Program trains docs to treat underserved groups

The San Joaquin Valley Program in Medical Education (PRIME) might not be that well known by residents yet, but it could improve health care for those who live in the eight-county area for years to come.

The program is training doctors, most of whom are from the San Joaquin Valley, who want to treat underserved populations in the area. Currently, the San Joaquin Valley has too few doctors, including both primary care physicians and specialists.

The SJ PRIME is a collaboration between the University of California at Merced, the UC Davis School of Medicine and UCSF Fresno’s Medical Education Program.

It is the sixth and latest addition to PRIMEs in place at UC medical schools, according to Sneha Patel, program manager of UC Davis Rural PRIME and SJ Valley PRIME. Long-range plans call for a medical school to be built at UC Merced, according to university officials.

In addition to the rigorous training they receive at UC Davis medical school, students in SJ Valley PRIME learn about health‐care issues specific to the valley. The program’s goal is for these medical school graduates to return to the area after their training is completed.

“The history goes way back,” says Brandy Nikaido, UC Merced spokeswoman.

She explains that planning for medical education began even before undergraduates arrived on the newest UC campus in September 2005. The other two UCs were chosen as partners, Nikaido said, for purposes of “building on the accreditation of UC Davis and the infrastructure of UCSF Fresno.”

Students’ acceptance to SJ Valley PRIME hinges on a knowledge of the valley and a desire to practice as physicians in the area, Nikaido says. They receive a $10,000 scholarship that is funded by Children’s Hospital Central California, Community Medical Centers and Bryn Forhan, a Fresno businesswoman and co‐chair of the Valley Coalition for UC Merced Medical School, according to the UC Davis School of Medicine Alumni Association.

Medical students often don’t know which branch of medicine they will enter after completing training, but a range of physicians is needed in the San Joaquin Valley, says Dr. Joan Voris, associate dean of UCSF Fresno Medical Education Program.

According to a 2008 study by the California Healthcare Foundation, the San Joaquin Valley is lacking in primary care physicians as well as specialists. The valley had 45 primary care physicians per 100,000 population, while the recommended number was 60‐80. Specialists in the valley were at 74 per 100,000 population, with recommendations calling for 85‐105.

The hope is that San Joaquin Valley PRIME will change those figures, starting with UC Merced’s initial group of five students, which completed its first year of medical school this summer.

“It was really hard, really intense,” Sidra Ayub, 26, says of the year. Her family moved to Modesto from Pakistan when Ayub was 5 years old. She says she knew from a young age that she wanted to be a community leader and “saw medicine as a good opportunity to open myself to that. Doctors set the tone for good will.”

Ayub understands firsthand the health‐care deficits in the valley. “I have the worst dental episodes,” she says, adding that she didn’t take care of her teeth because her family couldn’t afford preventative care.

“You have to get people early,” Ayub says, before they show signs of dental decay or illness. For that to happen you need enough health‐care practitioners and access to the proper medications. Take statins, medications that lower cholesterol, for instance. “Why shouldn’t people be on that?” Ayub asks, regardless of whether they live in New York City or a small valley town.

Such empathy fosters her desire and that of other PRIME students to undertake the daunting work involved in medical school and at the same time attend weekly seminars, shadow valley physicians, volunteer to help underserved patients and even participate in book clubs whose selections concentrate on valley issues.

This June, SJ Valley PRIME students boarded a bus that carried them from Sacramento to Delano, near Bakersfield. They learned during the two‐day trip about the food, culture, traditions and health‐care needs of such groups as the Filipino community in Stockton and the Laotians in Modesto.

David Hosley, executive director of UC Merced’s Sierra Nevada Research Institute, acted as tour guide and spoke to the students about equity issues in the valley. Gerald Haslam, historian, author and professor emeritus at Sonoma State, and his wife, Janice, spoke to students about life in the San Joaquin Valley, pointing out that the area is one of entry for many immigrants.

Dr. Tonya Fancher, associate director for curriculum, UC Merced San Joaquin Valley PRIME, said that when students spoke to her after the tour they asked why they hadn’t known about many of the problems facing valley residents. She said her hope is that PRIME students will develop a passion in particular areas, including advocacy and outreach.

The medical students will move to UCSF Fresno during their third year of school, according to Fancher, where they will work directly with patients. Hands‐on contact with patients throughout the valley will continue in the fourth year.

“The students are itching to be in the valley,” Fancher says, but notes that it is difficult to get them there from Davis when medical school happens in “four‐hour blocks.”

The time crunch is a familiar one to medical student Ayub. “We had more preceptorships (supervised practical training) than our classmates,” she says.

“They’re hard to squeeze in in eight hours.” But she managed, working at Kaiser Permanente Medical Center in Roseville, where she shadowed an internal medicine physician and took a class for diabetics that included sticking herself with a needle so that she could relate to what a patient feels.

Ayub calls herself and the four other students in San Joaquin PRIME “pretty close knit” and says they work closely with members of UC Davis’ Rural PRIME, which has had four classes of 12 students each. “We ask them lots of questions.”

“UC Davis is a nurturing environment,” Ayub says. “There’s no ‘That’s a stupid question.’”

And because the San Joaquin Valley PRIME is in its infancy, it will continue to evolve, says Voris of UCSF Fresno Medical Education. “Our goal is to have a program that is really unique. Year Eight will look different.”

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