Q&A with Andy Fosmire, President of the National AHEC Organization

By Laura Trude, HWIC Information Specialist

The National AHEC Organization (NAO) has almost forty years of experience creating successful programs that help address the workforce needs of underserved communities. Health Workforce News had the opportunity to interview Andrew (Andy) Fosmire, the current president of the NAO, about Area Health Education Centers’ efforts, current challenges, organizational changes, successful workforce pipeline programs, and opportunities for collaboration.

What are the roles of Area Health Education Centers (AHECs) in addressing health workforce issues?

There are some 55 AHEC programs and 235 centers across the country and as far out in the Pacific Basin as Guam / Micronesia and a brand new program in Puerto Rico. Our main mission is to assure the adequate supply and distribution of quality primary care providers in rural and underserved areas. To that end, AHECs basically have a three-pronged approach:

First, we have programs to recruit junior high and high school students, undeclared college students, and unemployed and underemployed adults into training programs to become practitioners. We recruit to all rungs of the health career ladder: from certified nursing assistants at the entry of the career ladder to primary care physicians.

Our second prong of the approach is to support students while they are in clinical training on rotation away from their home training program. We do that through a variety of methods: securing housing for them, interfacing with the preceptor, and being that community interface for the health professions training program so that when a student comes into a community, they have a successful experience in that rural or underserved area. We hope that it’s a positive enough experience they will come back and practice once they’ve graduated and become licensed and are able to practice.

The third prong to the approach is retention. Under the auspice of retention, AHECs provide continuing education and peer support to practicing professionals in those rural and underserved areas. One of the things rural providers often feel is professional isolation. If we can provide continuing education opportunities to them close to their home base and connect them with other providers close to home, then it helps them be connected to those communities but still feel up to date on practice.

What challenges are AHECs currently facing?

There’s a variety of challenges that Area Health Education Centers face, both at the center, regional, and national level. With the downturn in the economy and really tight state budgets, many states have reduced or eliminated their funding to AHEC programs. I’m also a center director at an AHEC in rural, Northwest Oklahoma, and this past year the state legislature eliminated funding from the budget for the Oklahoma AHEC program. Fortunately the hosts in our communities felt enough value in what we do that they came together and put together some bridge funding. Hopefully we’ll get back into the state budget next year. Funding is a huge piece.

The Affordable Care Act reauthorized the AHEC program. The issue is that the reauthorization model was built on an assumed appropriation of $125 million, but in reality, only $33 million was appropriated by Congress. That has been one of our big struggles this year. For example, existing AHEC programs that have been on the books for several years now, specifically two programs in Iowa, the Nebraska AHEC program, the Rhode Island AHEC program, were on a competitive continuing grant cycle. Their applications were approved for funding, but as HRSA was distributing the funds, there weren’t enough dollars to cover all of the grant applications that were out there. So although they were approved for funding, they did not receive any federal dollars this year.

The shortage of primary care providers is another challenge. We feel that the full $125 million is going to be critical especially given the needs that are going to be coming in the next few years as 30 million additional Americans suddenly have access to insurance. They are also going to need access to primary care providers, which are already currently at max capacity. One of the things we need to continue to work with our training programs is increasing capacity for training primary care providers. It goes back to the original intent forty years ago for the Area Health Education Center program, which was considered the recruiting arm of the system that was put in place with community health centers and the National Health Service Corps.

To that end, the National AHEC Organization just recently signed a contract with the National Health Service Corps to do a pilot study on implementing the Collegiate Health Service Corps developed by the Connecticut AHEC system. They are going to do a pilot study at five sites of service-learning based in health professions for college students who might be interested in going into health care. Through that service learning, they intend to develop in students that intrinsic motivation for working with rural and underserved communities.

What are some of the challenges of your role as president of the National AHEC Organization?

The National AHEC Organization’s mission is to tie together this diverse network of services and programs. One of the big challenges is that it’s been an all-volunteer led association. In our strategic plan in the last year, we realized that we had grown large enough we needed to move towards dedicated staff for the National AHEC Organization, someone that can work with us to advocate and represent us. As it has been, every year there’s a new president, so that president has to go out and redevelop those relationships at the national level with our partners, like the National Rural Health Association, the National Association of Community Health Centers (NACHC), and all these other entities that also address workforce needs.

With the current volunteer system, it’s also a challenge to have consistent representation at meetings, especially given the rural location of many AHEC programs. We’re looking for someone who can be a consistent representative for NAO at meetings and events.

As I said, that was part of our strategic plan that was developed at our board meeting of November last year. We’ve moved very, very quickly toward that goal. We’ve put in place a structure to name an interim executive director. Our plan is to have a full-time executive director in place April 1, 2011.

Tell me about some AHEC programs that have been particularly successful in facilitating the workforce pipeline.

In our own center, we have a variety of programs that are very popular with students and really meet the mission of recruitment and health career exploration. We’re not just showing these kids a variety of health professions they might like. We try to find students who have an interest or a heart for being a health professional and we help them to really explore that interest and find a health profession that would best fit their needs and the needs of the health profession.

One of the programs I like here is our “Day in the Life of a Health Care Professional,” which is a very intensive job-shadowing program that a student has to apply for. In the “Day in the Life of a Health Care Professional,” students do preparatory work and then spend a day with a mentor. We recruit health care professionals that are going to be cheerleaders for their profession. They share with students their story of why they chose the profession, they show them what a day is like in their career life, they eat lunch with them, and then they do some follow-up with the students to see if the student has any interest in the career or additional questions. Some students maintain contact with their mentor throughout their training programs and then come back to the hospital to work where they did their job shadowing.

I really like the program “Exploring the Health Professions” that was developed by Central New York AHEC for science and math teachers and career counselors at the high school level. They use health professions as a real-world primer for what they are teaching their students in class. They have a lot of hands-on activities, which the students really like. The teachers can tie the activities back into the lesson they are teaching. For example, if a math teacher is teaching geometry and the students want to know why they need to learn how to figure out angles, the teacher can pull from the “Exploring the Health Professions” curriculum out of the rehab therapy cluster, the physical therapy booklet, and talk about the use of a goniometer, which measures range of motion by angles, and show how that goniometer is in essence a protractor for measuring angles. The instructors like it, the students like it. Not only does it expose those students to real-world use of what they are learning in high school, but it also gives them information on those health professions.

That’s just a couple of examples of programs that are going on across the country. One of the adages people use is “You’ve seen one AHEC, you’ve seen one AHEC.” But really there’s a great deal of similarity in the essential core programming that AHECs do to address health care shortages through recruitment.

What can others do to collaborate with AHECs?

One of the things that AHECs are well-known for is the collaboration they do with dozens of different programs. We work with the community health centers, Health Occupations Students of America (HOSA), the National Health Service Corps, health professions schools, and others. Here in Oklahoma, we really try to work with the recruiting arms of the health professions schools so that we are not inundating local school systems. The Northwest Oklahoma AHEC actually does some recruiting for the local nursing school in conjunction with a local health care education coalition.

An excellent collaborative opportunity would be for other groups like hospital associations, state offices of rural health, state rural health associations that work in some way to feed the health professions pipeline, to partner with AHECs. If someone is reading this article and says, “Hey, we do pipeline programs!” they can go to www.nationalahec.org and find the closest AHEC center from the directory. If they say, “We would like to partner with you;” they should find a pretty receptive person on the other end.

If a provider is interested in being a mentor or preceptor, contacting that local regional center is the first step to giving that helping hand.

Is there anything else you would like to add?

I really believe very firmly in National AHEC Organization’s mission and in the AHEC mission. I’m an AHEC center director; I’ve been in this position ten years. It’s probably the most rewarding job I’ve had. I started out as a staff therapist in a hospital and I worked as a unit manager and a program director in inpatient services. Although I found those rewarding, it really pales in comparison to how much of an impact this job has had.

I’m seeing young people on both sides of the table – students that had no idea a health profession existed and got so fired up about it, our programs were a life-changing event for them and students that were so convinced they were going to be a nurse or a physician or some part of the health profession, and when we got them into some blood-and-guts stuff, they found that wasn’t what they wanted to do. I think that is as much of a success for our program as finding that student who had no clue about a health profession, because that student isn’t wasting time and resources and someone else can fill that slot. One of our success stories came out of a residential health explorations camp. This young man realized he couldn’t be a hands-on provider; it just wasn’t in his makeup. But he was still very interested in health care and he went on to study accounting and business and get a degree in health care management and became a health care administrator. I see that as a win as much as bringing that potential nurse or physician onboard.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.