North Carolina AHEC Program
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Bacon: AHEC’s Success Reflects Enduring Power of Partnerships

Reprinted from the University Gazette, January 29, 2013

Tom BaconIt was nearly 40 years ago, but Tom Bacon still remembers the hour he spent sitting in Glenn Wilson’s office in MacNider Hall as if it were yesterday. Looking back, he sees it as the hour that changed his career trajectory.

It took place in 1974, roughly two years after the N.C. General Assembly awarded Carolina an $8.5 million grant to develop a statewide system of area health education centers – or what would come to be known as AHEC.

Wilson was its founding director; Bacon, at that time, a doctoral student in public health who wanted to learn what this new organization was all about.

Bacon remembers Wilson standing in front of a North Carolina map that filled almost the entire wall and pointing to nine dots that spanned Asheville to Fayetteville to Wilmington.

And from those dots, Bacon could see Wilson’s vision for training health professionals to meet the needs of rural and other underserved communities take shape.

Early snowbirds
Bacon and his wife, Ellen, had been studying maps, too – in 1971 when they suffered through what they had decided would be their last frigid winter in Chicago.

Bacon was from Florida, Ellen from Arkansas, and they chose North Carolina because it was a place where snow was a novel surprise.

They had been in Chicago so Bacon could earn a master’s degree in demography from the University of Chicago. That degree helped him get a job doing population research at the Research Triangle Institute, which, in turn, equipped him with the skills and experience he needed to get a part-time job at AHEC about a year after his conversation with Wilson.

In 1977, as Bacon was about to finish his degree, Gene Mayer – who was then AHEC’s deputy director, soon to become the director – offered Bacon a position as associate director of evaluation.

Bacon continued in that role until 1982 when he was hired to lead the Mountain AHEC in Asheville. He returned to Chapel Hill to succeed Mayer as AHEC director in 1996, a position he will continue to hold under a successor is hired this spring.

Today, AHEC’s mission remains largely the same as in the 1970s: improving the distribution and retention of health-care providers, with a special emphasis on primary care and prevention; improving the diversity and cultural competence of the health-care workforce; enhancing the quality of care and improving outcomes; and addressing the health-care needs of underserved communities and populations.

“I am very fortunate to have worked for this program for 35 years because it has a mission that I believe in and it attracts the kind of people I love working with on this campus and in our AHEC centers,” Bacon said. “They are very talented people who are passionate about providing care to people and training the next generation of doctors, nurses, dentists, pharmacists and other health professionals that we will need.

"It was the best job in the state, and that’s why I stayed.”

Building on a legacy
As a new AHEC leader will look to the future, Bacon said, it is important to remember how far North Carolina has come in terms of extending health care to its neediest citizens. During World War II, North Carolina led the nation in the number of draftees rejected from military services because of poor health.

“It resulted in the funding for this medical school and this hospital,” Bacon said. In 1944, then Gov. J. Melville Broughton appointed the commission that recommended funding for both.

“It is remarkable history and it connects to AHEC through a series of visionary leaders, including Dr. W. Reece Berryhill,” Bacon said.

Berryhill was the founding dean of the four-year medical school, which was created to serve as “the medical school of the people.” But when Berryhill stepped down as dean in 1964, he realized that the mission of extending medical care throughout the state remained incomplete. So he led an effort in the late 1960s known as Division of Research and Education in Community Medical Care – a forerunner to AHEC.

“He saw AHEC as the continued expression of this medical school reaching out to serve the people of North Carolina,” Bacon said, and that vision remains as powerful today as it was then.

The power of partnerships
Bacon has led efforts to modernize AHEC and extend its educational reach through the use of technology. He has worked to make AHEC a vital resource for health-care providers as they seek to transform the way care is delivered in an era of health reform.

In 2010, AHEC received $13.6 million from the U.S. Department of Health and Human Resources to assist primary care practices throughout the state in implementing electronic health records – a technology that will become even more vital in improving quality and lowering costs in the future.

Last June, while AHEC was preparing a celebration of its 40th anniversary, Bacon met with Wilson again – this time to talk about how the program got started and to explore the mission AHEC might play in the next 40 years.

The two men talked about the support and vision of leaders such as the late William Friday, who had recommended federal support for AHEC in the early 1970s, and Ike Taylor, former medical school dean and father of singer James Taylor, who lobbied the N.C. General Assembly for AHEC’s initial funding.

They also spoke of the enduring value of partnerships in AHEC’s success.

“The key to our program is to be very clear about what our vision is, to be very clear about what our values are and to be very clear about what we would like to see happen in the way of improved health for the people of the state,” Bacon said.

Each year, AHEC supports thousands of students who are placed with community providers to gain real-world clinical experience and explore opportunities where they might ultimately practice. Since 1978, 3,200 physicians have graduated from AHEC residencies – most are in primary care, and more than half still practice in North Carolina, Bacon said.

These graduates are more likely to practice in the state’s small towns and rural areas, where they remain badly needed.

Nearly 200,000 health professionals each year attend AHEC continuing education programs, many targeted to national issues such as veteran’s mental health care, chronic illnesses in the elderly or childhood obesity.

“Our programs are designed to take the best of what everybody has to bring,” Bacon said. “It’s a little bit like conducting an orchestra. Everybody has a part to play if we are going to be able to achieve what we want to achieve.

“It goes back to Glenn Wilson’s concept of partnership. AHEC is nothing without its partners – at the community level and right here on campus.”

Looking to the future
Still, there are counties in North Carolina that lack a dentist or a permanent physician or have an inadequate number of nurses, Bacon said. The need is greatest in the state’s economically distressed areas, including the mountains, the northeast or along the South Carolina border – just as when AHEC began.

Geography is no longer the only barrier, he said. Urban poor lack health insurance, and a fast-growing, underserved Hispanic population sees language and culture as barriers to care.

Bacon is guardedly optimistic that the Patient Protection and Affordable Care Act, known as Obamacare, can be a positive force in eliminating some of these barriers.

Last year, the U.S. Supreme Court ruled the legislation was constitutional, but at the same time, gave each state the right to reject one of its major components: the expansion of Medicaid to serve the working poor.

Of the nearly 10 million people in North Carolina, about 1.3 million are uninsured, Bacon said. Of those, roughly half would be covered under Medicaid if the state decides to opt in, and many more would be covered through the health insurance exchange designed to offer small businesses and individuals more affordable insurance options.

Within the uncertain health-care environment, AHEC’s work will continue, Bacon said: “With its emphasis on training primary care providers and offering training programs and support services across the state, I believe the program is well positioned for the future to help providers adapt to improve health care for all North Carolinians.”

By Gary Moss, University Gazette