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The Role of AHECs: Working to Build a Rural Health Care Workforce
Clinical Coordinator Stephanie Westhoff shares scholarship and loan repayment information with medical students
The concept for Area Health Education Centers (AHEC) is not new, in fact, AHECs began to crop up around the nation in the early 1970s to create greater access to health care in rural and underserved pockets of the United States. Funded since the early 1980s - through an arm of the federal Bureau of Health Workforce, i.e., the Health Resources and Services Administration (HRSA) grant program, each statewide AHEC program resides within and is managed through the applicant institution: a public or private school of medicine or a school of nursing in states where there is no medical school nor an existing AHEC program.
As an awardee of two, multi-year HRSA grants (2012 and 2016) each with two-phased funding designed to diminish over six years,[1] the Alabama Statewide AHEC program is administered through a program office located at the campus of The University of Alabama at Birmingham (UAB): the applicant institution. The program is implemented in two-phases to encourage matching, local government funding. The Infrastructure and Develop (ID) phase of the grant offers full funding to Centers for six years, and the Point of Service and Maintenance (POSME) phase offers partial funding to Centers during the remaining years of the grant and as the grant is renewed. Each Center is responsible to secure independent funding after the six-year ID phase.
The regional AHECs operate as non-profit organizations to provide programs within a multi-county service area of the state - as defined by the program office. The Centers function independently from the program office through a cost-reimbursable contract and are governed by a volunteer board of directors. Each board oversees management of an established program of work or grant deliverables - by a professional staff. The long-term, statewide goal is to develop a statewide, healthcare workforce to serve the geographically isolated, economically or medically vulnerable.”[2]
Henry County Discovery MedCamp student flanked by SEAAHEC staff Neese Ball and Stephanie Westhoff
The Alabama Statewide AHEC Program features five regional centers that opened incrementally from 2013-2015 and, collectively, serve all 67 counties. The Southeast Alabama AHEC (SEAAHEC) opened in 2014 and is located in Montgomery. The SEAAHEC serves 15 counties from the River Region of Montgomery to the Georgia and Florida borders and employs an average staff of five who use a three-pronged approach to Recruit, Train, and Retain students – from rural or medically vulnerable communities. The model is consistent with all Alabama AHECs and supported by research that indicates that students who come from and train in rural areas have a greater inclination toward primary care and are more motivated to consider rural health care versus students who grow up and train in urban areas. [3]
RECRUIT
The SEAAHEC staff designs high school programs, summer camps, and after-school academies to raise awareness among students about the vast array of health-care career programs available and to provide campus tours and hands on activities with health professions faculty and students as mentors. Current programs include Health Career 101, Discovery MedCamp, and the Lowndes County Health Career Academy – a pilot program funded through a one-year grant.
TRAIN
The SEAAHEC clinical team works with medical students, nurse practitioner students, and physician assistant students to facilitate clinical training opportunities in rural and underserved areas where is the need is the greatest in the SEAAHEC service area. Students in scheduled training also may apply for limited housing and mileage-reimbursement assistance. A new AHEC Scholars Program is currently in a one-year planning stage and scheduled to begin in Fall 2018.
RETAIN
SEAAHEC staff work with community partners to provide Continuing Education (CE) and Continuing Medical Education (CME) opportunities for current providers. Since 2014, the SEAAHEC staff partners with the Central Alabama Health Care Systems (CAVHCS) to execute the VA Mental Health Summit. This is a federally mandated program designed to education providers about the unique and specific needs for our nation’s Veteran population.
Other continuing education offerings include Health Literacy, Behavioral Health, and discipline-specific programs, i.e. nursing, social work and other areas.
The SEAAHEC also functions to connect community-based, health care related activity as the Center moves toward the end of the ID funding phase or self-sustainability by the fall of 2019. Aside from the current HRSA grant, the Center also houses two other grant-funded programs, i.e. the Collaboration to Improve Blood Pressure in the U.S. Black Belt – Addressing the Triple Threat and the Lowndes County Health Career Academy.
Pictured left to right: SEAAHEC Practice Facilitator Macie Craft with North Carolina AHEC and West Central Alabama AHEC Practice Facilitators.
The Triple Threat Grant is a five-year comparative study administered through the UAB Department of Preventative Medicine utilizing Peer Coaches and Practice Facilitators who work with providers in Black Belt counties to help patients improve self-management of their chronic condition: hypertension. The Academy grant funds a monthly, health-career enrichment program for 10th-11th grade students in Lowndes County through a one-year Delta Regional Authority grant.
Since the 1970s and across the nation, AHECs are successfully improving access to health and attracting more rural students into health-care careers in rural and medically disadvantaged communities. The most successful states, like neighboring Georgia,[4] receive significant state funding, and the ASAP is working with state legislators to implement a similar funding relationship in Alabama.
Working within and alongside a healthcare industry that is projected by the U.S. Bureau of Labor Statistics to add more than 4 million jobs to the workforce across the nation by 2022, [5] the ASAP has an established history working within Alabama counties with the lowest health care rankings to recruit more, local high school students into health professions and to facilitate clinical training for post-secondary, health professions students within rural clinics.
Moreover, the AHEC model is focused as it specifically mentors students who grow up in rural Alabama and who have a desire to return to their home communities and serve as future providers: it is a rural-focused approach for a mostly rural state.
[1] Area Health Education Centers Funding Opportunity Announcement. U.S. Department of Health and Human Services Health Resources and Services Administration. (December 29, 2016). p. 13. The federal AHEC program requires non-federal, state or local government funding match. The ASAP applied for and is currently in the second (2012 & 2016), multi-year HRSA Award. Source: file:///C:/Users/MDV/Downloads/HRSA-17-071%20Finalv7.pdf.
[2] About HRSA. Health Resources and Services Administration. (November 2017). Source: https://www.hrsa.gov/about/index.html (2017).
[3] Barrett, F. A., Lipsky, M. S., Nawal L.M.; (February 2011); “The Impact of Rural Training Experiences on Medical Students: A Critical Review.” Vol. 86. (2). p. 259. Source: https://journals.lww.com/academicmedicine/Abstract/2011/02000/The_Impact_of_Rural_Training_Experiences_on.28.aspx. Pretorius R.W., Milling, .D.A, McGuigan, D., 2008 Jul-Sep;8(3):928. “Influence of a rural background on a medical student’s decision to specialize in family medicine.” Rural and Remote Health. Source: https://www.ncbi.nlm.nih.gov/pubmed/18778169.
[4] Kornegay, D. (October 2016). “GME in Georgia: Growth, Funding, and Sustainability.” Source: file:///C:/Users/MDV/Documents/AHEC/gme_white_paper.pdf.
[5] Torpey, E. (2014). “Millions of Jobs Now and In the Future.” Occupational Outlook Quarterly. P.1. Source: https://www.bls.gov/careeroutlook/2014/spring/art03.pdf.
