Internship programs connect students to primary care
From the December ACP Observer, copyright © 2006 by the American College of Physicians.
By Stacey Butterfield
Dana Perrin, MD, had wanted to be a doctor since he was in high school but he worried that he wasn't smart enough. So he majored in chemistry instead and became a research scientist for medical device companies.
It wasn't until after spending 20 years working with physicians on research that Dr. Perrin decided his dream might not be so unrealistic. Nine years ago, he began taking night classes and studying for the MCATs. Now age 54, he practices as a family physician at Suncoast Community Health Centers in Ruskin, Fla.
Dr. Perrin is also a preceptor in the Area Health Education Center (AHEC) program of the University of South Florida in Tampa. A national, federally funded program, AHEC's mission is to encourage students—from grade school to graduate school—to pursue careers in medicine, especially primary care.
With the current shortage of primary care providers, it is crucial to expose young people—particularly minority and disadvantaged students—to the practice of medicine, said Cynthia S. Selleck, DSN, AHEC's program director for the University of South Florida (USF). "We know that they're going to do a better job caring for the medically underserved, and we have years of data that show if you come from that kind of background, you're more likely to practice with those populations."
Medical school programs
Attracting medical students to primary care can be a challenge in the third year, when they face an array of specialty career options. AHEC tackles that problem by exposing students to the field very early on.
At the Wright State University Boonshoft School of Medicine in Dayton, Ohio, AHEC enables first-year students to spend six weeks in community health and social services facilities. Their work could include taking patient information, developing exercise programs or teaching nutrition classes.
"It's not directly clinical because these are first-year students. But they are enthusiastic because it's the first and only time in their first year that they have any experience with patients," said Katherine L. Cauley, PhD, AHEC program director at Wright State.
All third-year USF students practice in community health centers, many serving migrant workers.
"Typically, the students love the experience because they see lots of patients with problems that are different from what they see in private practice," said Dr. Selleck. Recently, a USF clinical faculty member diagnosed a patient with leprosy at a local free clinic and medical students followed that patient in the ER, she added—"Where else are they going to see that?"
In addition to interesting work experiences, the AHEC programs provide support and encouragement to students interested in primary care. "AHEC opened my eyes to what a primary care physician actually does. If it wasn't for Dr. Selleck, I don't think I would have believed in myself enough to do it," said Peter Chang, a third-year medical student at USF.
Those individual connections are a key part of the AHEC experience. Mr. Chang now serves as a mentor to the younger students he worked with as an AHEC camp counselor, offering support to students who don't have many professional role models. "Many minority students who want to go to medical school haven't even seen minority physicians," said Dr. Selleck.
Since AHEC was established by Congress in 1971, the program has exposed ever-growing numbers of students to community-based primary care. In a typical year, AHEC programs train 37,000 health professions students at community sites and provide health career enhancement and recruitment activities to more than 42,000 high school students across the country, according to the Department of Health and Human Services.
In Philadelphia, the Medical Society of Eastern Pennsylvania offers African-American college students a chance to see minority physicians on the job. Every summer for the past 14 years, selected students have spent eight weeks shadowing practicing physicians in different specialties.
Wilfreta G. Baugh, MD, shown with office assistant Alan Charles, coordinates an internship program in Philadelphia for African- American students.
"We try to give them a varied experience," said Wilfreta G. Baugh, MD, a general internist, who coordinates the program. "They see the best of us. They see the worst of us."
Most students come into the program with an interest in becoming a physician, but little idea of the heavy workload required. "At five o'clock, they think it's time to go home. But I say, 'No, that's when I go to the nursing home,'" said Dr. Baugh.
The program, called the African-American Internship in Medicine (AIM), grew out of concern about the dearth of minority physicians. With African-Americans representing only 3.4% of practicing physicians in the U.S., Dr. Baugh and colleagues were looking for a way to encourage young African-Americans to consider careers in medicine. Sponsored by GlaxoSmithKline, the program has trained more than 100 students over the past 14 summers.
The program provides a stipend to the students, who come from the major schools in the region—Temple University, University of Pennsylvania and Drexel University—and from around the country.
In addition to being a hub of medical education, Philadelphia is more than 40% African-American. A graduate of Jefferson Medical College in Philadelphia, Dr. Baugh now practices in Germantown, a predominantly African-American neighborhood in the northwest part of the city.
As an internist in an urban community, Dr. Baugh is well-aware of the shortage of young people entering internal medicine. She believes that programs like hers can help, but that it's not enough to overcome the financial disadvantages of working in primary care.
"I cannot get a young person to come into this office as a physician," she said of her own practice. "They think it's all well and noble, but with the financial burden of paying off the costs of medical school education, supporting a family and maintaining a medical practice, the remuneration is not equitable."
One of Dr. Baugh's former interns did take the leap into primary care, however. Delana Wardlaw, MD, participated in the program in 1994 and now practices as a family physician in Philadelphia.
"It was very instrumental to see African-American doctors who owned their own practices and were thriving in their own practices," Dr. Wardlaw said. "It made the goal seem that much more attainable."
Encouraging young African-Americans to serve their own communities is a priority for Dr. Baugh, but she worries that AIM internships aren't enough. "By the time kids are in fourth or fifth grade, they have already set their course, especially African-American boys," she said.
Starting in high school
Although there are not yet any pre-med courses in elementary schools, some programs scattered around the country offer students the chance to investigate health careers before they've entered college. Roosevelt High School in Minneapolis has one of the largest programs, with 300 students enrolled in its Health Careers Program.
The program began in 1989, in response to concerns about a future shortage of health care workers. Over time, the program has forged a variety of connections between the students and the local health care community, from mentor relationships with University of Michigan med students to a visiting surgeon who taught the students to do stitches on chicken breasts. Major funding is provided by Medtronic Corp., with additional financial support from medical supply companies and local hospitals.
In the past three years, Roseline Tsotfack, 18, has interned at a children's hospital, shadowed a nurse and attended numerous medical demonstrations and field trips.
Now in her senior year of high school, she plans to attend college and graduate school in pursuit of her dream to become either a physician or a nurse. "The health careers program is part of what pushed me to do it," she said.
Her classmate, Angela Manion, 17, agreed that the program kept her on track through high school. "I think the classes especially kept me more interested," Ms. Manion said, adding that her mentorship at the VA hospital was "pretty cool." She also plans to attend a four-year college.
The students' ambitions are particularly impressive in light of the fact that 78% of Roosevelt's students are on free or reduced lunch, said program coordinator Michael O'Connor.
The program can't afford to systematically track its graduates, but he said he regularly hears from former students who are in nursing school or pre-med programs.
Mr. O'Connor and other youth health program directors hope that with the right support and encouragement, at least some of that work force will become the primary care providers of future generations.
"We have the students who are going to be the future work force," he said.
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