Area Health Education Centers work behind scenes to make a difference, help bring health providers to rural areas

By Tara Kaprowy

Kentucky Health News

When student Holly de la Peña learned she'd been assigned to a physician's assistant rotation in rural southeastern Kentucky, she was a little nervous. Having grown up in Paris, Ky., near Lexington, and having never ventured much farther than the 30-minute drive to the University of Kentucky, the prospect of going to live for six weeks in a town she'd never visited with a family she'd never even met was intimidating. "I was very anxious to travel alone and stay in a strange environment and not have any friends in the area," she recalled. "It was a little scary."

But after arriving in London, Ky., de la Peña realized things were going to be just fine, thanks in no small part to the local Area Health Education Center that helped her. "They did everything for me," she said. "They gave me the connection of where to stay, they gave me information about the community. They even gave me a list of restaurants, activities that were offered and where certain churches were located." In fact, de la Peña found the experience so rewarding and she became so connected to the town, she and her husband decided to move to London shortly after her graduation. She's been practicing as a physician assistant there for the past 10 years.

Stories like de la Peña's are exactly what staff at Area Health Education Centers, which serve every county in the state, are hoping to hear. "It's gratifying to know that the work our staff pays off for our region," said Dwain Harris, director of Southern Kentucky AHEC. (Photo: Dr. Brian Ellis of Danville works with UK medical student Megan Song)

Though they can go unnoticed, AHECs have been working behind the scenes for decades. The program started as a federal initiative in 1971 and was designed to get more doctors working in rural areas. "Particularly rural communities had a hard time getting enough doctors," said Dr. Jim Norton, the UK medical school's associate dean for educational engagement. "They felt if medical students spent part of their time training in rural areas they might then practice in rural, underserved communities."

In 1972, Kentucky applied to receive money from the federal initiative. When it was denied, the state decided to set up its own system, calling it AHES — the Area Health Education System. That system was designed to serve and attract all types of health-care providers, not just medical students. "There was funding provided to support students when they went away from the mother ship to an underserved community," Norton said. "And there were staff scattered around the state that were the local contacts to help them find housing."

Around 1980, the University of Louisville and University of Kentucky decided to try again to receive federal funding. It was granted, and the state has been receiving about $700,000 every year since. In turn, the state kicks in about $2 million each year. AHES changed its name to AHEC when centers were set up across the state. Today, there are eight such centers, four in Western Kentucky administered by U of L and four in Eastern Kentucky administered by UK.

The main goal remains the same: link students in all types of health professions to rural and underserved training sites, such as clinics, hospitals and physician offices. From 2008 to 2010, student physicians, nurses, pharmacists, dentists and allied health professionals such as physician assistants received training at more than 10,000 AHEC-supported rotations. In 2009-2010, 1,727 students did AHEC rotations representing more than 8,700 student work weeks.

YOUTH PIPELINES

Over the years, the program has expanded. Now the work to attract health professionals to rural areas starts well before students are getting ready to graduate from college. Called health career pipeline programs, AHEC staffers work with middle- and high-school students to encourage them to pursue health careers. "We stress the importance of taking math and science courses, about how it's important not to take a year off after high school, and we allow them to shadow health care providers," said Carlos Marin, AHEC program administrator at UK. (Photo: Rockcastle Regional Hospital nurse Bill Wells demonstrates nursing skills on a mannequin during Southern Kentucky AHEC's 2011 summer health-careers camp.)

In the last school year, more than 23,000 kindergarten to 12th-grade students in Kentucky were exposed to some type of health career activity, including classroom presentations, camps, clubs and workshops.

De la Peña's 15-year-old son Evan is now part of the pipeline. This summer he attended an AHEC-sponsored science and health camp. He learned fundamental suturing techniques and how to start an IV, became CPR certified, and attended lectures by several health-care professionals. "Even if your child doesn't want to be a doctor, they're learning about all of these different professions that they wouldn't have the opportunity to learn about, unless someone in their family had that type of job," de la Peña said. "Plus, it lets them recognize the need in a small community."

SERVING THEIR COMMUNITIES

The AHECs' official motto is to "connect students to health careers, health professionals to communities and communities to better health," but each center works independently to meet local needs. Part of the work at the North Central AHEC, for example, is reaching out to its Hispanic community. At the Purchase AHEC, there is a vigorous oral health initiative. In Mount Vernon, maternal education is a major focus, with the Southern Kentucky AHEC hosting educational baby showers to help combat the area's high rate of premature births.

Northwest AHEC, which covers Louisville and seven nearby counties, helps people who lost their jobs get trained in health care professions and back to work. "We're working with the workforce development boards real closely," said Center Director Brenda Fitzpatrick. "We're helping displaced workers look at other careers because there is a slew of health care careers that will support this system. The health care industry is the fastest growing job industry right now. There's a whole new gamut out there for us."

RESULTS?

But do AHEC efforts reach the original goal, to get more health professionals working in underserved areas? Officials admit it's a difficult question to answer, partly because many students are now required to do rural rotations. "If you look at the history of it, from an anecdotal view, yes, it does work," Marin said. "The question is: Can we say X number of students have gone through AHECs and so have gone to rural communities? No. It's difficult because all of our students go through AHEC rotations."

Even asking a doctor why he or she decided to practice where he or she does can have a complicated answer. "The answer is going to be a whole lot of things," Norton said. "He might say, well, I grew up here. Or I did a rotation here. Or my family was here. To identify what is the cause is probably futile because there is a combination of factors."

De la Peña agreed. She and her husband already knew they wanted to return to small-town living when they had children, for example. But AHEC cemented the deal, and kept her in Kentucky. "With AHEC going out of their way to make your stay as accommodating as possible, to make you feel comfortable and giving you an opportunity to mesh with a community, that does establish some roots," she said. "You meet people, they befriend you, you keep in touch, you want to come back. And that can lead to future employment."