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The UCAM option: Exposure to urban clinics and culture

Fourth-year medical student Anna Donoghue examines a young patient at the United Family Medicine Clinic while UCAM codirector Tim Rumsey, M.D., observes. (Photo: Scott Streble)

The Medical School was ahead of the curve when it designed a novel program to expose students to urban family medicine—nearly 20 years ago

Last January, the U.S. Senate released a report with the alarming headline, “30 Million New Patients and 11 Months to Go: Who Will Provide Their Primary Care?”

The facts bear out the senators’ concerns that when the Affordable Care Act (ACA) is fully implemented next year, there will be a dearth of primary care docs awaiting the onslaught of newly insured patients.

Consider the numbers: In 2011, only 7 percent of medical school graduates nationally chose a primary care career, despite the fact that more than half of patient visits are to primary care doctors. Fifty years ago, more than half of America’s doctors practiced primary medicine; today, fewer than one in three are primary practitioners, and many of those doctors are nearing retirement.

The problem only gets worse in urban settings, where residents suffer from common health disorders—high blood pressure, obesity, diabetes—in disproportionately high numbers, and where primary care doctors are scarce.

Not surprisingly, medical schools across the country are looking for ways to bring students face-to-face with what they call the “underserved” urban population. Often such exposure encourages students to consider a career in primary care medicine. To the University of Minnesota’s credit, its Medical School has not just one, but two, programs designed to foster student learning in an urban, primary care setting.

“Primary care is known to be the most effective, most efficient way of delivering health care,” says Christopher Reif, M.D., M.P.H., one of three codirectors of UCAM. The Urban Community Ambulatory Medicine program allows 12 students per year to spend a three-month rotation at an urban family medicine clinic in Minneapolis or St. Paul.

“Most of our training in medical school is devoted to health and disease in individuals,” says Reif. “But UCAM asks, ‘How do we promote the health of the community in places where the burden of disease is heaviest?’”

The power of UCAM

When Elizabeth Beckman, M.D., started medical school at the University in 2009, she already had a passion for working with an urban population struggling with mental illness, so she naturally looked for opportunities to build her experience with that patient group. When she discovered UCAM, her interest only grew.

“UCAM was far and away the best experience I had in medical school,” says Beckman, who graduated this spring and recently began a combined family medicine/psychiatry residency at the University of Cincinnati/The Christ Hospital. “The time I spent in a family medicine clinic taught me how essential it is to help patients improve their health in the context of their community, instead of just within the context of the medical system.”

UCAM is forerunner to another program recently launched in the Medical School called MetroPAP, or the Metropolitan Physician Associate Program (see the related story Urban Engagement). Both urban programs, ironically, owe their existence to the University’s renowned Rural Physician Associate Program—better known as RPAP.

Established in the 1970s, RPAP was the first program of its kind in the world to offer a clerkship or medical school rotation that sent students into rural settings to work in family practice clinics. RPAP was so successful that it has served as a model for other medical schools around the world looking to launch similar programs.

And in the early ’90s, it also inspired a group of second-year medical students at the University to launch UCAM.

UCAM’s beginnings

In 1993, Joanna Perkins, M.D., M.S., then a medical student, and a couple of her classmates were regular attendees at the American Medical Women’s Association meetings on campus.

“Several of us in the group started talking about what we’d be doing for clerkships,” recalls Perkins, who is now medical director of outreach and a staff physician in pediatric cancer and blood disorders at Children’s Hospitals and Clinics of Minnesota. “Several people were interested in RPAP, but a few of us were more interested in working in an urban setting. So we went to the RPAP administrator and asked what we’d have to do to set up a similar program in the city.”

Perkins, along with Anne Edwards, M.D., and Colleen Townsend, M.D., did the legwork, and UCAM was officially launched in 1994.

“I worked at the Bloomington Lake Clinic in South Minneapolis [since relocated after a fire],” says Perkins, “and while I ultimately chose to work in pediatric oncology, I knew I wanted to continue to serve in that same community.”

UCAM not only immersed the students in the clinic setting but also exposed them to the cultural realities of the neighborhoods in which they served.

“We met with Hmong shamans and Native American healers,” Perkins explains. “We went to community advocacy groups’ meetings and sat in on neighborhood focus groups. We wanted to complement the medical experience with supplemental cultural learning.”

UCAM Codirector Christopher Reif, M.D., M.P.H., makes a plan for the day with medical students (from left) Anna Donoghue, Ashley Dohlen, and Mariel Lougee at the Community-University Health Care Center. (Photo: Scott Streble)

Why it works

UCAM clearly met a need, and students responded enthusiastically—and still do today: The rotation is already filled for the next two years with students eager to get hands-on experience with patients at sites like the Broadway Clinic in North Minneapolis (one of the family medicine department’s four Twin Cities residency programs) and La Clinica on St. Paul’s West Side.

“UCAM gives students exposure to the very real, and practical, side of medicine,” says David Power, M.D., M.P.H., another UCAM codirector. “They learn not just about the illnesses so prevalent in these communities—depression, chemical dependency, diabetes—but how to fill out disability paperwork, or how patients qualify for Medical Assistance. Nowhere else in the Medical School curriculum is there information on these sorts of real-world problems.”

It’s very common, Power adds, to hear students say that UCAM was a life-changing experience. Besides gaining clinic experience, the students spend time with their mentors, codirectors Reif and Timothy Rumsey, M.D., a family physician who works at United Family Medicine Residency Program in St. Paul and runs a clinic for homeless people one day a week at the Dorothy Day Center.

According to Power, UCAM has been overwhelmingly successful in encouraging students to consider a family medicine career: About two-thirds of UCAM students go on to work in primary care. That’s significant today, as medical schools struggle to meet the growing demand.

The need remains critical

“We definitely need more primary care docs to meet the demands that ACA will bring,” says Power. “It’s been estimated that to meet the future health needs of the population, we will need 40 percent of medical school graduates to choose that path. The U has a very strong primary care focus—last year 18 percent of our students chose family medicine; 29 percent chose medicine, pediatrics, and med-peds, but, increasingly, smaller numbers of graduates from those disciplines choose to practice primary care. So both of these programs—UCAM and MetroPAP—are critical for exposing students to primary care.”

Reif believes that medicine needs to find new educational models. “We have to invest in prevention up front in order to save money in the long run,” he says. “And prevention works best in community clinics where doctors can intervene early and keep small problems from becoming major medical concerns.”

Since there are only a handful of urban family medicine clinics in the Twin Cities, UCAM is at capacity for the near future. But with dedicated mentors like Reif and Rumsey, the program will likely continue inspiring students to follow the path to primary care medicine.

Barbara Knox is a Minneapolis-based writer and editor who covers a wide range of topics for local and national publications.

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