How the crises of 2020 underscored the value of Area Health Education Centers

Andrew Spitznogle always liked science, but what attracted him to medical school was more than his interest in biology, biochemistry, and the etiology of disease.

He was looking for conversation – meaningful discussions with patients "to help them toward well-being and longevity while also easing pain and suffering."

The third-year medical student at the New York Institute of Technology College of Osteopathic Medicine participated in a Manhattan-Staten Island AHEC program during the summer of 2020 — the height of the COVID-19 pandemic and social justice unrest.

"The program provided an outside perspective of medicine, which was not entirely clear in the classroom," Spitznogle said. "Discussion of social injustice in medicine in terms of race, wealth, zip code, and sexual identity put the meaning of my schooling into context."

Area Health Education Centers, or AHECs, were created by Congress 50 years ago to strengthen the healthcare workforce in underserved areas and exist in most states, the District of Columbia, and many U.S. territories.

Because they work somewhat behind the scenes, AHECs may not be familiar to many outside of healthcare, but they have touched millions of lives.

One of AHEC's many programs is AHEC Scholars. Implemented in 2018, it provides supplemental education to health professions students that focuses on key topics such as cultural competency and emerging health issues.

The crises of 2020 exposed gaps in the healthcare system – and further revealed the value of the AHEC Scholars curriculum.

Pharmacy resident Brian Tran was in the Southwest Georgia AHEC Scholars program, which allowed him to be a part of outreach clinics for farmers and to get certifications in telehealth and Mental Health First Aid.

"Both certifications shined during the past year due to the COVID-19 pandemic," Tran said, "as healthcare organizations started to utilize telehealth and as social distancing and isolation created concern for mental health."

In the academic year 2019-2020, AHECs supported 5,632 AHEC Scholars, approximately 38 percent of whom came from a rural background. Nearly 46 percent of the participants came from a disadvantaged background.

In a post-program survey, 90 percent of AHEC Scholars rated themselves confident in their ability to reflect on and describe their perceptions and biases of individuals from different professional or cultural backgrounds, compared to 36 percent before the program.

"The foresight HRSA (the Health Resources and Services Administration) demonstrated in developing the AHEC Scholars program was incredible," said Gloria Burnett, president of the National AHEC Organization (NAO) and director of Alaska's AHEC program. "We look forward to seeing the impact of these AHEC Scholars as they begin practicing in our nation's most vulnerable communities."

In its latest budget justification, HRSA noted that in a recent five-year period, the nation's AHECs trained more than 1.8 million individuals.

Forty-two percent of those completing programs were from a rural background, 40 percent were from disadvantaged backgrounds, and 29 percent were underrepresented minorities.

"There are a lot of success stories behind that data," Burnett said. "For decades, we have consistently shaped the healthcare workforce in a positive way for those who need it most, one student and one community at a time."

Currently funded at $43.25 million, NAO is asking Congress for $67 million for AHECs in fiscal year 2022, which, for context, is comparable to the annual budget of a single medium-sized U.S. hospital. That funding level would fulfill the vision in current AHEC legislation that each regional AHEC would have stable support of at least $250,000 to serve its communities. There are some 300 AHEC regional centers and program offices nationwide.

"When adjusted for inflation, our funding has barely risen over the years," said Dwain Harris, NAO chief executive officer, "even as the need for our services has grown. Some of our centers are staffed with a single employee, which isn't how we were designed to operate."