By Alec Rosenberg
Fourth-year medical student Jamila Harris saw community members in her native San Francisco neighborhood struggle to navigate the health system. So she helped give them a voice.
Third-year medical student Tirza Cannon met rural Amador County high school students who needed physical exams to compete in fall sports but couldn't afford them. She stepped in, so they could play.
Second-year medical student Jacob Bailey, the only one of his peers to attend college, saw teens who faced similar obstacles in southeast San Diego. He taught them health classes, sparking their interest not only in nutrition but also higher education.
Filled with passion and promise, these students are just getting started. They are part of the University of California's Program in Medical Education (PRIME), an innovative initiative to train doctors to serve where they are most needed in the state. UC already trains roughly two-thirds of all medical students in California, but the state faces a shortage of up to 17,000 physicians by 2015. UC PRIME is helping to fill the gap in a unique way — with students who are from the state's underserved communities or strongly connected to them.
UC PRIME, which offers specialized training for an M.D. and master's degree in five years, started in 2004 at UC Irvine and has expanded systemwide. PRIME students must meet the program's criteria and UC medical school admission requirements. Total PRIME enrollment has grown from about 200 students in academic year 2009-10 to approximately 250 this fall — the first substantial increase in UC medical school enrollment in 40 years. A sixth PRIME program focusing on the needs of the San Joaquin Valley opens in 2011 in partnership with UC Davis, UCSF Fresno and UC Merced. Meanwhile, clinics continue to apply to work with PRIME students.
"Because of the needs California faces in terms of its physician work force, we set out to expand medical school enrollment in ways that were unique and responsive to the needs of the medically underserved," said Dr. Cathryn Nation, UC associate vice president for health sciences and services. "This really is a systemwide effort involving educational programs that are aligned with a very clear purpose."
PRIME's focus on medically underserved communities already is achieving much-needed increases in medical student diversity. More than half of UC PRIME students are from groups traditionally underrepresented in medicine.
Irvine PRIME: building bridges
Sarah Lopez, the oldest of six siblings, grew up in a Latino community in Orange County where day laborers, housekeepers and others lacked health insurance, faced language barriers and didn't trust the medical system. She wanted to give back to her community, so she joined the inaugural PRIME class at UC Irvine - the first U.S. medical education program addressing the unique health care needs of Latinos.
"The PRIME program focused on how we create a bridge between our patients and our community," Lopez said.
Through PRIME, Lopez visited Cuernavaca, Mexico, to observe the role of promotoras — outreach workers who serve as community health advocates. She worked with Orange County promotoras to teach Latinos the importance of Pap smears.
Lopez, part of the first PRIME graduating class in 2009, is now a USC resident in an emergency room at a county hospital, where she is joined by a PRIME intern. Lopez translates for Spanish speakers "every hour of my job" and sees patients with diabetes, obesity and high blood pressure. She is working to connect patients with promotoras. Her goal is to practice emergency medicine near her hometown.
"I think some people expected us to fail," Lopez said. "The PRIME program gives you an outlook and perspective on medicine that will one day change the way we practice health care in the United States."
UCSF PRIME: serving urban neighborhoods
San Francisco native Jamila Harris was inspired by her mom's community activism but frustrated that her friends did not get the health care they needed. After earning a bachelor's degree from UC Berkeley and working at a women's free clinic in San Francisco, she pursued her passion to become a doctor through UCSF PRIME. "It focuses on people like me who are interested in serving the community," Harris said. "It was a perfect fit."
UCSF, which hosts a systemwide PRIME student conference in October, has a PRIME program that includes students from the UCSF School of Medicine and the Joint Medical Program at UC Berkeley. Through PRIME, Harris has toured San Quentin prison, helped organize a health career fair for Oakland elementary students and done rotations at Maxine Hall Health Center in San Francisco's Western Addition, the very neighborhood where she grew up.
Being in PRIME has reminded her why she wants to become a psychiatrist.
"It's a commitment to serving underserved populations," Harris said. "I definitely will do community work."
Davis PRIME: Rural doctors
UC Davis PRIME touches across rural California from King City to Redding. Third-year students Tirza Cannon and Sahar Doctorvaladan are working four-week rotations in Jackson at Sutter Amador Hospital and its clinics.
The caseload runs the gamut. Rattlesnake bites are at record levels. The 66-bed hospital delivers 30 babies a month. The internal medicine clinic sees mostly elderly patients. The outlying Plymouth clinic sees mostly younger, uninsured patients. "We're on the front lines of the recession," said Sutter Amador's Dr. Catherine Leja.
When Doctorvaladan's clinical instructor Dr. Robert Young joined Sutter Amador six years ago, there were three other practicing obstetricians. Now there's one. "So it's plenty of opportunity to see the patients," Young said.
In her first week, Doctorvaladan helped deliver twin girls. "It was my first birth," she said. "It was definitely very miraculous and magical."
At 5, Doctorvaladan immigrated with her family to the United States from Iran, escaping a war with neighboring Iraq. The poverty and lack of medical care left an impression on Doctorvaladan, whose great-grandfather four generations back was his village's only physician. After attending UC Davis as an undergraduate, she feels connected to rural communities and wants to practice in a small town.
"Wherever there is a need, that's where I'd like to be," Doctorvaladan said.
Cannon works with clinical instructor Dr. Robert Hartmann, a Sutter Amador physician and county public health officer, known locally as "Dr. Bob" after 22 years in Jackson. On a recent work day, she saw an elderly patient who had injured his hip. Then it was off to the Plymouth clinic for orientation. Next it was a chance for community service: She met Hartmann at Amador High School to provide free physical exams to low-income students so they can play fall sports.
"It's nice to be able to get out in the community," said Cannon, who spent a year in Uganda as a child. She also was shaped by her time as a UC Davis undergrad, firefighter and health educator in Sonoma County. "I think my interest in practicing in a rural community has been strengthened since being here," she said.
Hartmann is energized by the students' enthusiasm and eager to share teachable moments with them, wishing some might return to practice in Jackson. "We just have this glimmer of hope that one or two or three or a half dozen of them will like Amador County enough that they'll come back," Hartmann said.
The next PRIME: progress in the valley
PRIME is part of UC's strategy to expand its medical education efforts. UC's sixth medical school at UC Riverside is slated to open in 2012. Meanwhile, UC Merced is taking steps toward a medical school, including a new PRIME program, with UC Regents receiving a briefing at their September meeting.
"Our PRIME program focuses on excellence in student education and integrates continuous quality-of-care improvements," said Dr. Fred Meyers, executive director of medical education and academic planning at UC Merced.
"It emphasizes the importance of community-based research to enhance the health and well being of everyone living in the San Joaquin Valley and, ultimately, it enables these future physicians to become the leaders of health care and public health in the valley," said Meyers, who also is executive associate dean of the UC Davis School of Medicine.
The UC Merced San Joaquin Valley program expects to collaborate with UCSF Fresno and other valley hospitals and clinics. One site considering participation is Mercy Medical Center Merced, which opened a 194-bed hospital in May.
Merced has many people who are poor and uninsured. They lack transportation and face language barriers, along with pollution problems and chronic diseases such as diabetes and obesity, said Mercy Merced's Dr. John Paik-Tesch.
"I see a partnership with UC as an opportunity to address many of the needs," Paik-Tesch said.
Many UC Merced students are interested in medical careers, said Provost Keith Alley. Nearly 100 people — about half from the valley — already have applied for UC Merced PRIME's initial six slots next year. The plan is to expand to 12 or 24 students per class, depending on funding.
The state's budget deficit is such that no state support was provided for PRIME the past two years. UC made funding available on a one-time basis in 2008-09 for PRIME expansion, but the absence of core state support for these programs puts them at risk.
"We look forward to applying what we've already learned with Rural-PRIME to UC Merced San Joaquin Valley PRIME, only the focus will be more on the underserved and public health," said Dr. Don Hilty, who directs UC Davis Rural-PRIME and co-directs UC Merced San Joaquin Valley PRIME.
UCLA PRIME: serving the diverse disadvantaged
UCLA's PRIME program, focused on diverse medically disadvantaged communities, includes partnerships with UC Riverside and Charles Drew University. Third-year UCLA/UC Riverside PRIME student Marizabel Orellana grew up in a low-income Los Angeles community. A single mom, she struggled financially, working to help support her mother, younger brother and her daughter while becoming the first in her family to attend college. When counselors told her she couldn't become a doctor, she didn't listen.
"I've had to prove a lot of people wrong," Orellana said. "My daughter was a big motivation. Being a single mom, I wanted her to have the things I didn't have."
In her first two years at UC Riverside, Orellana served as a mentor, helped at a student-run health clinic and worked with fellow students to launch a Junior Interns Program at Renacimiento Community Center in Pomona, involving teens as volunteers and encouraging them to go to college.
Said Orellana: "I tell them, ‘I did it. If I can do it, anyone can do it.'"
Orellana wants to work in family or emergency medicine in a low-income area of Southern California. In her third year at UCLA, she is now doing rotations at county hospitals. Her advocacy goes beyond the bedside - she has pushed for health care access on Capitol Hill and is filming a documentary about efforts to bring health care to Adelanto, a town in San Bernardino County.
"I don't mind working 100 hours a week," Orellana said. "I love it."
UC San Diego PRIME: expanding health equity
Many of Jacob Bailey's friends didn't graduate from high school. Bailey, a native of Los Angeles' Harbor area whose mom's family is from Mexico, served a two-year mission in Mexico City and graduated from the University of Utah, one of only seven Latinos in his college's class. He now is a second-year student in UC San Diego's PRIME Health Equity program.
"The focus PRIME has on serving the underserved, the people where I grew up, the people that I care about, made it an easy choice," said Bailey, who wants to work in an urban Latino community where he can see patients, teach students and do research.
Through PRIME, Bailey has participated in Doc-for-a-Day outreach sessions with teens and taught health classes to students at Lincoln, an underserved high school in southeast San Diego. He helped them learn healthy habits and encouraged them to do well in school.
Bailey and fellow PRIME students meet at least once a quarter in what they call sí se puede sessions. They talk about the highs and lows of being in the program, providing support to each other.
"We really do believe that PRIME students will be leaders in medicine," Bailey said. "All of us are so passionate about being champions for the underserved."