great potential

for both top-down policy solutions and local-level

programs, projects, and collaborations. There is

great promise in partnering for the kind of longterm

change that will be needed to address the

primary care workforce shortage. NACHC and

NAO can come together to improve the supply,

recruitment, distribution, retention, and quality of

primary care practitioners and other health

professionals in rural and underserved communities



The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Partnerships and Collaborations

Collaboration as a Strategy to

Address the Health Workforce


Mark Loafman, MD, MPH; Linda Kanzleiter, MPsSC, DEd; and Felice Vargo

The HRSA Workforce Development Collaboration has identified many

benefits for AHEC and CHC collaboration. The development of a tool kit,

which builds upon successful collaboration, will make available tangible

resources to encourage additional partnerships.

Recruitment, retention, and distribution of the

primary care clinician workforce, especially for

rural and underserved communities, remain

among the nation’s more complex and persistent

problems. Of the nearly 65% of the nation’s

counties wholly or partially designated as

Primary Care Health Professional Shortage

Areas (HPSAs), roughly 70% are located in

rural and frontier areas. Although the need for

additional primary care physicians is well

established, the number of physicians choosing

a primary care residency continues to decline.

Furthermore, the percentage of primary care

residents who stay in

primary care (as opposed

to subspecialty care) is

also decreasing. Developing

effective and

sustainable interventions

to address the shortage,

distribution, and

retention of the primary

care workforce for safetynet

facilities is the

primary goal of the

Workforce Development

Collaborative (WDC).

Power of Partnerships

For nearly 30 years, two

national programs, the

Area Health Education

Centers (AHEC) and the Community Health

Centers (CHC), have addressed access issues

by supporting the development of an appropriate

health-professions workforce and a system of

community-based clinics, respectively. Together

they have had a significant impact on the

nation’s primary care safety net.

The AHEC communitybased

training network is

well-positioned to

connect CHCs to health

professions education and

training, both as clinical

training sites for students

and residents and as

sources of professional

development for health

center clinicians.

The AHEC program influences both the

selection of primary care disciplines and the

choice of practice location by potential entrants

into the health professions. It does so by shaping

the education, training experiences, and professional

development of health professions

students and residents within the context of the

community, especially underserved communities.

The critical ingredient of AHEC programmatic

success is its support of academic-community

partnerships. In underserved areas, AHECs are

an essential resource for the supply, distribution,

and retention of the health professions workforce.

The national network of

CHCs (including migrant,

homeless, and public

housing health centers)

has grown to become the

healthcare home for a

substantial portion of the

nation’s uninsured,

underinsured, and at-risk

populations. These centers

provide primary care and

preventive services to

nearly 16 million patients

annually with a range of

services that often extend

beyond those provided in

a typical doctor’s office and

include behavioral health,

care coordination, and outreach.

Multidisciplinary care like that provided in

CHCs is an important strategy for improving

both access and quality of care. Implementing

and spreading these changes will require

providers with additional skills and competencies.

Mark Loafman, MD,

MPH, is Assistant

Professor of Family

Medicine at Northwestern

University Medical School

and served as the Chief

Medical Officer at PCC

Wellness Center, Chicago,


Linda Kanzleiter, MPsSC,

DEd, is Vice Chair of

Community Medicine and

Outreach and Associate

Professor at the Pennsylvania

State University College of

Medicine and the Co-

Director of the Pennsylvania-

Delaware AHEC Program,

Hershey, PA.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 9

Partnerships and Collaborations

Collaboration as a Strategy to Address the Health

Workforce Crisis

Felice Vargo is an organizational


consultant in Indianapolis,



According to the Institute of Medicine’s report,

Crossing the Quality Chasm: A New Heath

System for the 21st Century, these changes are

characterized by “a shift from acute to chronic

care, the need to manage a continually expanding

evidence base and technological innovations,

more clinical practice occurring in teams and

complex delivery arrangements, and changing

patient-clinician relationships.”

It is critical that

professionals in training

have the opportunity to

learn in and contribute to

such environments. The

AHEC communitybased

training network is

well-positioned to connect

CHCs to health professions

education and

training, both as clinical

training sites for students

and residents and as

sources of professional

development for health

center clinicians.

Shared Mission:

Improving Recruitment

and Retention Through

Effective AHEC-CHC


Active participation in

successful health-professions education and

training programs can effectively influence

recruitment and retention issues in many

settings. A variety of factors have converged in

recent years that strongly favor the use of CHCs

as model training sites. Community-based

training of health professions students and

residents, has much to do with their future

selection of disciplines and choices of practice

locations. This represents perhaps the most crucial

reason for a link between AHECs and CHCs.

A formal affiliation with an academic medical

community via the AHEC program can enhance

recruitment efforts for CHCs through benefits

such as adjunct faculty appointments, access to

other teaching faculty (including specialists), and

shared learning/teaching opportunities to

acquire the latest “cutting edge” information. A

successful linkage can reduce fear of professional

A formal affiliation with an

academic medical

community via the AHEC

program can enhance

recruitment efforts for CHCs

through benefits such as

adjunct faculty

appointments, access to other

teaching faculty (including

specialists), and shared


opportunities to acquire the

latest “cutting edge”


isolation that potential candidates experience

when considering a rural opportunity. Retention

of valued clinicians can be enhanced by successful

connections to a cadre of ongoing professional

development opportunities. Furthermore,

retention is influenced favorably when healthcenter

practitioners expand their roles as mentors

and teachers of health professions students and

residents and fully

capture their potential for

recruitment and retention.

HRSA Workforce

Development Collaborative—New


for Improving Access

The HRSA Workforce

Development Collaborative

(WDC) was created

in response to the

President’s 2002 Health

Centers Initiative aimed

at strengthening the

healthcare safety net for

those most in need.

Because AHECs and

CHCs have successfully

established training

relationships, an expansion

of this partnership

became a natural strategy

to address the recruitment

and retention of primary care providers. Discussions

of a work group with this focus stemmed

from internal dialogue between the Bureau of

Health Professions (BHPr) and Bureau of

Primary Health Care (BHPC). In 2004 and

2005, joint presentations were delivered at

various national meetings, including the National

AHEC Organization (NAO), National Association

of Community Health Centers (NACHC),

and BHPr and BPHC all-grantee meetings.

These forums provided the opportunities to

address the pending workforce crisis and appeal to

the interest and participation of grantees. These

initial steps led to the creation of the more formal

workforce collaborative in 2006.

Currently, group members include representatives

of AHECs, CHCs, Primary Care Associations,

Primary Care Organizations, Geriatric

Education Centers, university-affiliated faculty,

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Partnerships and Collaborations

Collaboration as a Strategy to Address the Health

Workforce Crisis

and recruitment and retention consultants.

These individuals convene monthly to discuss

issues relative to CHC health workforce

shortages and advance strategies on how

AHECs and other academic health centers can

establish long-term training linkages in response

to persistent workforce needs.

To facilitate work toward this goal, WDC

members continue active engagement in

disseminating information on the importance of

AHEC-CHC training relationships. This past

August, members presented seven workforce

sessions at the NACHC Community Health

Institute meeting in Texas, where the need for

such partnerships was acknowledged. WDC

members are currently developing follow-up

presentations for the 2008 NAO and NACHC

meetings. While presentations at such national

meetings are important, the group’s basic focus

has been to develop a toolkit for use by local

partnerships in expanding and/or developing

educational linkages between safety-net

providers (i.e., CHCs) and health professional

training institutions, including AHECs. This

product will include valuable tools, references,

and resources such as guidance for establishing

partnerships and examples from the field of

models that work and best practices. It will

address strategies to enhance recruitment and

retention through the following training and

educational linkages: 1) medical student training;

2) nursing, dental, and associated health

professions; 3) residency training programs; 4)

health careers development for 9 th -12 th grade

students; 5) professional development; and 6)

impact of a systems approach to improve training

linkages and enhance recruitment and retention.

Without major new sources of primary care

health professionals, few alternatives exist in the

near term to address the workforce crisis other

than existing programs and systems. Fortunately,

much can be done by aligning and better linking

CHCs, and academic health centers through

AHEC. Active collaborative partnerships among

these entities provide an opportunity to enhance

our ability to train and retain the nation’s best

and brightest primary healthcare professionals

while simultaneously encouraging them to locate

and practice in medically underserved communities.

Janet Head, RN, EdD, and H. John Blossom, MD,

also contributed to this article.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 11

Partnerships and Collaborations

Partnership for Primary Care:

David Garr, MD; Janice Benson, MD; and Kelley Withy, MD, PhD

A summary of a new partnership between the NAO and STFM

designed to increase the pipeline of future family physicians is presented.

The project links STFM’s Future Family Docs project with AHEC

health careers programs in a more formal manner.

David Garr, MD ,is

Executive Director of the

South Carolina AHEC

Program in Charleston, SC.

Janice Benson, MD, is

Board Liaison for the

Group on Community

Medicine, Society for

Teachers of Family

Medicine in Leawood, KS.

Kelley Withy, MD, PhD,

is Program Director of the

Hawaii Pacific Basin

AHEC in Honolulu, HI.

With decreasing federal funding available

for medical education and health care

workforce pipeline programs, partnerships

that provide support for student experiences

and medical training in rural and

underserved communities can be quite

beneficial. The Society of Teachers of

Family Medicine (STFM) is a 4,800

member association linked through the

“family” of family medicine organizations

including the American Academy of Family

Physicians. STFM members are primarily

medical educators and community-based

family medicine preceptors dedicated to

teaching medical students the skills of

family medicine. The mission of STFM is to

promote the provision of high quality,

comprehensive health care that is accessible,

coordinated, culturally and linguistically

competent, and community directed.

STFM is dedicated to improving the health

of all people through education, research,

patient care, and advocacy.

In recent years the specialty of family medicine,

like other primary care disciplines, has

been challenged to recruit medical students

into the specialty. This downturn in recruitment

has occurred despite the growing

evidence that family medicine based care

improves health outcomes and is more cost

effective. Recently, family medicine organizations

collaborated to examine these issues in

the “Future of Family Medicine” (FFM)

project (

index.html). As a result of the FFM project,

several objectives were established. STFM

took responsibility as the lead organization to

develop a plan to increase the number of

family physicians based upon the FFM

reports. An STFM task force was established

to develop resources so any and every family

medicine doctor can take responsibility to help

develop the family medicine workforce.

To accomplish their goal, STFM created

specific objectives that include developing a

pre-medical school recruitment initiative and

programs that guide, mentor and train

medical students towards careers in family

medicine, Future Family Docs Rocks! (See This web site

consists of career information, stories and

resources to encourage and support family

physicians to serve as mentors for young people

who reside in their communities who express

an interest in becoming physicians. The goal of

this program is to increase the number of school

age children who consider family medicine as a

possible career. The primary challenge STFM

faces is gaining access to K-12 students. The

Future Family Docs project came to the attention

of NAO through a brief editorial in the Annals of

Family Medicine (May/June 2006).

Existing Collaborations

Productive collaborative relationships already

exist between many family physicians and

AHECs. A 2006 survey of AHEC organizations

assessed collaboration between AHECs

and family medicine departments and residency

programs. Responses were received

from 121 of 242 AHEC organizations

representing 43 of the 46 states that have

AHECs. Of those AHECs responding, 25%

of the program offices and 2% of AHEC

centers reported being located within divisions

or departments of family medicine. Five

AHEC centers and two AHEC program

offices were located in family medicine residency

programs. Of the AHECs not located in

a family medicine department/division or

residency, 93% reported working closely with

departments/divisions of family medicine and

79% reported working closely with family

medicine residency programs. Eighty-seven

percent of responding AHECs indicated that

they arranged preceptorships for medical

students and 49% for family medicine resi-


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Partnerships and Collaborations

Partnership for Primary Care:

dents. Seventy-nine percent of AHEC

respondents reported arranging interdisciplinary

clinical training for medical students and

42% for residents.

In 2006, STFM also surveyed its members

and leaders to learn about current involvement

in recruiting students into medicine in general

and into family medicine in particular. Seventy-one

members and family medicine

department chairs responded to the survey. Of

the respondents, 67% indicated they were

involved in some type of recruitment activities,

with most at the medical school level. Looking

earlier in the pipeline, 65% of respondents

reported linking with college students and 59%

with K-12 students. These pre-medical school

activities varied – most often the experiences

involved students “shadowing” practitioners in

clinical practice with some lectures/discussions

with students around health topics.

The NAO and STFM

organizations have

agreed to collaborate on

activities to promote the

recruitment of motivated

students into health

careers, particularly into

family medicine.

Expanding Collaborations

The NAO and STFM

organizations have

agreed to collaborate on

activities to promote the

recruitment of motivated

students into health

careers, particularly into

family medicine. This

partnership was formalized

in a new Memorandum

of Understanding

signed by the Boards of

the NAO and STFM in

May 2007. The purpose

of this agreement is to

formally commit to

learning about and understanding each other’s

organizations, purpose and programs, to

collaborate on education and policy issues of

mutual interest, and to collaborate on activities

that promote recruitment of students into

family medicine. Informal NAO/STFM

collaboration has occurred on a local level for

years through communication with preceptors,

shared resources, and presentations and panel

discussions at conferences. Current efforts will

expand the partnership to engage more family

medicine physicians in promoting and participating

in AHEC programs and promote the

development of resources that encourage

family medicine as a preferred career path for

addressing the health care needs of the


This new partnership will initially spotlight a

small number of AHEC programs in seven

states (California, Colorado, Hawaii, Louisiana,

Maine, Missouri, and South Carolina) as

a pilot project. These are existing AHEC

programs that expressed interest in developing

projects to demonstrate successful collaborations

with STFM. These AHEC centers

have selected an aspect of their programs that

encourage students from economically disadvantaged

backgrounds, underserved rural and

urban areas, and from underrepresented

minority groups to consider careers in health

care. Initial efforts will be to spotlight these

programs through joint conference presentations

and use of the Future Family Docs

website, and increase the awareness of NAO/

STFM programs among

community-based family

physicians. Additional

goals are to provide

resources to family

physicians to promote

health careers and

encourage them to

contact their local

AHEC programs to

determine how they may

help or participate in

AHEC activities. The

pilot project will help

determine if family

medicine doctors are

able to refer students with an interest in health

careers to AHEC programs for additional

mentoring. Together STFM and AHEC will

develop monitoring and evaluation tools to

determine joint outcomes.

The representatives from STFM and NAO

who are collaborating on this new partnership

are excited about its potential to

increase the number of family doctors in the

future. Please visit the STFM website

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 13

Recruitment, Retention and Practice

Preparing Health Professionals

for Tomorrow

Mary Amundson, MA

By detailing a healthcare workforce pipeline model and developing specific

goals, a medical school has a head start on the formation of an AHEC

program to meet future rural health professional needs.

Mary Amundson, MA, is

an assistant professor in

the Center for Rural

Health at the University

of North Dakota (UND)

School of Medicine and

Health Sciences in Grand

Forks, ND.

The demand for healthcare providers is driven

by many factors, such as, the aging of the

nation’s population, expanded technology, the

increasing use of specialists, and more pharmaceuticals

available to the population. An

additional issue is that clinicians in rural areas

must cover great distances just to reach

individuals in need of health care. With an

ever-increasing health workforce shortage, it is

imperative that rural areas employ creative

strategies to ensure their citizens have access to

the care they need.

Area Health Education Centers (AHECs)

play an important role in developing future

providers. There has been considerable

research into factors that predict where

physicians will practice. For example, one study

concludes that where the physician is from is

related to where he or she will practice, 1 while

other articles document that a strong predictor

of rural practice is growing up in a rural area. 2

It is vitally important that attention be paid to

increasing the interest in and awareness of

health careers for the youngest students, those

in kindergarten through grade 12, in addition to

students in post-secondary education. Developing

activities that pique the interest of these

young minds is an important step in creating

the healthcare workforce of the future, and

health careers programs of this type are one of

the core functions of an AHEC.

To begin addressing healthcare shortages in

North Dakota, the Center for Rural Health, in

partnership with other state organizations, held

a Health Care Workforce Summit in December

2006. The purpose of the summit was to

explore current and emerging challenges

associated with the supply and demand of the

healthcare workforce in the state and to begin

developing an action plan to address these

challenges. Approximately 200 people

attended the summit, including over 50 state

legislators, as well as representatives from state

government, statewide organizations, economic

development commissions, healthcare employers

and academicians, and others.

During the summit a workforce pipeline model

was developed (Figure 1). 3 Each step of the

pipeline offers opportunities to target supply or

demand, including workforce training, recruitment,

and retention. The pipeline begins by

introducing elementary and high school

students to careers in health care and attracting

high school and nontraditional students

into health professions programs. The pipeline

incorporates accessibility to training programs

across North Dakota (on-site as well as

distance learning) and recruitment and

retention of healthcare professionals by

employers and communities across the state.

The summit helped to provide the information

needed for the University of North Dakota

School of Medicine and Health Sciences to

begin preparation for submission of an AHEC

grant in 2008. Goals developed within each of

the five steps are closely aligned with the goals

of the AHEC program as we seek to expand,

recruit, and retain the healthcare workforce.

Excellent educational models exist throughout

the country that are currently implemented in

AHECs or could be further replicated by

AHECs. For example, in the K-12 pipeline

science fairs can be planned that engage

students in the mysteries of science as it relates

to the human anatomy. One event, organized

by medical students at the University of North

Dakota, is designed to stimulate children’s

interest in science and features a hands-on

approach to learning. Supervised by medical


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Recruitment, Retention and Practice

Preparing Health Professionals for Tomorrow

Figure 1: The North Dakota Health Care Workforce Pipeline

students, the activities focus on human health

and anatomy, the heart and the importance of

exercise, awareness of the dangers of tobacco

use, medical instruments and how they are

used, and various projects that demonstrate

scientific principles.

Programs that introduce young people to

health careers and strengthen their skills in

science are important but have an even greater

impact if followed by other programs throughout

the students’ educational experience. Dr.

Tom Arnold, an obstetrician in Dickinson,

North Dakota, has utilized a Medical Explorers

program for high school students and

provides an example of what can be done at

the local level to inspire students. Offered as

an extension of the Boy Scouts of America

Explorer Program, this activity is designed to

help prepare students to make good educational

and career decisions. As a result of these

efforts, Dr. Arnold has one physician Explorer

graduate who will be joining his practice, and

five other former students who are presently in

medical school. Other students have been

inspired to enter nursing and other healthprofession

programs as a result of his efforts.

Other K-12 activities include partnering with

local schools, as many activities can be developed

to further expose students to careers in

the healthcare field. For example, a health fair

can be developed at the local hospital that

shows students the variety of positions

available in the healthcare field, from dietetics,

X-ray and laboratory technology to nursing and

medicine. Students are exposed to the wide

array of opportunities available. Additionally,

courses can be developed in high school.

Southwest Health Care Services in Bowman,

North Dakota, worked with their school system

to prepare students to become Emergency

Medical Technicians (EMT). When certified,

these students will be available to meet the

needs of the community, which is extremely

important as EMTs are in short supply in

many rural areas across the state and country.

All of the above activities point to the importance

of forming partnerships. As AHECs are

a vital part of the communities in which they

are located, it is important to remember that

successful rural recruitment and retention are

based on the community and the practice

working together. Fred Moskol, former

National Rural Health Association president,

has said, “The community grows the practice;

the practice grows the community.” Partnerships

among AHECs, local schools, and

community organizations can help address the

shortage of health professionals for the future.

But more needs to be done. Getting involved

in programs for current health professions

students that provide them with hands-on,

real-life experiences is vitally important.

If the pipeline process is to succeed, K-12

programs must be followed by experiences that

are part of the higher education process. Area

Health Education Centers provide health

professional student education at the community

level—a critical component in addressing

the nation’s immediate healthcare shortages. A

program sponsored through the U.S. Depart-

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 15

Recruitment, Retention and Practice

Preparing Health Professionals for Tomorrow

ment of Health and Human Services, Health

Resources Services Administration’s National

Health Service Corps, does just that. The

Student/Resident Experiences and Rotation in

Community Health (SEARCH) program

affords students in medicine, nursing, dentistry,

and behavioral health opportunities in

rural and underserved practice settings early in

their training that can help to dispel the myths

associated with practice in those areas. This

community-based interdisciplinary, clinical

experience is often the

student’s first exposure

to rural/underserved

settings that provide a

very different atmosphere

from the academic

environment. One

student summed up her

SEARCH experience by

stating that “SEARCH

has provided me a great

opportunity that I

otherwise would not

have been able to have. It was neat to learn

more about medicine and more about practicing

family medicine in a rural community. I

think this experience will help me in my future

schooling, as well as helping to determine my

career choices.”

Not only is there much work to do on the front

end of the recruitment spectrum, i.e., developing

the next generation of providers, but

AHECs can also help to prepare the communities

and healthcare facilities to increase the

successful recruitment and retention of

Successful rural

recruitment and

retention are based on

the community and the

practice working


healthcare providers (steps four and five in the

pipeline). Encouraging healthcare facilities to

be involved in student education through a

variety of rotations will help to develop

relationships between the healthcare facilities

and students. When students have a great

rotation experience, it can have a positive effect

on their career choices and selection of practice

sites. As one student commented after the

SEARCH experience, “Before doing this

program I thought I’d never want to be in rural

health care, but now a

week into it I am strongly

considering it.”

On the retention side of

this continuum, AHECs

can offer a variety of

educational programs for

clinicians in the field to

provide current information

that helps them in

their daily practice.

Offering seminars on

precepting, for example, could help clinicians

manage their time in a way that would ultimately

provide a better experience for both the

clinician and the student.

Involvement in student education at all levels is

essential to help develop the next generation of

healthcare clinicians. Because AHECs are a

vital part of the communities in which they are

located, there is one important point to

remember: successful rural recruitment and

retention are based on the community and the

practice working together.



Wade, M.E., Brokaw, J.J., Zollinger, T.W., Wilson, J.S., Springer, J.R., Deal, D.W., White, G.W., Barclay,

J.C., & Holloway, A.M. (2007). Influence of hometown on family physicians’ choice to practice in rural

settings. Family Medicine, 39(4), 248-54.


Brunk, D. (2001, March). Rural practice can make you feel truly needed—Brief article. Family Practice News,

V31(5) p.42.


Wakefield , M., Amundson, M., Moulton, P. (2006) Policy Brief: North Dakota Health Care Workforce:

Planning Together to Meet Future Health Care Needs Part I. Upper Midwest Rural Health Research



The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Recruitment, Retention and Practice

Wisconsin Academy for Rural

Medicine and Wisconsin

AHEC: A Team Approach

Byron Crouse, MD; and Alison Klein

A new tract in the University of Wisconsin School of Medicine and Public

Health to prepare physicians for rural practice is described. The Wisconsin

AHEC is an integral partner with WARM by recruiting students and

giving them community-based experiences.

Nationally, 20% of the population lives in rural

areas where 9% of physicians have practices.

Wisconsin’s physician maldistribution is even

more skewed, with 28% of Wisconsin citizens

living in rural areas and only 11% of its

physician workforce having practices there.

Eighty-three percent (60 of 72) of Wisconsin

counties are designated as totally or partially

underserved, and 77% of these underserved

counties are rural. A March 2004 report by the

Wisconsin Hospital Association and Wisconsin

Medical Society entitled “Who Will Care for

Our Patients?” described a shortage of primarycare

physicians in both rural Wisconsin and

central-city Milwaukee. Furthermore, specialty

physicians (orthopedic surgeons, radiologists,

etc.) continue to be in demand but are difficult

to recruit statewide. The lack of an adequate

physician workforce has important consequences:

people have to wait longer to receive

care, they may need to travel long distances, or

some will decide not to seek care at all. It is

expected that this problem will intensify in the

future as the population ages and older

physicians retire.

In 2004, the Wisconsin Medical Education

Advisory Committee, a statewide coalition of

health systems, providers, and communities

responded to this need by applying to the

Wisconsin Partnership Fund (WPF) for a

$25,000 Collaboration Planning Grant. The

WPF was created within the University of

Wisconsin School of Medicine and Public Health

(SMPH) as a result of Blue Cross/Blue Shield’s

conversion to a for-profit corporation. Its mission

includes improving the health of people in

Wisconsin through community-academic

partnerships that focus on health promotion, disease

prevention, health policy, and health disparities.

Subsequently, a WPF 2005 Strategic Initiatives

Grant funded the basic framework for a rural

medical education program, the Wisconsin

Academy for Rural Medicine (WARM), which

received approval from SMPH’s Academic

Planning Committee in August 2006. The

Wisconsin AHEC has been involved in the

development of WARM from the beginning

and remains an active participant of the advisory

board and WARM admissions subcommittee.

An evidence-based approach to solving

Wisconsin’s physician shortage, WARM is a

comprehensive rural medical education program

dedicated to improving the health of rural

Wisconsin communities by increasing the supply

of local physicians. The medical school class size

will increase incrementally until it reaches 25

additional students per year. The program

utilizes a targeted admissions process designed

to select those students most likely to develop

rural medical practices. These students will

participate in a longitudinal educational curriculum

designed to prepare them for rural practice

by providing two years of clinical training in rural

Wisconsin settings and fulfilling the requirements

of the SMPH. A unique aspect of

WARM allows students to pursue a career in

any specialty, unlike some rural medical education

programs that involve only family medicine.

The extended length of the rural clinical

experience, the breadth of the proposed

WARM program which encompasses undergraduate,

graduate and continuing medical

education, and the fact that no other rural

program nationally has embraced multiple

specialty areas make WARM unique and

innovative. WARM is the keystone for the

Wisconsin Rural Pipeline for physician

workforce development.

Byron Crouse, MD, is

Professor of Family

Medicine and Associate

Dean for Rural and

Community Health at the

University of Wisconsin

School of Medicine and

Public Health in Madison,


Alison Klein is Assistant

Director of Wisconsin

Academy for Rural

Medicine (WARM) in

Madison, WI.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 17

Recruitment, Retention and Practice

Wisconsin Academy for Rural Medicine and Wisconsin

AHEC: A Team Approach

WARM has partnered with three health

systems in the state and their respective rural

clinics, which will serve as the rural learning

environments for WARM students in their third

and fourth years of medical school. Physicians,

public health professionals, and community

leaders will work with these regional partners to

provide additional applicable training.

While WARM has enjoyed some early

successes, the program has encountered

challenges as well. An early challenge is the

skepticism of some faculty members who believe

that medical education cannot be delivered

outside Madison. Part of this may be due to the

notion that “it has always been in Madison,” and

part of it may be due to the misperception that

the quality of education outside an urban area is

less than desirable. In fact, students in the

medical school’s Longitudinal Rural Rotation, a

Another challenge WARM has faced is to shift

the admissions committee’s review of applications

from its traditional focus on Grade Point

Average (GPA) and Medical College Admissions

Test (MCAT) scores to a more holistic

approach. While it is important to take objective

factors into consideration, other characteristics,

such as personal qualities and community

engagement, should also be considered. The

WARM admissions subcommittee looks closely

at the applicant’s ties to rural Wisconsin and the

contributions that he or she has made to the

community over time.

Wisconsin’s AHEC system will continue to play

a vital role in helping to promote the WARM

program, identifying potential future applicants

and nurturing an interest in rural medicine. In

fact, AHEC is on the front lines of this effort

(see Figure 1).

Figure 1: Wisconsin Rural Pipeline (adapted from recent IOM report 1 )

five- to six-month immersion in a rural community,

have consistently rated their experiences as

being very positive, and WARM hopes to build

on the strengths of this successful program. One

strategy to alleviate this initial concern is to

schedule visits between the Madison-based

clerkship directors and their counterparts in the

rural learning communities. These meetings,

which are currently underway, not only provide

an opportunity for them to meet each other but

also give each party an opportunity to learn

about the resources each site has to offer. The

two parties lay the groundwork for working

together to deliver the curriculum, optimizing the

use of the educational resources and opportunities

that exist in the region and rural locations.

The career enticement programs offered by the

Wisconsin AHEC system are vital to WARM’s

efforts to recruit talented young people to pursue

a career in rural medicine. One recent example

of this partnership is exemplified by a letter from

a Health Careers Summer Camp participant

that was forwarded to WARM by the Southwest

Wisconsin AHEC program. The rural

Wisconsin student expressed how much he had

enjoyed the summer camp, where he learned

what to do in high school to prepare for a health

career. These AHEC personal contacts are key

to identifying potential WARM applicants.

The Wisconsin AHEC system’s commitment to

promote healthcare careers and WARM’s

mission to increase the number of physicians

practicing in rural Wisconsin provide a strong

foundation for collaboration in years to come.



Committee on The Future of Rural Health Care. 2005. Quality Through Collaboration: The Future of

Rural Health Care (Quality Chasm): National Academies Press


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Recruitment, Retention and Practice

Where Can Science Take You?

Kathy Huntley, MS

A description of a program that provides a health career immersion experience for

students in grades 8-10 is described. The program includes activities related to

physical therapy, veterinary medicine, and the human brain.

How do we convince young people

to take all the science and mathematics

that are available in their

high schools so that they are

prepared for challenging

coursework in college? That was the

question that launched a new

program and a rewarding collaboration

for the Southern Minnesota

Area Health Education Center.

The senior leadership of the

Southern Minnesota AHEC

initiated a planning process to

address this issue with the staff of

the University of Minnesota’s

Southwest Research and Outreach Center,

located at Lamberton. Out of this collaboration

the University on the Prairie © : Where Can

Science Take You? was born.

The first University on the Prairie, held August

7-9, 2007, was a 3-day immersion experience

that introduced 37 high-ability youth entering

grades 8-10 to careers in 4 science-based

industries important to the economy and quality

of life in southern Minnesota: health care, food

science, environmental science, and engineering.

The goal of the program was to raise the

students’ awareness of the fascinating careers

available in these fields by giving them hands-on

experiences guided by University of Minnesota

faculty. Students were not asked to choose an

interest area. All students received a total of 4.5

hours of instruction and hands-on activities in

each of the four subjects in order to open their

eyes to new career possibilities. To be eligible to

attend the program, a 3.0 grade point average

and a recommendation from a teacher or school

counselor was required.

University of Minnesota faculty members

developed curriculum that included as much

interactive learning as possible and incorporated

information about careers in their fields. Personal

stories about why they chose their careers were

encouraged. Faculty members were assisted in

each classroom by two or three secondary school

Student Brodie Raymond

examines brain tissue.

science teachers from the southern

Minnesota region. In return for

their help in the classroom, these

associate teachers received a

stipend and continuing education

credits. The real benefit for the

associate teachers was the

opportunity to work alongside

university faculty members and to

gather new curriculum ideas to

bring back to their classrooms.

On the first day in the healthcare

track, a University of Minnesota

physical therapy faculty member,

plus three physical therapists from the Southern

Minnesota AHEC region, staffed four learning

stations that the students rotated through in

small groups. In one, they practiced how physical

therapists help people develop strength and

flexibility. They identified bones and muscles

and practiced strengthening exercises. At the

cardiovascular rehabilitation station they took

blood pressures, checked their pulses, and

learned about heart disease risk, prevention, and

recovery. At the third station, a therapist

demonstrated how electrical stimulation is

sometimes used to exercise muscles. Students

also engaged in experiments to learn how

sensory deprivation affects balance. At the last

station, the students learned about wound care

by cleaning a wound in an orange using scalpels

and tweezers.

Food-animal production is an important industry

in southern Minnesota, and one of the most

serious professional shortages is in large-animal

veterinary medicine. Consequently, vet med

was the healthcare career featured on day two.

A university faculty member was assisted in the

class by a veterinary medicine student. Students

viewed and handled display items of animal

bones and plasticized organs. The centerpiece of

the class was the dissection of a recently

euthanized pig. The vet med student talked

through the process as she performed a

necropsy that exposed all the internal organs.

Kathy Huntley, MS, is the

Executive Director of

Southern Minnesota

AHEC, based in Willmar,


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 19

Recruitment, Retention and Practice

Where Can Science Take You?

Dr. Jeanne Lojovich,

Physical Therapy faculty

member, has a student

practice a balance exercise

depicting sensory


Students then were invited to don surgical

gloves and explore what they were seeing. A

few held back, but most were eager to look,

touch, and ask questions. Two volunteer

nurses for University on the Prairie were

standing by in case anyone became ill or

looked as if they might faint, but the students

were too busy learning to need their help.

The healthcare topic for the final day focused

on the human brain and the many careers that

involve treating diseases of the brain, such as

psychology, psychiatry, trauma rehabilitation,

and speech therapy, among others. The

University of Minnesota Neuroscience

Department sent its Brain Awareness Team,

two staff members dedicated to educating

school-age children. They brought preserved

brain and spinal cord specimens, as well as

models and diagrams, so that the students

could see normal and abnormal brain tissue.

After a lesson on how the nerves and brain

function, the students were put to work

creating neurons out of strings and beads and

then joining them together to illustrate cell

communication. This was followed by exercises

that demonstrated the changes and

adaptations the brain needs to make after


Of the 37 students attending University on

the Prairie, 32% were female and 68% were

male. Even though females were

underrepresented as a percentage of

population, this level of interest among

girls for a science program is encouraging.

Between the associate teachers

and the faculty, 40% were female. This

mix of male and female instructors

provided strong evidence that sciencebased

careers are suitable for both

men and women.

Ten percent of the students identified

themselves as being Hispanic or non-

Caucasian, reflecting the growing

diversity of the region. One instructor

out of the 17 faculty and associate

teachers was Hispanic. The rest were

non-Hispanic Caucasian.

At the end of the last day, students were

surveyed on the impact of the courses on their

attitudes toward careers in the health field.

Veterinary medicine students identify organs as they

explore the necropsied pig.

Ninety-one percent of the students indicated

that attending University on the Prairie

increased their interest in taking more science


Students were also asked to fill in the blanks on

the following two questions: I was thinking

about ____ as a possible career before I came

here. Since coming to University on the Prairie,

I am also thinking about _____ as a career. On

the first question 11 students indicated some

type of health career, but on the second

question 17 students listed a health career. Of

those who named a health career on the first

question, none had mentioned physical

therapy, but on the second question, five

individuals expressed an interest in PT. The

same increase in interest was noted for veterinary

medicine. None of the students reported

thinking about vet med before the program, but

four named it as a possible career choice after

learning about it.

Southern Minnesota AHEC and its partners

are planning to offer University on the Prairie

annually. For more information about the

partners, visit the following websites: Minnesota

AHEC:; Southwest

Research and Outreach Center:


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Recruitment, Retention and Practice

Geriatric Assessment

Interdisciplinary Team Training:

A Collaboration Among the

Maryland AHECs and the

University System of Maryland

Donna Wilson, BA, MA; Reba Cornman, MSW, LCSW-C; and Terri Socha, BA

Two rural AHECs in Maryland coordinate an interdisciplinary program

to train healthcare students to work together in a structured environment to

address health problems of the elderly.

For over ten years, the Eastern Shore and

Western Maryland AHECs have worked with

the University System of Maryland (USM)

campuses to coordinate a unique learning

experience for health science students,

Geriatric Assessment Interdisciplinary Team

(GAIT). GAIT was designed to enable

participants to develop the knowledge and

skills necessary to function effectively as

members of a healthcare team serving the

geriatric population. While the academic

setting provides course content specific to the

discipline, GAIT provides the opportunity for

students from multiple disciplines to interact as

a team at a healthcare facility located in a rural

and/or underserved area.

GAIT programs are held in a variety of

healthcare facilities, including hospitals, adult

day care, rehabilitation, long-term care, health

departments, hospice, and outpatient services

that the AHEC coordinators have chosen

based on the reputation of the facility and the

willingness of the facility to host a GAIT

project. Each GAIT rotation has a didactic and

clinical theme based on the care specialty of

each facility. Host sites are located throughout

the areas served by the two rural AHECs, with

many areas designated Health Professional

Shortage Areas (HPSAs) and/or Medically

Underserved Areas (MUAs).

At the training sites, students increase their

knowledge of interdisciplinary teams through a

variety of learning activities. Utilizing portions

of the Geriatric Interdisciplinary Team Training

(GITT) curriculum, 1 facilitators of the Interdisciplinary

Team Dynamics component provide

students with basic principles, including team

stages, communication skills, conflict resolution,

and the team care environment. On day one of

the two-day GAIT experience, students are

divided into interdisciplinary teams with

representatives from multiple disciplines.

Students have the opportunity to experience

team dynamics through various activities, such

as, case studies, team exercises, and informal

socializing during meals.

On day two, the student teams are assigned a

geriatric patient chosen by the healthcare

facility. Geriatric patients frequently present

with multiple chronic conditions that require

coordinated care of numerous healthcare

professionals. Working as an interdisciplinary

healthcare team, the

students review the

medical record and

interview the patient

and family members

when they are

available. On the

basis of their

findings and

drawing on their

discipline’s expertise

and knowledge, the

teams then develop

an interdisciplinary

care plan. That care

Reba Cornman, MSW,

LCSW-C, is Director of

Geriatric and Gerontology

Education and Research

Program of the University of

Maryland in Baltimore, MD.

Donna Wilson, BA, MA, is

GAIT Coordinator of

Eastern Shore AHEC in

Cambridge, MD.

Terri Socha, BA, is Clinical

Education and Geriatric

Programs Coordinator of

Western Maryland AHEC

in Cumberland, MD.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 21

Recruitment, Retention and Practice

Cultural Competency

Geriatric Assessment Interdisciplinary Team (GAIT)


plan is then presented to the GAIT participants,

as well as to the healthcare staff at the


At the conclusion of each GAIT program,

students evaluate the experience. Participants

note that it helps them appreciate their own

knowledge and skills within their discipline and

increases confidence in their ability to apply

their knowledge and skills as practitioners in a

team setting. According to recent students,

participation in GAIT helped them to

“develop a deeper understanding of each

discipline and their role in patient treatment,”

to “see things from a completely different

perspective,” and to “feel more comfortable

with my skills as I begin to make the transfer

from student to practitioner.” GAIT participants

also perform a pre- and post- selfassessment

of their team skills to determine

whether they perceive improvement.

Participants for GAIT are recruited through

university faculty and advisers by the Maryland

AHEC’s GAIT Coordinators. The

AHECs publicize the dates and locations of

scheduled GAIT programs in advance through

e-mail messages, brochures, classroom visits,

student interest groups, and meetings.

Some faculty incorporate the GAIT program

into their curriculum, making attendance

mandatory. Other faculty award students extra

credit for attending a GAIT program. Most

faculty require that students write a short

paper reflecting on the GAIT experience and

how they can apply the newly acquired

knowledge and skills in their practices. Nicole

Brandt, PharmD, Associate Professor of

Geriatric Pharmacotherapy, University of

Maryland School of Pharmacy, notes, “GAIT

has provided an invaluable and unique

experience for all my students who wish to

have an exposure to geriatrics. It has helped

encourage students to work with older people

and to seek professional opportunities in the

underserved areas of Maryland by virtue of

meeting dedicated professionals who work well

together on behalf of their clients. In addition,

the AHEC staff has provided superlative

leadership and guidance to the students, in

addition to being excellent liaisons between the

campus and rural Maryland.”

The Maryland program relies on grants to

support the program, including special funding

from USM to the Geriatrics and Gerontology

Education and Research (GGEAR) Program

at the University of Maryland-Baltimore and

recent funding for the Eastern Shore AHEC

from the Johns Hopkins Geriatric Education

Center. However, the GAIT program could be

replicated with minimal cost by centers that

have students from three or more disciplines at

their sites for clinical rotations and by centers

that are located near the academic sites. In

addition, a one-day GAIT was successfully

piloted that involved students reading the

interdisciplinary healthcare team materials and

case studies in advance. Students arrived at the

host site prepared to discuss the case studies

and to participate in abbreviated team activities

prior to working at the host site on their

interdisciplinary team assessment. For a small

group of highly motivated students, a one-day

program is a viable option and can lower costs.

According to an Institute of Medicine Report,

“All health professionals should be educated to

deliver patient-centered care as members of an

interdisciplinary team.” 2 Geriatric Assessment

Interdisciplinary Team training programs

provide one of these educational experience.

With continued funding and support of the

University System of Maryland and the Johns

Hopkins Geriatric Education Center, GAIT

will ensure that future healthcare professionals

are prepared to take an interdisciplinary

approach to assessment and treatment of

patients, which can result in high-quality, costeffective

care with better patient outcomes.



Hyer, K., Flaherty, E., Fairchild, S., Bottrell, M., Mezey, M., & Fulmer, T. (Eds.). (2001). Geriatric

Interdisciplinary Team Training: The GITT kit. New York: John A. Hartford Foundation, Inc.


Institute of Medicine Committee on the Health Professions Education Summit. (2003). Health professions

education: A bridge to quality. Washington, DC: National Academies Press.


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Rural Health and Technology

Improving Senior Care Through

Technology: A Collaborative


Gail O. Mazzocco, EdD, RN; and Andrea Novak, MS, RN-BC, FAEN

This article reports on a partnership between an AHEC program and a

school of nursing to expand use of human patient simulators in training

nursing faculty and personnel in improving the care of geriatric patients.

The need to improve healthcare services to

the elderly will grow significantly over the

next 10 years. This is especially true in rural

areas, where there are fewer seniors and

service access and educational resources may

be limited. 1 The human patient simulator

(HPS) affords healthcare professionals an

opportunity to learn how to safely manage a

variety of geriatric problems without risk.

Unfortunately, such state-of-the art equipment

is commonly available only in metropolitan

areas. In an attempt to address this

issue, the North Carolina AHEC Program

used an existing collaborative relationship

with the School of Nursing at the University

of North Carolina at Chapel Hill (UNC-

CH). Dr. Mary Palmer, a professor in the

School of Nursing, has a Health Resources

and Services Administration-funded grant

entitled “Improving the Care of Acutely Ill

Elderly” that, in partnership with the NC

AHEC system, aims to improve the quality

of care provided to acutely ill older adults in

the state’s rural and underserved areas. As a

part of the endeavor, the grant funded a

single computer-driven HPS that AHEC

nurses in rural areas were trained to use to

offer “close to home” geriatric best-practice

workshops to nurses and nursing assistants

who work with the elderly.

The North Carolina AHEC Program Office

developed a strategy to expand this educational

program using special onetime legislative

funding that had to demonstrate impact. The

NC AHEC program proposed a plan to extend

outreach of the HRSA geriatric grant to nurse

faculty members, nursing students, and a

broader region of the state.

The plan involved the North Carolina

AHEC Program Office, the UNC-CH

School of Nursing, and the regional

AHECs. Each had a significant role to play:

• The NC AHEC Program Office

provided funds to purchase two simulators

in addition to one that was funded

through the grant. As a result, simulators

were available on-site at three

regional AHECs in rural parts of the


• The UNC-CH School of Nursing

provided training in the use of the HPS

and in teaching the geriatric course

curriculum as specified in the grant. Six

AHEC nurse educators and eight

nursing school faculty members from

rural community colleges were trained

to operate the simulator and to teach

content on geriatric best practices.

• Over the course of five months, three

regional AHECs taught over 100

registered nurses, licensed practical

nurses, and nurse’s aides the curriculum

using the HPS. Attendees had the

opportunity to practice their skills in a

safe, simulated environment that has

been shown to increase awareness of

patient care and safety issues in a

clinical setting. 2 In addition, nurse

faculty members used the simulator for

student experiences.

In its second year the project will expand to

two additional AHECs, and two simulators

will move to those other AHECs. One HPS

will remain in the southeastern portion of

the state, where it will be shared with other

AHECs for educational programming,

(Continued on page 26)

Gail O. Mazzocco, EdD,

RN, is Statewide AHEC

Nursing Liaison and

Clinical Associate Professor

of the School of Nursing at

the University of North

Carolina in Chapel Hill,


Andrea Novak, MS, RN-

BC, FAEN, is

Administrator, Nursing

and Interdisciplinary

Continuing Education

Training Center, and

Coordinator of Southern

Regional AHEC in

Fayetteville, NC.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 23

AHECs Make A Difference

Connecting Students to Careers, Professionals to Communities, and Communities to Better Health.

44444444444 44444444444

Connecting students to careers Connecting professionals to communities Connecting communities to better health

4 Over 308,000 students introduced to health career

opportunities through AHEC

4 Over 41,000 high school students received more

than 20 hours of health career exposure, information,

and academic enhancement

4 Majority of students served were underrepresented

or disadvantaged

4 Over 111,000 health professions students trained in

19,000 community-based sites

4 Students placed with over 18,000 community preceptors

4 Nearly 9,000 training sites located in underserved areas,

including over 4,000 in health professions shortage areas

and over 1,000 at community health centers

4 43,000 health professions students trained in medically

underserved areas

4 Over 368,000 health professionals trained in AHEC

continuing education programs

4 Conducted nearly 32,000 continuing education


4 Awarded 1.6 million contact hours



NAO Committee on Research and Evaluation 2006, CPMS/UPR

AHEC funding at the federal level is through the Bureau of Health Professions, HRSA.

Rural Health and Technology

Improving Senior Care Through Technology:

A Collaborative Approach

student teaching, and virtual

clinical experiences.

One AHEC’s Experience:

Program Outcomes

Southern Regional AHEC (SR

AHEC), one of three original

regional AHEC partners in the

“Improving the Care of Acutely Ill

Elderly” grant, is disseminating

geriatric educational programming

to three nursing practice levels

(RN, LPN, and NA).

Specific outcomes in that region


• Expanding existing partnerships.

The training included

both the use of the HPS and

unfolding case scenarios.

Nursing faculty assisted the

AHEC nurses with teaching the

curriculum, which provided the community

college faculty with tools they could

use to incorporate into their classes.

• Addressing the nursing shortage. The

lack of a sufficient number of clinical

sites is one factor that prevents nursing

programs from admitting qualified

SR AHEC Family Practice Resident performs patient assessment

on human patient simulator.

applicants. Human patient simulation

can serve as an effective stand-in for

traditional clinical experiences, thus

increasing clinical training opportunities.

3,4 This program provided nursing

faculty a chance to explore how this

option could work in a rural setting.

SR AHEC Family Practice

Residents and Campbell

University Pharmacy

Students participate in a

cardiac arrest mock code.


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Rural Health and Technology

Improving Senior Care Through Technology:

A Collaborative Approach

• Developing an approach to economic

sustainability. SR AHEC helped to

support the costs of the HPS by using it

for other programs and professional

groups. These included training in

Advanced Cardiac Life Support

(ACLS), the Trauma Nurse Core

Course (TNCC), and running mock

codes for the Duke/SR AHEC Family

Practice Residency program and

students in the Pharmacy program at

Campbell University.


• Collaborating partners need to have a

clear understanding of and be firmly

committed to their respective roles and

responsibilities from the outset.

• There needs to be ongoing training and

support for those nursing faculty and

AHEC nurses who use the HPS. This

type of high-tech equipment is complex,

and rural areas may lack the technological

help and advanced instruction that

allows the equipment to be used to the

fullest. One of the complaints from

faculty at the few state nursing programs

that own simulators is that they

have been able to use only the most

basic features since they lacked the

technical support to develop more

complicated patient scenarios.

This grant could not have achieved its

statewide goals without the NC AHEC

support and collaboration that made its

success possible. This is a case where

onetime funds were used to purchase

equipment and supplies – a common activity

- and to address the nursing shortage

through faculty development and virtual

clinical experiences that were not a part of

the original grant but will be an enduring

part of the local nursing community.

Dr. Keia Hobbs, SR AHEC Faculty, demonstrates

assessment on human patient simulators to SR

AHEC Family Practice Residents.



United States Department of Agriculture: Economic Research Service Briefing Room. Rural Population and

Migration. (2006). Retrieved from


Henneman, E., Cunningham, H., Roche, J., & Curnin, M. (2007). Human patient simulation: Teaching

students to provide safe care. Nurse Educator, 32(5), 212-217.


Maricopa Community College. (2004). Expanding nursing program capacity: Clinical coordination. Presentation

at the National Council for Workforce Education.


Massachusetts Board of Higher Education. (2005). Centralized clinical placements for nursing students: A review

of existing models and considerations for Massachusetts. Prepared by Tobin Communications in association with

Farley Associates, Inc.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 27

Rural Health and Technology

Northern New York Successes in

Healthcare Workforce


Richard K. Merchant, MS

A database-driven website has been developed and implemented and has

exhibited success in addressing the healthcare workforce needs through

exposing students to health careers, matching students to job opportunities,

and linking to other economic development efforts.

Richard K. Merchant, MS,

is Chief Executive Officer

of the Northern Area

Health Education Center,

Inc.(NAHEC) in Canton,


In order to support the health workforce

development activities in its region, the

Northern Area Health Education Center

(NAHEC) designed, developed, and implemented

a database-driven website that has

successfully addressed a component of the

supply side of the healthcare workforce

equation. Its employment in rural northern

New York has had numerous beneficial effects,

not the least of which has been its use as a

resource on economic development activities in

the area.

The project was initiated in 2003 when

NAHEC contracted Iradix Consulting to build

a regional database-driven website system,

entitled My Health Career®. The website was

envisioned to provide users with information

about, and connections to, healthcare careers,

training, and employment within the region.

More important, the web portal was built

within an SQL database infrastructure that

would collect numerous data points and have

the capability to conduct queries related to

those individuals registered in the system. This

capability resulted in the ability to analyze,

engage, and report on healthcare workforce

supply in the region.

NAHEC’s educational partners use My Health

Career routinely to fill seats with the best

students as well as to answer the question, If

we offer this new training program, who will

show up? Healthcare employers not only use

the system to attract quality employees but

also invest in the system in order to sustain its

viability. Of substantial importance is the

manner in which My Health Career has served

to bring community partners together. Because

the system provides community-based

information and linkages within a defined

region, it has become increasingly easier for

NAHEC to convene community partners and

facilitate collaborative initiatives based on

select data. These collaborations have used the

information and data from My Health Career to

engage the most appropriate populations,

make informed programmatic decisions, and

monitor results.

An unseen benefit emerged as the project

evolved from an information portal to a

powerful linkage and data-reporting platform.

NAHEC has been approached by economic

development agencies in the region requesting

information about the composition of the

current and future healthcare workforce

supply. The reports provided to these agencies

enable them to strengthen their case to site

selectors as being a favorable community for

new businesses to locate. Healthcare

workforce, healthcare systems, and workforce

Ryan Robinson explored pharmacy through an

internship and was accepted into Albany College of

Pharmacy for the Fall 2007 semester.


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Rural Health and Technology

Northern New York Successes in Healthcare Workforce


development systems are all

foundational criteria

included in business site


NAHEC over the past four

years, has focused much of

its energy on conducting

outreach to area schools.

Currently, 25% of all junior

and high school students are

registered into the My

Health Career database.

Through My Health Career,

registrants explore local

healthcare careers, construct

a career plan, engage with

community resources, apply

for community-based career

exploration programs, apply

directly for enrollment into

area training programs, and

ultimately apply for employment

with local healthcare

employers. NAHEC

community-based career

exploration programs have consistently had

more than 10 times as many applicants as

there are program openings. Graduates of

NAHEC’s community-based programs have

more than a 93% placement rate in area

healthcare training programs and jobs. The

data-identified gap between those interested

in community programs and the funds to

support them has been used to leverage local,

regional, and grant funding.

Although the system was initially designed to

focus primarily on the pipeline population, it has

also become a platform for a broader array of

educational services. My Health Career currently

offers a range of continuing education, employment,

and professional development opportunities

for practicing health professionals.

NAHEC originally dedicated a full-time

employee to populate My Health Career with the

necessary information specific to the center’s

service region. Once this process was completed,

the employee was then assigned to devote 20%

of her overall time to the project to enter any new

Case Manager Erin Pratt presents My Health Career to high school


information and generate reports. Each year

since the project’s inception, NAHEC has

dedicated one or two full-time employees to

provide outreach to schools in the region. This

outreach, which includes student career

exploration on My Health Career, has allowed

the project to serve even greater numbers of


My Health Career has been licensed to AHECs

throughout New York State and the state of

Maine. Because of its success at the local level,

community leaders requested that NAHEC

build a multi-industry system based on the My

Health Career platform. The resulting NorthStar

Community Career Web has now been adopted

throughout the majority of NAHEC’s service

region. The implication of this appears quite

favorable. As evidenced by the community’s

request for the NorthStar system, NAHEC has

delivered not just a healthcare workforce

development tool in My Health Career but a

platform for providing essential workforce supply

information and a method for fostering substantive

community development.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 29

Rural Health and Technology

Clear Connections: A Feasibility

Study Model to Bring

Telemental Health Services to

Rural Communities

Catherine Russell, EdD; and Patricia Beckenhaupt, MPH, RN

Through a multi-organization collaboration, an AHEC provides research

services as part of a feasibility study on telemental health which sets the

stage for development of future mental health services in the eastern part of


Catherine Russell, EdD, is

Executive Director of

Eastern CT AHEC in

Jewett City, CT.

Patricia Beckenhaupt,

MPH, RN, is Director of

Health of Northeast

District Department of

Health in Brooklyn, CT.

The Eastern Area Health Education Center

located in Jewett City, Connecticut, collaborated

with the Northeast District Department

of Health in Brooklyn, Connecticut, and 35

other professionals representing diverse state

and community organizations in the Clear

Connections Telemental Health Feasibility Study.

The feasibility study, conducted between

March and June 2007, explored telecommunications

technology as a means to connect

children to mental health providers in rural


Terms such as telemental health and

telepsychiatry are used to describe the provision

of mental health and psychiatric services via

telecommunication systems that enable twoway,

interactive, real-time communication

between the patient and provider. 1

In addition to utilizing several experiential

methods, such as a three-site videoconference

demonstration and telepsychiatry site visit,

focus groups were a key component of the

study and provided the Clear Connections

Advisory Committee with the perspectives of

stakeholders and professionals in northeastern

Connecticut. EAHEC facilitated the focus

groups, conducted a literature review, and

coauthored the study. The following is a

summary of the four major groups that

participated in this process.

Adolescent Focus Groups

Participants in two adolescent focus groups felt

that it was difficult to get help for their

problems and that they rely on their friends for

support. Collectively, the adolescent participants

also reported the greatest problem

experienced by their peer group was substance

abuse and coping with related peer pressure.

The greatest barrier to accessing services

expressed by the adolescents was lack of

transportation in getting from school to an

agency for an appointment.

The adolescents in one focus group initially

raised concern about someone hacking into a

teleconference-based system but later appeared

to accept reassurance that the technology

was designed to assure confidentiality and

prevent any invasion of privacy. The adolescents

then expressed enthusiasm at the

possibility of accessing counseling and support

services while at school and thought that if the

equipment could be brought home, it would

allow their parents and families to participate in

counseling as well. Fear and mistrust of the

healthcare system, a substantial barrier

identified by this group, seemed to dissipate

with the ease of receiving therapeutic services

over a screen, allowing more comfort in being

honest with a therapist not actually in the room.

Other adolescents were firm in their belief that

hacking into the system was easy and compared

telepsychiatry to, a chat

room that they believe is easily violated by their

peers. They were reluctant to consider the

possibilities of telepsychiatry and focused on

the cost of therapy and liability for the equipment

should someone become angry and


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Rural Health and Technology

Clear Connections: A Feasibility Study Model to Bring

Telemental Health Services to Rural Communities

intentionally destroy it. The adolescents also

expressed privacy concerns with accessing

services at school. They felt a need for more

privacy from their peers and teachers. The

current cost of mental health services emerged

as a major issue for one group, while the other

thought that paying for telemental health

services was a “problem for the adults” to

resolve. The disparity seen in the two adolescent

focus groups suggests that further research

is needed in order to engage adolescents


Parents and Care Coordinator Focus Groups

Parents and mentors were very hopeful and

willing to try telemental health services for their

families. Parents had an opportunity to

participate in three different focus groups.

Families United, a support and advocacy group

for parents with children who have mental

illness, hosted one group. A local Family

Resource Center sponsored another, while

some parents participated during one of the

previously mentioned adolescent focus groups.

Current barriers for parents in accessing mental

health services for their children included

having to take extended time off from work to

travel to appointments, finding child care for

other children, having to wait because appointments

were backed up, and not being able to

access services in a timely manner unless the

child/adolescent was suicidal or in crisis. Cost

and insurance were also identified as major


While some of the parents thought school was

an appropriate and helpful location for

telemental health services, others thought a

neutral site such as a library or community

center was a more appropriate setting. Some

parents identified confidentiality as a concern if

telemental health services were to be provided

at school, while others thought that telemental

health services offered at school would eliminate

barriers and did not think confidentiality

would be an issue. One father stated that he

would invest in the equipment for his home to

avoid having to travel out of state for his son’s

treatment, which was a burden for the whole

family. Collectively, parents expressed the

opinion that there were not enough services to

support and educate families appropriately and

that telemental health might provide potential

solutions to these problems.

School Personnel Focus Group

A local school system in Putnam, Connecticut,

conducted a focus group of 10 teachers and

administrators. There was agreement among

the teachers and parents that mental health

issues have grown over the past decade and

services have not been able to respond to the

increased local need. School personnel ranked

cost, waiting time, and insurance as the top

three barriers to accessing care. School personnel

suggested that if telemental health services

were available in the schools, parents might

expect the schools to handle behavioral issues

and might become even less involved in their

children’s care. The Clear Connections

Advisory Committee site visit to Value

Behavioral Health of Pennsylvania supported

this as a possible result. In many cases there,

parents did not attend the telemental health

session when the child received services during

the school day.

School personnel and parents

were equally concerned about

each other’s roles and

boundaries regarding

children. and about how the

other group should respond.

Overall, telehealth was seen

as a viable option to increase

delivery of mental health services by school


Healthcare Providers’ Focus Groups

The advanced practice registered nurses and

other nursing staff of a family health center

clinic participated in a key informant group

interview and expressed the need for medication

management, individual and family

counseling, and screening for attention deficit

and hyperactivity disorder. The nursing staff

felt that “overall, access and affordability had

improved over the last ten years, but there had

been little improvement, if any, over the last

two years.” The pediatricians from the Pediatric

Center of Day Kimball Hospital also partici-

Parents and mentors were

very hopeful and willing

to try telemental health

services for their families.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 31

Rural Health and Technology

Clear Connections: A Feasibility Study Model to Bring

Telemental Health Services to Rural Communities

pated in a key informant interview and

concurred that the lack of mental health care

providers in the region has been “going on for

some time and has not gotten any better. . . . In

fact, it is gradually getting worse as the volume

of uninsured or state-covered patients are not

readily accepted.”

The nursing staff of the clinic felt that they

“neither possess the proper screening tools,

such as questionnaires nor do they always have

the time to spend with

patients needing mental

health services.” They

further explained they

were unable to conduct a

thorough evaluation

because they do not have

training in mental health

and would not be able to

prescribe proper medications

if necessary owing

to the “ever-changing

spectrum of medications

available.” Day Kimball

Hospital’s pediatricians

stated that their concern

in delivering mental

health care lies with

assessing medication


Fulfilling the AHEC Role in Rural Health

Participating in this feasibility study allowed

Eastern AHEC to fulfill an important role in

assessing the available resources and gaps in

The partnerships

established by Eastern

AHEC, local healthcare

providers, the local public

health department, and

dozens of other

community stakeholders

now form the foundation

for the future of

telemental health

services in this region.

mental health services in rural Eastern


Focus groups and key informant interviews

were two of the necessary pieces that provided

insight into the possibility of using new

technology to improve access to mental health

care. Further, focus group information, in

combination with data supporting growing

unmet needs, enabled the study’s Advisory

Committee to recommend the development of

a pilot project, which is

now under consideration

for future funding. The

partnerships established

by Eastern AHEC, local

healthcare providers, the

local public health

department, and dozens

of other community

stakeholders now form

the foundation for the

future of telemental

health services in this


The Clear Connections

Telemental Health

Feasibility Study

provided this AHEC

with an excellent

opportunity to fulfill its mission to improve

healthcare outcomes by creating partnerships

in education and health care, providing support

to healthcare professionals, and strengthening

the quality and supply of healthcare providers.



Armstrong, T., & Sprang, R. (2004). Telemedicine technical assistance documents: A guide to getting

started in telemedicine, pp. 188-205. Columbia, Missouri: University of Missouri School of Medicine.

AHEC – Connecting students to careers, professionals

to communities, and communities to better health.


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Rural Health and Technology

Web-Based Tools Extend

AHEC’s Impact to Support

Rural Health in Texas

Shannon Kirkland, MBA; Mouyong Liu; and Paula Winkler, MEd

The article describes new web-based systems designed to improve health

workforce services to rural communities. Three Texas AHEC programs

developed an interactive health career guide and an automated careermatching

system to serve students and health professionals throughout

the state.

AHEC programs across the country provide

support for underserved communities in

maintaining their health care. The scope of

AHEC’s mission, whether at the program or

center level, is a matter of managing hundreds

of relationships for meaningful impact to

address the challenges of providing health care

in communities that are often isolated and

economically disadvantaged and have limited

health and education infrastructure.

For AHECs that serve large rural areas, the

challenges of maintaining these relationships

with key stakeholders (i.e., K-12 educators,

higher education, physicians, and other

healthcare providers and community leaders)

and impacting the critical health workforce and

health-improvement needs of these communities

are compounded by the geographic

isolation of rural areas.

In Texas, the AHECs have sought ways to use

web-based technology to maximize resources—

including personnel, funding, and programming

to meet the needs of constituents most efficiently—as

well as effectively track individual

and organizational partners. The three Texas

AHEC programs have worked together to

develop technology solutions that broaden the

scope of programming beyond the physical

limitations of regional staffing. These projects

have not only leveraged the resources of the

AHECs and their host academic health centers

but have also been the result of partnerships

with various state agencies and universities. Two

web-based end-user projects that have been

developed are an interactive health career guide

called and an automated

career-matching system for health

professionals and employers called

In addition to these end-user applications, an

internal data-management system called

iAHEC has been developed collaboratively by

the Texas AHECs to track programmatic

activities. While the system has streamlined

the AHECs’ ability to develop required

reports, it has also served to enhance AHECs

strategic operations.

Online Health Careers Guide

Like many AHEC programs, Texas has

published a health career guide for more than

10 years. This publication has transitioned to

include a website with the same information.

With the creation of the third edition of Texas

HOT Jobs two years ago, the HOT Jobs

website was expanded to include interactive

components that allow students to explore

health careers as well as search for educational

programs (identified by AHEC region). This

website receives approximately 5,000 visits

per month.

The most recent phase of the HOT Jobs web

development has created a Career Profile

Management feature, which allows students to

set up a unique profile, select their top health

career choices, and have access to additional

specific career preparation content based on

those selections. In addition, this development

phase included creating a mechanism for the

Texas AHECs to communicate directly with

students who have self-identified health career

interests, and target them with regular messages,

based on their specific career interests, locations,

and opportunities to pursue their career goals.

Shannon Kirkland, MBA,

is with the West Texas

AHEC Program Office in

Lubbock, TX.

Mouyong Liu is

Technology Projects

Coordinator at East Texas

AHEC Program Office in

Galveston, TX.

Paula Winkler, MEd, is

Director of South Central

AHEC in San Antonio,


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 33

Rural Health and Technology

Web-Based Tools Extend AHEC’s Impact to Support

Rural Health in Texas

Online Health Careers Matching System

Texas Health Match was developed by the

AHECs and their partners to create a mechanism

to disseminate information about

healthcare job opportunities in a forum that

provides immediate access to a broad audience

of job seekers. The

website is designed specifically for healthcare

job matching in Texas; users can search jobs or

resumes by public health region or by career

discipline and specialty. Much like, the system streamlines the

process, allowing direct communication

between job seekers and employers.

Currently as a free service, this resource has

3,000 visits a month and benefits rural community

healthcare organizations that struggle with

recruiting. At the time of this printing, there were

more than 350 jobs with 136 employers posted.

As of late fall 2007, 77 employment placements

had been made.


iAHEC is the web-based data-management

system developed by the Texas AHECs within

the past 18 months. The AHEC infrastructure

meets the programatic needs for reporting

activities, managing relationships and collaborations,

tracking impact of longitudinal programs,

and supporting advocacy. The first phase of

development is for internal AHEC use; it has

supported AHEC’s work across the state by

streamlining data collection and expanding

options for evaluating programs and activities so

that AHEC may strategically address identified

needs, target activities to cover the entire region

served, and communicate the scope and value of

AHEC work to the people served.

Other Benefits

The next phase will integrate iAHEC with and,

as well as implement new modules, such as an

automated student rotation match system. The

goal of this expansion is to involve more

academic and community partners as direct

contributors to the system.

In addition to these core statewide initiatives,

each AHEC program has found ways to

improve rural communities’ healthcare infrastructure

in their regions. Through its website,, East Texas AHEC has

spearheaded an initiative to improve public

health through education about good health

habits, user-friendly public information dissemination

strategies, and resources to help communities

plan and address public health concerns.

Initially developed as a resource for communities

to use in preparing for a flu pandemic, the

concept is developing to include information

about other public health concerns. The other

Texas AHEC Programs, as well as Oklahoma

AHEC, participate under East Texas’ leadership.

The South Texas AHEC has partnered with the

Heartland National Tuberculosis Center in San

Antonio, an extended bridge connection to the

Texas Association of Local Health Officials to

provide a Nursing TB Assessment series to 35

rural counties in Texas, as well as additional rural

AHEC sites in Oklahoma, Illinois, and North

Dakota. Additionally, AHEC-sponsored Family

Medicine Grand Rounds are provided through

sponsorship of the South Central AHEC every

Friday to the 38 counties in South Texas. In the

past year, over 5,000 health professionals in

these communities have participated in these

training programs. Finally, South Texas AHECs

have archived all these presentations on their

website so that professionals in U.S. rural

communities and throughout the world may have

access to the information.

The West Texas AHEC has partnered with the

Texas Tech University Health Sciences Center

library to provide access to its electronic medical

library resources for the rural health professionals

across West Texas who serve as preceptors for

community-based clinical rotations. Access to the

breadth of these resources (i.e., more than

15,000 electronic journals and numerous

databases and customizable patient education in

English and Spanish) and preparatory tools for

board certification is not available to these

providers except through AHEC.

Extending the capacity of AHEC’s impact by

creating opportunities for rural communities,

healthcare professionals, and students to directly

access technology-based resources is crucial for

long-term, sustainable support for rural



The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Health Career Training

Rural Health and Technology

Laboratory Professionals Are

Critical to Health Care

Sue S. Beglinger, MS, MT (ASCP), CLS (NCA); and Mary A. Nelson, MT (ASCP)

The critical role that laboratory professionals play and the need for such

professionals are detailed, along with current efforts to create innovative

degree programs to address the shortage of laboratory professionals in

southern Wisconsin.

Clinical laboratory scientists and technicians are

personnel who have an essential role in the

delivery of health care. They are a group of

professionals who aid physicians in detecting

and diagnosing disease, determine the presence

of pre-disease states, and monitor the treatment

given to patients. With more than 70% of

the information in a patient chart record

generated by diagnostic laboratory services 1 and

the average patient requiring 42 laboratory

tests per hospital visit, 2 it would be impossible

for a hospital to treat and monitor patients if the

laboratory were no longer able to provide

services due to a lack of qualified personnel.

“The demand for health care services is

increasing because of the aging population.

Wisconsin’s hospitals are already beginning to

experience increased workforce challenges

including emergency room crowding, reductions

in bed availability, increases in surgery waiting

time, cancellations of surgeries, emergency room

diversions due to unfilled staff positions, and

reduction in special services.” 3 While the

geriatric population is expected to grow 48%

between 2000 and 2020, 4 the closing of clinical

lab training programs due to funding cuts has

resulted in a shortage of training institutions. 5

Only two laboratory professionals graduate for

every seven retiring laboratory professionals. 6,7

The shortage of qualified laboratory professionals

hits rural Wisconsin’s healthcare facilities

particularly hard. Rural laboratory directors are

finding it increasingly difficult to recruit staff.

Positions remain vacant for extended periods of

time, which causes existing personnel to work

long hours and increases the potential for

serious laboratory error. The Clinical Laboratory

Improvement Act of 1988 (CLIA) allows

for clinical laboratories to hire individuals with

Bachelor of Science degrees to perform

laboratory testing. However, adequate training

in proceedures and techniques must be

provided. When laboratories are short-staffed,

it is difficult to provide the required CLIA


Rural hospitals in southwestern Wisconsin

requested the Clinical Laboratory Technician

(CLT) program at Madison Area Technical

College (MATC) to assist in this professional

training. Since baccalaureate-degreed individuals

require only the specialized clinical

laboratory classes to meet graduation and

certification requirements for MATC, offering

the clinical laboratory courses in an accelerated

format was a logical solution to quickly meet

the needs of rural hospital labs. MATC

turned to Southwest Wisconsin Area Health

Education Center (SWAHEC) for financial

assistance in developing the first accelerated

offering for the CLT curriculum. A major goal

of this project was to create an online delivery

of course materials, thus minimizing travel for

rural students. Limiting the time students were

required to be on campus was critical to the

success of the program.

The online curriculum was developed between

July 2002 and June 2004. Ten students began

the program in August 2004, with nine

completing it in August 2005. Of the nine

accelerated graduates, five were employed in

rural communities. The initial success of the

Accelerated CLT program, largely due to

SWAHEC’s assistance in planning a curriculum

that provided a fast track to employment,

led to MATC’s offering the accelerated CLT

training again for 2007-8.

The reality of laboratory personnel shortages

is all too clear. Laboratory professionals are

an aging category of healthcare workers;

there is a concern that whole departments

Sue Beglinger, MS,


is Clinical Laboratory

Technician Program

Director of MATC in

Madison, WI.

Mary A. Nelson, BS,

MT(ASCP), is Clinical

Coordinator and Instructor

of the Clinical Laboratory

Technician Program,

Madison Area Technical

College, Madison, WI.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 35

Rural Health and Technology

Laboratory Professionals Are Critical to Health Care

may retire at one time. As a case in point,

one Wisconsin hospital blood bank has a

staff of eight in which all techs are over the

age of 62.

SWAHEC sponsors many activities to

recruit individuals into healthcare careers,

including health career summer camps,

online health career information, and

participation in career expos. Through these

activities, along with SWAHEC’s sponsoring

of curriculum development, an ideal

partnership with MATC has evolved.

In addition to the Accelerated CLT program,

partnering with SWAHEC helped

the CLT Program start a specialized shortcourse

program for phlebotomists, a group of

laboratory technicians who specialize in

blood collection and specimen processing.

The success of the phlebotomy training

resulted in ongoing funding of a phlebotomy

program every semester by MATC.

SWAHEC’s most recent partnership is in

support for developing an online, webbased,

continuing education program for

laboratory professionals. This program will

aid practicing laboratory technicians and

scientists in completing the mandatory

continuing education necessary to maintain

certification for employment.

Southern Wisconsin has benefited from

SWAHEC’s assistance in educational

programming that addresses the needs of

the clinical laboratory to provide accurate

and precise laboratory test results by

certified personnel. The partnership with

Madison Area Technical College has been

integral to this success.



Silicon Valley Roots: Foundational occupations with growth potential SOC 29-2011. (2006). Medical and

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Taylor, J. B. (2004). Relationships among patient age, diagnosis, hospital type, and clinical laboratory

utilization. Clinical Laboratory Science, 18(1), 8-15.


Potter, B., and Peters, D. (2001, August). Will Wisconsin have a health care workforce to meet its needs?

Wisconsin Public Health and Health Policy Institute, 2(9). Retrieved August 14, 2007, from http://


National Center for Health Workforce Analysis. (2001). The Wisconsin health workforce: Highlights from the health

workforce profile. Retrieved August 14, 2007, from



Castillo, J.B. (2000). The decline of clinical laboratory science programs in colleges and universities. Journal of

Allied Health, 29(1), 30-35.


Health Resources and Services Administration Bureau of Health Professions. (2005, July). The clinical laboratory

workforce: The changing picture of supply, demand, education, and practice. Retrieved August 14, 2007, from http://


U.S. Department of Labor, Bureau of Labor Statistics. (2006). Clinical laboratory scientists and technicians.

Retrieved October 10, 2007, from


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Health Career Training

Rural Life and AHEC Connections

Amish Health Project:

Plain and Simple

Maggie Turnbull, MA/WEd, MT (ASCP)

The Amish Health Project describes how AHEC developed an ongoing

relationship with a unique and medically underserved population. This

partnership continues to improve the health of the community by providing

educational programs and increasing access to health care.

The “Plain People” of Logan and Hardin

counties at Ohio make up one of the largest

populations of Amish in the world. 1 In

2001, the Lima AHEC (LAHEC) recognized

a unique opportunity to contribute to

the health of these people and began the

Amish Health Project.

The first step LAHEC took was to learn the

Amish ways by attending Project Hoffnung

Amish Wellness Day in Holmes County,

another county with a large population of

Amish, where the elders shared their rich

history and founding beliefs. The second

step was to experience cultural differences

by visiting Amish neighbors and establishing

relationships. Women like Martha, who

has a quilt shop, shared the needs of her

people in the small “new order” community

near the Village of Belle Center. They have

a fairly conventional lifestyle in modest

homes with generated power and indoor

plumbing. They live a simple familyoriented

life and provide for themselves by

working farms or as finish carpenters. A few

families have baked-goods shops or small

fabrics stores attached to their houses.

Some, cautiously, seek medical care when ill,

and some attend free public screenings.

Their resources do not allow for routine or

long-term treatment, and very few have a

medical home.

The Hardin County Amish, located in the

area southeast of the small town of Kenton,

are a “primitive,” reclusive sect of “old order

Amish” who live by a very strict religious

code. About 135 families, with 8-10

children each, subsist on the earnings from

their meager farms. The fathers and sons

work their fields with teams of large workhorses

and hand plows, while the mothers

and older daughters raise the children and

tend to the chickens and the barnyard

chores. They use wood-burning stoves; a

pump at the kitchen sink provides water;

there is no other indoor plumbing. Their

access to health care is limited because

Kenton is in a medically underserved area

with no public transportation, and the cost

of hiring private drivers is unaffordable for

many. These Amish will not use life flights

(emergency transports by helicopter) and

many prefer not to call 911 for rescue

squads. They rely on a trusted few who will

provide for them in exchange for a chicken, a

few loaves of bread, a handmade quilt, or a

piece of furniture.

The two sects are very different and are

governed by the rules of their individual

churches. Their main source of education is

the church, primarily the bishops and elders.

They do rely on trusted English (i.e. non-

Amish) neighbors to relay information from

one to the other. They read their newspaper,

The Budget, and a very few select publications

in the home but are discouraged or

prohibited from reading other material

unless it is reviewed by the church. Most are

discouraged, and some are actually prevented,

from participating in surveys or data

collection of any kind. They do not understand

the need to know or how the information

will be used, and in many cases, they do

not understand the questions. The Kenton

Amish do not have Social Security numbers

and only recently started reporting births,

deaths, and marriages.

Maggie Turnbull, MA,

Wed, MT (ASCP), is

Director of the Lima/

Medical University of

Toledo College of Medicine

AHEC in Lima, OH.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 37

Rural Health Life Career and AHEC Training Connections

Amish Health Project: Plain and Simple

Both sects care for the ill and elderly within

their community. They do not subscribe to

Medicare or Medicaid programs and have

no health insurance. If a need arises, they

have massive auctions or fund-raisers to pay

medical bills in cash. Since traditional

medicine is not well understood, preventive

health care is not a natural part of their lives

and is used only selectively in both communities.

Some younger Amish do immunize

their children and will seek prenatal care if

they have experienced difficult pregnancies

in the past. Most babies are delivered by

Amish midwives at home. Natural remedies

are preferred over prescription medications,

and treatments from chiropractors or

alternative medicine practitioners are sought

before physicians are consulted.


success strategies:

• Invite a small group of women to a

wellness day at a nearby church or

in a private home.

• Invite healthcare providers to give

talks on subjects of interest to the


• Offer no cost screenings: glucose,

cholesterol, BP, derma scans, bone

density scans.

• Insure that physicians are willing

and able to privately answer


• Encourage the women to talk with

the presenters, one-on-one, on

subjects of their choosing.

• Serve an informal meal or refreshments,

and assist in the preparation

and clean-up.

• Offer to provide transportation.

The Lima Area Health Education Center

(LAHEC) began work with this population

by inviting a small group of women to a

wellness day at a nearby church camp.

Local providers gave talks on breast and

ovarian cancer since several members of the

community had recently died from these

diseases. They enjoyed lunch together and

then talked privately on subjects of the

women’s choosing. The following year,

LAHEC was invited into an Amish home

and began offering screenings that have

now expanded to include derma and bonedensity

scans, blood pressure screening,

glucose testing, and Komen-funded

mammographies. Local partners include

health departments, diabetic centers,

county extension office providers, and


This past year LAHEC encountered a

difficult situation when the mobile mammography

unit was no longer able to travel.

The Amish home that was offered to host

the mobile unit was unable to generate

sufficient power to support a portable

mammography unit, so Hardin Memorial

Hospital provided a vacant medical office in

Belle Center. Most recently, LAHEC

connected with the Lima Community

Health Center to provide dental services.

Emergency treatment salvaged a woman’s

severely decayed tooth, and now multiple

family members and neighbors are being


The Amish community has appreciated this

generosity and goodwill. As the relationship

among the Amish, LAHEC, and the local

healthcare community has deepened,

Amish visits to the community health center

have increased 38.2% in the past six

months. In fact, the Lima CHC is considering

establishing a satellite in Hardin


The challenge is to provide health education

for the Amish without imposing our “English

ways” on them. A few guidelines were

developed to foster respectful relationships:

• Maintain respect for their cultural



The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Health Career Training

Rural Life and AHEC Connections

Amish Health Project: Plain and Simple

Belle Center medical office site that houses treatment services for the community.

• Use a plain and simple approach when

providing a program.

• Gain the trust of the bishops and elders

and consult with them on a regular


• Offer programs based on their need to


• Provide the learning experience in a

way that maintains their comfort level.

• Use experiential learning as much as


• Accept “no, thanks” when an activity is


One of the best qualities of AHEC staff is

their ability to offer genuine hospitality and

sincere caring for those they serve. This

approach opens doors and invites learning.

Developing an ongoing relationship with the

Amish communities and patiently communicating

from year to year help keep the doors

open. The goal and challenge for the future

is to continue elevating awareness, providing

educational programs, improving access to

care, and expanding prevention efforts.



Hostetler, J.A. (1995). Amish life. Scottsdale, PA:

Harold Press.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 39

Rural Health Life Career and AHEC Training Connections

The Rural/Frontier Women’s

Health Coordinating Center in


Rocio Flores-Zuniga

A multi-agency partnership led by the AHEC of Southern Nevada aims to

improve women’s health services in its region. The Rural Frontier

Women’s Health Coordinating Center has successfully developed a

comprehensive set of programs to increase women’s knowledge of health

issues, and to improve the quality of programs for health professionals on

women’s health topics.

Rocio Flores-Zuniga is

RFCC Center Director

and Women’s Issues

Program Manager of

AHEC of Southern

Nevada in Las Vegas, NV.

In August 2005 the AHEC of Southern

Nevada (AHEC SN) received a Rural/Frontier

Women’s Health Coordinating Center (RFCC)

grant. An advisory committee was formed. The

members included representatives from the

School of Nursing at the University of Nevada,

Las Vegas, the Nevada Office of Minority

Health, WorldDoc, Inc., Nevada Health

Centers, Inc., Nevada Rural Mental Health

Network, Great Basin

Primary Care Association,

Access Health, and

the other Nevada

AHECs. This committee

helped develop the

goals and objectives that

the Women’s Issues

Program staff at AHEC

would use to deliver

services to the women

residing in rural/frontier

areas in Nevada and

their healthcare providers.

The major challenges

that women living

in these areas face are

geographic isolation,

fewer health-related resources, higher uninsured

rates than in urban areas, less access to

public transportation, and healthcare workforce


The overall goal of the RFCC was to enhance

the network of services to women in order to

increase access to health care. One step to

achieve this goal included studying how

women and their families are impacted by the

The major challenges that

women living in these

areas face are geographic

isolation, fewer healthrelated

resources, higher

uninsured rates than in

urban areas, less access to

public transportation, and

healthcare workforce


geographical challenge. In collaboration with

the Center for Health Disparities and Research

at the School of Public Health at the

University of Nevada, Las Vegas, the RFCC

developed a program offered to the rural/

frontier counties designed to educate women

on taking a leadership role in their own as well

as their families’ healthcare needs.

A key question for the

RFCC was, if the

trainings were developed

would women attend?

The RFCC conducted

the woman’s leadership

trainings and evaluated

participation in these free

programs offered at

convenient locations near

their homes. With the

help of the initial

participants and rural/

frontier newspapers,

attendance rates

increased at subsequent

meetings. Women’s

health encompasses a

variety of topics, and the goal is to enhance

women’s knowledge. The RFCC targeted

community centers, libraries, senior citizen

centers, and other locations where the

community comes together. From this data, a

rural/frontier Nevada resource directory was

developed that is continually updated. It is

available through the AHEC RFCC

website at:

RFCC%20HOMEPAGE.htm. The direc-


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Health Career Training

Rural Life and AHEC Connections

The Rural/Frontier Women’s Health Coordinating

Center in Nevada

tory is formatted by county and services and is

open to any organization that delivers services to

women and their families, including churches,

schools, and social service agencies.

During the second year, the RFCC staff

traveled to different counties around the state

offering education on leadership, advocacy,

women’s health, mental health, cancer, dental

care, and other topics related to prevention and

early detection. The RFCC also provided

health professionals with Continuing Medical

Education approved courses on different

women’s health topics. For instance, the RFCC

offered three-hour training sessions about the

human papillomavirus (HPV) vaccine and its

impact in Nevada. The RFCC also offered a

three-hour training

program on depression in

women. This training

was offered live in Las

Vegas and extended to

10 other rural/frontier

sites via videoconference.

This was an opportunity

for rural/frontier

healthcare professionals

to attend the session

without having to travel

long distances to


With the help of

Community Health

Nurses around the state, the RFCC disseminates

information directly to women residing in

rural/frontier areas. The RFCC is researching

the use of “telehealth” technology, which uses

RFCC developed a

program offered to the

rural/frontier counties

designed to educate

women and prepare them

to take a leadership role

for their own as well as

their families’ healthcare


Lander County Nevada - a rural county in the state

of Nevada.

videoconferencing equipment to transfer

medical information to patients that live in

rural/frontier areas who cannot otherwise

receive traditional

medical attention. The

RFCC is currently

conducting a study on

transportation issues

around the state. There is

no method of transportation

to assist women and

their families in getting to

medical appointments.

The RFCC has increased

the collaborative

efforts of our partners,

other agencies, and rural/

frontier communities in

impacting women’s health. The RFCC hopes

to continue this collaboration and to seek new

sources of funding, since the national grant

funds have been curtailed.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 41

Rural Health Life Career and AHEC Training Connections

What the Heck Is an AHEC?

Richard R. Perry, MA

Oklahoma AHEC Program’s “Story of Bob” provides a succinct, yet

comprehensive answer to the question raised by legislators and others:

What the Heck is an AHEC?

Many AHEC programs and centers have

wrestled over the years with the challenge of

finding a succinct way to describe the AHEC

program to legislators as part of their advocacy

program. As a complicated healthcare

workforce infrastructure program with a variety

of important and complementary initiatives,

AHEC has sometimes proven difficult to

explain to legislators in the brief time usually

available to do so. The Oklahoma AHEC,

however, has succeeded in crafting a description

of its program that, while somewhat longer

than the proverbial 15-second sound byte, is

an engaging description that is not so long that

it causes legislators’ eyes to glaze over.

Over the last few years Oklahoma experienced

massive turnover in the legislature because of

term limits. Many of these new legislators were

not in the legislature when AHEC was initially

funded and they did not know much about the

AHEC program. The legislators summoned

the Oklahoma AHEC leadership to the state

capitol to gain a better understanding of what

AHEC was about and to learn not only why

they should continue to fund the program but

why the program was seeking a significant

increase in funding for its rural programs.

Instead of utilizing a more traditional approach

in describing the Oklahoma AHEC Program,

which focuses on rural health, the leadership of

the program decided to develop a fictional story

about a boy named Bob. Woven into what

came to be known as “The Story of Bob,”

however, were many of the actual programs and

activities of the Oklahoma AHEC Program as

well as the names of all four Oklahoma AHEC

Centers. A fictional approach was taken

because there was no single real individual in

Oklahoma who had managed to participate in

all the programs described in the story, but

there were many who had taken advantage of

one or several programs. The fictional approach,

on the other hand, captured the potential

impact that the Oklahoma AHEC Program, if

properly funded and supported by the legislature,

could have on some real “Bob” in the

future. The “Story of Bob” has been utilized in

print and oral form and has engendered much

positive feedback from legislators and friends of

AHEC because they now “get” what AHEC

is all about. By the way, the Oklahoma

legislature increased funding for the Oklahoma

AHEC Program by 54% for 2007-8.

What Does Oklahoma AHEC Do?

The Story of Bob

“Let me tell you a story about a family from Tuskahoma in Southeast Oklahoma. It’s a pretty

small place—they don’t even list its population on the state road maps.

The Thompson family lives there—Mom, Dad, one child, and Grandma. Dad works and does

OK. Mom stays home and cares for Grandma, who has Alzheimer’s disease. The child, Bob, is in

the ninth grade, does pretty well in school, and has begun to think about what he might like “to

be” when he grows up. He doesn’t really know what to think—no one in his family has ever gone

to college.

Richard Perry, MA, is

Program Director of the

Oklahoma AHEC in

Tulsa, OK.

A medical student from Oklahoma State University Center for Health Sciences (OSUCHS) in

Tulsa came to talk to Bob’s science class about how she decided to be a doctor, what courses she took

in school, and how hard she had to work. Bob thought it was pretty exciting. But how in the


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

Health Career Training

Rural Life and AHEC Connections

What the Heck Is an AHEC?

world had this medical student ended up coming to his small school to talk, Bob wondered. He

asked her and she told him she was doing a one-month clinical rotation in nearby Idabel and

that the regional AHEC coordinator had set the visit up. Later in the year, AHEC had a

Physician Assistant (PA) student from Oklahoma University come to Bob’s class to tell them about

being a PA. Bob had never heard of a PA before.

Well, now Bob was really excited. Maybe he could be a doctor or a PA when he grew up. But he

needed to know more. He asked his science teacher how he could learn more about the health

professions. His teacher said that the AHEC person who had set up the classroom visits could

help. They called the AHEC regional office in Poteau at Carl Albert State College and found out

that AHEC had two personnel, one that worked with the health professional students and one

that worked with high school students. The secretary said that she would have the staff person

who works with high schools call.

The SEAHEC Career Education Coordinator called and told Bob about a week-long summer

camp called MASH Camp that the NWAHEC in Enid held each year where kids his age

explored various health professions in-depth. Bob got in touch with the NWAHEC and, with

some scholarships, he signed up to go to Enid for a week. While there, the group toured the OSU

Center for Health Sciences, the OU Health Sciences Center, one of the big hospitals in Enid, and

talked to health professionals in town and health professional students serving as counselors. He

was convinced—he was going to go to be a health professional.

Bob went back home to Tuskahoma and contacted SEAHEC. “MASH camp was great! What else

can I do?” asked Bob. The Career Coordinator told him about some shadowing opportunities she

could facilitate for him with a nearby physician, and at the community health center in very

rural Battiste and the Choctaw Nation Indian Hospital in Talihina. She would also send him

some career information and get in touch with his teacher to help her plan a course schedule for

him that would benefit his application to college.

Time passed. Bob took science classes in high school and did something every year with the

SEAHEC Career Education program. He successfully enrolled in college at Southeastern State

University in Durant. Bob met some of the Family Medicine residents who were training in

Durant and worked as an aide in the hospital while in college. In the summer, he continued to go

back to MASH Camp as a counselor.

Bob did well in college—he made good grades, was a leader in his class, and volunteered his

time. He was an impressive student. The big day came and he applied to medical school and got

an interview. His friends at the residency program and SEAHEC helped him with his interviewing

skills. Bob deeply impressed the interviewing team and he was admitted to the medical


Medical school! Bob had never worked so hard. He learned that the AHEC had a summer

experience program where, after his first year, he could go to a rural community for a month and

shadow a primary care physician in his office and hospital. He signed up and went to Elk City

in Western Oklahoma. He’d never heard of Elk City before, but the SWAHEC regional office in

Lawton helped him get there, found him a place to live, and connected him with the physician

preceptor. During the month, the AHEC also helped him connect with some community groups and

he did a short community service project with one of the agencies. What a great month! He got to talk

to patients! And he saw firsthand that physicians in rural Oklahoma were very good doctors and could

provide very good health care. Bob decided then and there that he was going to be a rural physician

when he graduated.

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 43

Rural Health Life Career and AHEC Training Connections

What the Heck Is an AHEC?

During medical school, Bob had occasion to return to rural Oklahoma on various rotations. Each

time, a representative of one of the regional AHEC programs helped him connect to the community.

The experience in Miami in Northeast Oklahoma was a real eye opener! The NEAHEC

program and a local physician had developed an environmental health elective where he learned

all about Tar Creek—a massive Super Fund site—where lead exposure in children and contaminated

watersheds are big problems.

When he finished medical school, Bob went back to the Family Medicine residency program in

Durant and, when he finished, chose to practice at the community health center in Battiste, near

his hometown. Now Bob works with the regional AHEC as a local mentor for high school and

health professional students who want to learn about Community Health Centers and caring for

the underserved. The “path” took Bob 15 years to complete!

But we are not quite finished with Bob’s family. Bob’s mom attended a community education

workshop on “Caring for your loved one in your home” that was developed by the NWAHEC

program in Enid and conducted by the SEAHEC program. She learned a lot about caring for

older adults and was better able to care for her mom. After Grandmother died, Bob’s mom

trained to be a Certified Nurse Assistant and took an advanced course as a Geriatric Technician,

a course developed by the NEAHEC that focused on Alzheimer’s disease. After working for a few

years in a nursing home and sitting in on some courses that AHEC facilitated in conjunction

with the state’s Geriatric Education Center, Bob’s mom enrolled in the nursing program at Carl

Albert State College. She is now an RN. She still attends continuing education courses offered

locally by AHEC every chance she gets, especially those conducted by her own son!


The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 45

NAO would like to thank our Medallion Members

for their continued support:


AHEC of Southern Nevada Las Vegas, NV

Northern Louisiana AHEC Bossier City, LA


University of South Florida AHEC Program Tampa, FL


American Medical Association Chicago, IL

ATSU/KCOM AHEC Program Office Kirksville, MO

Cascades East AHEC, Bend, OR

Everglades AHEC West Palm Beach, FL

Massachusetts AHEC Network Shrewsbury, MA

Rural Health Projects/Northwest Oklahoma AHEC Enid, OK

Southwest Louisiana AHEC “Hearts” Program Lafayette, LA

Southwestern Connecticut AHEC Trumbull, CT

NAO – 4 th Annual

Spring Policy Days

April 8-10, 2008

L’Enfant Plaza Hotel

480 L’Enfant Plaza SW

Washington, DC

• Advocacy education

• Policy education

• Capitol Hill visits

Registration brochure will be available soon.

Why not promote

your product/

service in the

National AHEC


For more details, contact



The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007

The National AHEC Bulletin Volume XXIV, Number 1 Autumn/Winter 2007 47

The National AHEC Bulletin Editorial Board


Robert J. Alpino, MIA

*Thomas J. Bacon, DrPH, Co-Chair

Joel Davidson, MA, MPA

Gretchen Forsell, MPH, RD

Sally A. Henry, MA, RN, FHCE, Co-Chair

Shannon Kirkland

Andrea Novak, MS, RN, BC, FAEN

Kenneth Oakley, PhD, FACHE

Rosemary Orgren, PhD

*Stephen Silberman, DMD, MPH, DrPh

*Kathleen Vasquez, MSEd

Kelley Withy, MD, PhD


Louis D. Coccodrilli, MPH

Cynthia Selleck, DSN

Nancy Sugden

Andy Fosmire, MS, CTRS


Gay S. Plungas, MPH


National AHEC Organization Board of Directors

Cynthia S. Selleck, DSN – President

Rose M. Yuhos, RN – President-elect

Linda Cragin – Secretary

Gretchen Forsell, MPH, RD – Treasurer

Andy Fosmire, MS, CTRS – Parliamentarian

Susan Moreland, CAE – Immediate Past President

Robert Trachtenberg, MS – PDCG Chair

Kelley Withy, MD, PhD – PDCG Vice Chair

H. John Blossom, MD – PDCG Representative

Mary Mitchell – CDCG Chair

Marcia K. Brand, PhD, Associate Administrator for Health Professions

Marilyn B. Biviano, PhD, Director, DMD

Louis D. Coccodrilli, MPH, Acting Deputy Director, DMD

National AHEC Program Contacts

Phone: (301) 443-6950

David D. Hanny, PhD, MPH, Program Officer, AHEC Branch

Norma Hatot, CAPT/USPHS, Program Officer, AHEC Branch

Vanessa F. Saldanha, MPH, ASPH Fellow

Adriana Guerra, MPH, ASPH Fellow

Leo Wermers, Staff Assistant, AHEC Branch

The National AHEC Bulletin is a publication of the National AHEC Organization (NAO).

Requests for copies of the Bulletin should be directed to NAO Headquarters,

The National AHEC Bulletin


Call for Articles

“Urban Health in America: The AHEC Role”

According to the 2000 U.S. Census, nearly 4 out of 5 Americans live in urban areas. While a disproportionate

number of healthcare providers are located in metropolitan areas, there are nevertheless many medically

underserved urban communities and special populations. According to HRSA, approximately one-third of

primary care and dental HPSAs are located in metropolitan areas and the number of underserved citizens in

these metropolitan HPSAs is about equal to the number in rural primary care and dental HPSAs.

A primary mission of the AHEC Program since its founding in 1972 has been to improve the supply, distribution,

and retention of primary care practitioners and other health professionals in underserved communities. In the

1976 reauthorization of the AHEC Program by Congress, additional focus was placed on improving access to

health care in urban underserved areas. The National AHEC Bulletin requests articles for the Spring/Summer

2008 issue that demonstrate how AHECs work in collaboration with educational and healthcare delivery institutions

and other community organizations to:

• Strengthen the recruitment of young people from urban areas to enter health professions education


• Enhance the recruitment and retention of health professionals in urban communities, in collaboration

with other community partners

• Provide interdisciplinary urban experiences for students and residents from multiple disciplines to

prepare them to function as members of the healthcare team

• Enhance training to the existing healthcare workforce to address emerging issues affecting urban

areas, including disaster preparedness, pandemic flu, substance abuse, violent behavior, or other

public health issues

• Develop strategies to improve the availability of primary care providers and other health professionals to

meet the needs of community health centers and other urban safety-net providers

• Offer programs designed to prepare health professionals to more effectively serve an increasingly

diverse urban population, and to reduce health disparities

• Conduct needs assessments to identify emerging health issues facing urban populations

Deadline for First Draft of Articles: February 29, 2008

Editorial Guidelines for article submission can be found at:

Please submit drafts, photos, and accompanying materials to:

If you have any questions, please contact one of the following:

Joel E. Davidson, MA, MPA

Executive Director

Southwest Wisconsin AHEC

Robert J. Alpino, MIA

Administrative Director

Eastern Virginia AHEC

The National AHEC Organization Mission

NAO is the national organization that supports and advances the AHEC

network in improving the health of individuals and communities by

transforming health care through education.

The AHEC Mission

To enhance access to quality health care, particularly primary and preventive

care, by improving the supply and distribution of healthcare professionals through

community/academic educational partnerships.

Contact NAO

NAO Headquarters Address:

109 VIP Drive, Suite 220

Wexford, PA 15090

Phone: (888) 412-7424

Fax: (724) 935-1560

NAO Headquarters Contacts:

Judy Lyle

Annie Wiest

Barbara Arend

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