Quality care to the disadvantaged and learning opportunities to students

In an ideal world, every city and rural community would have enough doctors to meet the health-care needs of its residents, including the economically disadvantaged.

University of Florida first-year medical student Nadia Lugo wants to bring that ideal world a little closer to reality. She's gotten an early start through a UF College of Medicine preceptorship project organized by the North Florida Area Health Education Centers Program. It is part of the state AHEC system, which helps academic institutions deliver health care to the disadvantaged while providing real-world learning opportunities for students and professionals.

After final exams in early December, Lugo and her 112 first-semester classmates worked with primary-care physicians in rural and urban communities throughout North Florida. For two weeks the students shadowed the physicians, gaining experience not usually offered until the third year of medical school.

"I made the decision to work with rural or inner-city populations before I started medical school, but AHEC pushed the idea along," said Lugo, an Orlando native who decided at age 10 to pursue a career in medicine.

UF is the principal academic partner in the North Florida AHEC Program, now in its thirteenth year of successful operation, thanks to a combination of state and federal funding, staffing by UF health professionals and students, and community support.

During fiscal year 2001- 02, the North Florida AHEC Program provided approximately $4.5 million in services and helped nearly 37,000 patients. Health-care services included dental care, psychiatric counseling, pharmacy consults and primary-care office visits, said Larry Rooks, M.D., a UF associate professor of community health and family medicine and director of the program.

"The bottom line is how we affect the health of the underserved," Rooks said. "One of the major mechanisms we use to do that is community-based training opportunities we design, such as the first-semester preceptorships for medical students."

North Florida AHEC is geographically the largest of the state's five AHEC programs, serving 37 counties, Rooks said. Faculty and students from the Health Science Center colleges of Dentistry, Health Professions, Medicine, Nursing and Pharmacy provide many of the services.

In her preceptorship, Lugo assisted family physician Shenary Cotter, M.D., who has a solo practice in Williston, a small town 20 miles southwest of the UF campus. For about 30 hours a week, Lugo interviewed patients, observed examinations and helped with outpatient procedures.

"I was exposed to every aspect of family medicine you could imagine, including pediatrics, obstetrics and geriatrics," Lugo said. "Dr. Cotter is really dedicated to her work; she'll go to the end to make sure everyone can get what they need, even if they can�t afford it."

Cotter said she was impressed by Lugo, who learned quickly and interacted well with patients. In the past year, Cotter has worked with eight resident physicians and two medical students from UF.

"They keep me on my toes because they know things I don't because medical science changes so fast," said Cotter, a 1996 graduate of UF's College of Medicine.

AHEC provides a crucial link between UF's College of Medicine and the community, said Robert Watson, M.D., senior associate dean for educational affairs with the college.

Watson, along with Allen Neims, M.D., Ph.D., former dean of the college, and J. Ocie Harris, M.D., former professor of medicine, initiated UF's leading role in the program in 1990. Harris was the program's first director and recently accepted a position as dean of the Florida State University medical school.

"AHEC has been incredibly important to the College of Medicine," Watson said. "It has enabled us to do some innovative things that wouldn't have happened otherwise."

The first-year preceptorship, which the medical school added to its curriculum shortly after the program was launched, was one of the first attempts by a U.S. medical school to allow beginning students to participate in real-world medical practice, he said.

Today the North Florida AHEC Program involves dozens of initiatives focused on service and learning, health promotion and disease prevention, community-based training, and recruitment and enrichment of students from underrepresented minority groups.

During fiscal year 2001ᆖ, North Florida AHEC provided 240 medical students with nearly 46,000 hours of training, while 78 nurse practitioner students participated in more than 15,000 hours of clinical training, and 59 physician assistant students conducted 25,000 hours of training, all at community-based sites.

The North Florida AHEC Program is divided into four regional service areas - West Florida, Big Bend, Northeast Florida and Suwannee River - each based at a regional center with its own board of directors, said Barbara Richardson, Ph.D., R.N., director of the Suwannee River AHEC Regional Center in Alachua. The centers operate as independent, not-for-profit corporations, monitoring local health-care needs and offering services to meet them.

"We've always prided ourselves on partnership with the people we serve, to give them what they need," said Richardson, who has been with the center since its inception in 1992. In fiscal year 2001- 02, the North Florida AHEC Program provided 24,000 North Florida residents with 36,000 hours of health education on topics such as diabetes, tobacco cessation, nutrition, cardiovascular disease, osteoporosis and obesity.

Although UF is the principal academic partner in North Florida AHEC, the program includes Florida A&M University, the University of West Florida and the University of North Florida, as well as 11 junior and community colleges. UF also collaborates with FSU, which recently established the state's fifth AHEC program, operating statewide with no regional centers.

Some North Florida AHEC initiatives are launched statewide, such as Project IMPACT, an eight-week educational effort offered simultaneously by all 10 regional centers in the state, Richardson said. These initiatives usually involve emerging health priorities. Recent efforts have addressed cardiovascular disease prevention, obesity and the dangers of secondhand tobacco smoke.

The program also provides continuing medical education for professionals through on-site and distance education courses, delivering approximately 18,000 hours of education to 2,600 health professionals in fiscal year 2001ᆖ, Rooks said.

At rural clinics where it may be difficult to secure permanent staff, the program placed 119 primary-care resident physicians who provided 43,000 hours of service in fiscal year 2001ᆖ, equivalent to more than 20 full-time physicians working an entire year, he said.

"We don't hire physicians or run clinics," Rooks said. "But we contract with clinical departments that conduct community-based training, and they can use the funds to support faculty members assigned to that work."

Rooks and co-director Alan Jameson manage the financial affairs of North Florida AHEC, handling an annual budget of $3 million from the state Department of Health and $500,000 from the U.S. Department of Health and Human Services.

About three-quarters of the funds are contracted out to the four regional centers, which use the money to support initiatives at the regional level, sometimes contracting back with UF and other institutions, as well as community clinics, physicians and nurse practitioners, Jameson said.

"The cooperative relationship among the AHEC programs statewide is a real success story," he said. "We now have a confederation called the Florida AHEC Network, through which we plan state programs and deal with issues such as students traveling from one AHEC program's territory to another."

Despite the extensive infrastructure and impressive numbers, AHEC comes down to individuals. It's about the medical students whose preceptorship experiences strengthen their commitment to work with the less fortunate. It's about the health professionals who serve as role models for the next generation. And it's about the Florida citizens who can see a doctor, pharmacist or nurse to obtain high-quality health care that might not otherwise be available.

"I think AHEC is the best health-care bargain the state has ever had," said Watson. "For a relatively small investment, the system delivers enormous impact in terms of services to communities and developing health-care providers."