The Area Health Education Centers (AHEC) Program is a federally funded program established in the United States in 1972 "to improve the supply, distribution, retention and quality of primary care and other health practitioners in medically underserved areas."Bacon 2000, p. 288 The program is "part of a national effort to improve access to health services through changes in the education and training of health professionals."Gessert and Smith 1981, p. 116 The program particularly focuses on primary care.

AHECs are nonprofit organizations strategically located within designated regions where health care and health care education needs are not adequately met. An AHEC works within its region to make health care education (including residency and student rotations) locally available, on the premise that health care workers are likely to remain in an area where they train.Gessert and Smith 1981, p. 116 An AHEC also works to support practicing professionals with continuing education programs and other support resources and to attract youth (particularly those from minority and medically underserved populations) to health care professions. An AHEC partners with community organizations and academic institutions to fulfill its mission.

According to the National AHEC Organization, in 2015 more than 300 AHEC program offices and centers comprised the national AHEC network. AHECs are distributed across 48 states and the District of Columbia.Blossom 2009 In each state, the central program office(s) associated with a university health science center administrates the program and coordinates the efforts of the state’s regional AHECs. "Organization and staffing of AHECs varies greatly and is dependent on the supporting academic health center and availability of financial resources,"Seibert, p. 346 as well as the particular needs of the local area. "Each regional center has an office staffed by a center director and a variable number of support staff that may include an education coordinator, librarian, and 1 or more educators or program coordinators."Seibert, p. 346 Some AHECs also operate family medicine residency programs, employing medical personnel and support staff.

Purpose

The National AHEC Organization, the professional association of AHECs, reports that most regional AHECs work in the following program areas:Retrieved Feb 5, 2010 from

Health Careers Recruitment and Preparation: AHECs attempt to expand the health care workforce, including maximizing diversity and facilitating distribution, especially in underserved communities. To achieve this goal, AHECs offer health career camps, science enrichment programs, healthy lifestyle programs, health careers curricula and programs for elementary, middle school, and high school students. These programs introduce students to a wide assortment of health career possibilities, guide them in goal setting and educational planning, and offer science courses to strengthen critical thinking skills. Working with K-12 schools, colleges and community partners, AHECs target both economically disadvantaged students and those from underrepresented minority groups in school programs and summer institutes. Health Professions Training: AHECs provide community placements, service learning opportunities and clinical experiences for medical, dental, physician assistant, nursing, pharmacy and allied health students and residents in rural and urban underserved communities. AHEC placements (rotations) give them the opportunity to experience health care in settings that differ from typical health science centers. Through interaction with patients in hospitals, community health centers, county health departments, free health care clinics, and local practitioner’s offices, students and residents can observe the economic and cultural barriers to care and the needs of underserved and ethnically diverse populations in a primary care environment. Health Professionals Support: AHECs provide accredited continuing education offerings and professional support for health care professionals, especially those practicing in underserved areas. These programs are designed to enhance clinical skills and help maintain professional certifications. Programs also focus on recruitment, placement, and retention activities to address health care workforce needs. Health and Community Development: AHECs evaluate the health needs of their regions and provide responses to those needs. AHECs develop community health education and health provider training programs in areas with diverse and underserved populations.

History

The AHEC concept and mission originated in a 1970 Carnegie Commission report, Higher Education and the Nation’s Health: Policies for Medical and Dental Education. The report was concerned with "the serious shortage of professional health manpower, the need for expanding and restructuring the education of professional health personnel, and the vital importance of adapting the education of health manpower to the changes needed for an effective system of delivery of health care in the United States."Carnegie 1970, p. v Among its many recommendations for remedying the problems it detailed, the Carnegie Commission urged a cooperative relationship between communities and health science centers, geographic dispersion of health training centers, shortened training periods for physicians, and creation of "126 area health education centers (AHECs) to serve localities without a health science center." The Commission also charged universities "to cooperate with other agencies in helping to develop more effective health care delivery systems in their communities and surrounding areas."Carnegie 1970, p. 91 These and other recommendations were designed to "put essential health services within one hour of driving time for over 95 percent of all Americans and within this same amount of time for all health care personnel."Carnegie 1970, p 6-9

This landmark report proposed a new model for health care education, noting that "The United States today faces only one serious manpower shortage, and that is in health care personnel. This shortage can become even more acute as health insurance expands, leading to even more unmet needs and greater cost inflation, unless corrective action is taken now. It takes a long lead time to get more doctors and dentists."Carnegie 1970, p. 2

The medical education model proposed by the Carnegie Commission in 1970 represented a significant divergence from the Flexner model stimulated by the Flexner Report of 1910 to the Carnegie Foundation for the Advancement of Teaching.Flexner 1910 Based on research by Abraham Flexner during visits to 147 medical schools in the U.S. and eight in Canada, the Carnegie report recommended increasing the quality of medical care by physicians by increasing admittance and graduation standards, extending training periods, and eliminating medical schools that did not meet standards. Proprietary two-year institutions that resembled trade schools for physicians came under particular criticism. In the period following the Flexner Report, the number of medical school graduates and medical schools declined, with the number of medical schools stabilizing at 76 by 1929.Reynolds 2008, p.1004 Conversely, the population was steadily increasing, with a rise of 35 million between 1925 and 1950.Reynolds 2008, p. 1004 Declaring a crisis in meeting the health care needs of the population, the Carnegie Commission report of 1970 called for policies that would increase the health care workforce to fill the growing gaps in health care.Carnegie 1970, p. 4-5

The new model of 1970 called for increased production of health care professionals, an increase in the number of training centers, geographic dispersion of training centers, expanded use and increased production of trained supportive professionals (physician assistants, nurse practitioners, and allied health professions to supplement physicians and dentists, and increased diversity of persons trained. "To serve all the people everywhere," the new model called for the following changes:Carnegie 1970, p. 6

Expanding "the number of places for training doctors during this next decade [1970-1980] by 50 percent, and of dentists by 20 percent. Many of these new places should be filled by women and members of minority groups."Carnegie 1970, p. 6 Expanding the roles and increasing the supply of supportive personnel, noting that "Allied health personnel can be trained more quickly and less expensively than doctors and dentists, and their availability will make possible the better use of the time and skill of doctors and dentists."Carnegie 1970, p. 6 Increasing the number and dispersion of allied health training centers to include "comprehensive colleges and community colleges."Carnegie 1970, p. 6

"The responsibility for administering federal support of AHECs in conformity with the Carnegie model, that is, through contracts with university health centers, was assigned by June to the BHME in DHEW [Bureau of Health Manpower in the Department of Health, Education and Welfare, National Institutes of Health] by the Office of Management and Budget…on June 12, 1972 the BHME released a letter of announcement of a program for the support of AHECs, which was sent to all who had requested information regarding the ‘Health Manpower Initiative Awards’ of the Comprehensive Health Manpower Training Act of 1971 ... They were told that the government would refuse to consider any response postmarked later than June 25, 1972 ... The announcement…stated that contracts would be awarded no later than September 30, 1972.Odegaard 1979 pp. 14-15

"(In any consideration of the history of the first 11 AHECs, the short time span between the announcement of the federal program on June 12 and the award of contracts on September 30 should be kept firmly in mind.)" Odegaard 1979 pp. 15 "The national AHEC office not only had to work fast; it was also understaffed from its inception, with only three professional employees to supervise relations with 11 projects widely scattered over the nation."Odegaard 1979 p. 21

The House Appropriations hearing report stated: "certain staffing patterns were noted in BHM which indicate that there may be staffing imbalances among divisions ... . the Division of Medicine was administering about four times the amount of funds administered by the Division of Dentistry, but with 24 percent less staff…In sharper contrast, the AHEC staff was administering funds totaling about 44 percent of the funds administered by the Division of Dentistry, but with only 3 percent of the size of the Division of Dentistry staff."United States Cong. 1978. p. 422

In a footnote to his report, Odegaard cited sources of information on the AHEC program. He noted, "An additional source of information is found in the response to a request for information from the congressional surveys and investigation staff contained in a letter of reply dated December 23, 1977 from Daniel R. Smith, Chief, AHEC staff and National Coordinator and the only federal official in the executive branch who has been associated with the federal AHEC program since its implementation."Odegaard 1979 p. 21

Legislation and funding