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For New Doctors and at-need Patients, Northcentral Pennsylvania AHEC Program a Win-Win

By Rick Docksai

deborah sawyer
Deborah Sawyer, M.S.Ed., Executive Director of the Northcentral Pennsylvania Health Education Center (AHEC)

Medical school is anything but cheap: 2010’s graduates averaged $159,000 in loan debt per student, according to the American Medical Association. So it’s understandable that many new medical professionals intend to migrate to wealthy urban neighborhoods, where they can fetch high salaries and pay down their massive student-loan debts quickly.

Deb Sawyer is helping medical students make progress on their careers and their debts by doing the exact opposite: As executive director of the Northcentral Pennsylvania Area Health Education Center (AHEC), she is connecting them to programs that will cut their loan debts in return for periods of working in some of Pennsylvania’s most at-need rural locales.

“There is a definite benefit, and for some that’s quite attractive,” Sawyer says. “It’s definitely something that people should be aware of and make use of.”

The Northcentral Pennsylvania AHEC, based in Wellsboro, PA, sits in a farming-based region where doctors are unusually hard to find. The federal government has declared parts of Tioga County— into which Wellsboro is incorporated—and of nine neighboring counties as “designated shortage areas,” which means that the medical workforce is so understaffed that federal agencies are intervening to correct it. Every U.S. state and territory has at a few designated shortage areas, according to the U.S. Health Resources and Services Administration, which keeps a running list of them.

As part of its response, the federal government will “forgive”—i.e., pay off—portions of medical students’ loans in return for the students working after graduation as physicians in these areas. Some of the counties offer their own loan-repayment programs, as well.

Where can interested medical students find opportunities to take the government up on this offer? The Northcentral Pennsylvania AHEC, which works with health providers in Tioga and the nine other underserved counties, is a great place to start.

Linking Medical Students and Medical Centers

Sawyer’s AHEC is one of seven AHECS that span Pennsylvania, and is within the larger umbrella of AHEC that covers the United States. Every AHEC works to bring medical students and medical professionals to underserved areas within its jurisdiction. Sawyer’s AHEC does its part in Tioga and the nine neighboring north-central Pennsylvania counties.

She and her staffers put medical students in touch with for-credit volunteer and training opportunities at clinics and hospitals located in the 10 counties. Each participating student is paired with a doctor or nurse— referred to as a “preceptor”—and helps him or her with day-to-day tasks.

The preceptor may assign the student more responsibilities, depending on how much prior medical education he or she has completed. It’s common for fourth-year students, for instance, to conduct physical exams of patients.

“A fourth-year student knows more than a third-year one,” Sawyer says.

Students and preceptors work one-on-one together for durations of time called “rotations,” which run from four to eight weeks. AHEC provides student housing—Sawyer says that a “huge portion” of her AHEC’s budget goes toward housing students.

Once their rotations are up, the students return to their home universities, which give them academic credit for rotation completion. But after graduation, many of those students decide to come back to the Northcentral Pennsylvania AHEC and complete their “residency,” the final period of medical training that follows the acquisition of a medical degree.

Residencies are like the rotations—participants work in hospital settings under the supervision of professional doctors—only much longer and far more intensive. All medical students in the United States, regardless of where they attend medical school, have to complete residencies to be eligible for board certification or admission into many specialist-training medical programs.

A medical school graduate decides where he or she might complete residency. To many graduates and alumni of Sawyer’s AHEC program, the Northcentral Pennsylvania region is the place to go. The weeks that they had spent living in the Northcentral Pennsylvania communities and working with the local medical teams leaves them with lasting impressions.

“Before they start, we do an evaluation and ask if the rotation program has had an impact on them,” Sawyer says of these returning alumni. “A lot say it’s made them more likely to practice in Pennsylvania.”

Residency ends, and permanent medical careers begin. Once they complete their residencies Northcentral AHEC alumni often contact Sawyer’s AHEC to see which local facilities have open opportunities for a provider. The graduates don’t have to stay in the Northcentral Pennsylvania region post-residency, but a substantial number do, according to Sawyer. Others move to underserved areas elsewhere. Either way, Sawyer considers it great news. Her job, and the job of all AHEC staffers, is to help low-income communities be healthy, whether it be in Pennsylvania or not.

“What we do, our primary mission, is to help communities meet their primary health care needs,” she says.

Support for Established Practitioners

Bringing new medical practitioners to north-central Pennsylvania is only one step, Sawyer notes: The next step is keeping them there. In a rural setting like this one, it is easy for a health professional to feel isolated, and that isolation may lead him or her to relocate to somewhere with more people and more career prospects.

To counter this, Sawyer’s AHEC offers series of continuing-education health courses and networking events just for the career practitioners. Some classes take place over the Internet, but many classes and events are in-person meetings, which Sawyer says gives providers human contact and connectedness that they would otherwise be greatly missing.

“There are things about meeting in person that the Internet can’t replace,” Sawyer says.

Bucking the Bigger Trend

Doctor shortages are a continuing problem in rural America. The American Academy of Family Physicians reports that while 21% of Americans live in rural regions, only 10% of doctors practice there. That adds up to thousands of small rural communities that know what it is like to need medical services and to not have them—and to know the irreplaceable service that AHECs such as Sawyer’s are doing by bringing them new medical workers.

“We try to help out the systems with recruitment in any we can,” says Sawyer.