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UGAPreMed a magazine for uga pre-med students

VOLUME II ISSUE THREE

PHYSICIAN Georgia ranked among lowest in physician per capita

TO VACCINATE OR NOT TO VACCINATE?

GRU/UGA MEDICAL PARTNERSHIP AN INTERVIEW

HEALTHCARE IN ATHENS

MEDICAL INTERNSHIPS IN ATHENS


|What’s Inside|

FEATURE PRESENTATION

DEPARTMENTS

TO VACCINATE OR NOT TO VACCINATE?

3 EDITOR’S LETTER

BY BETHANY WATSON

A message from our Editor

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4 YOUR VOICE

Should Healthcare Be Provided For Illegal Immigrants?

6 THROWBACK

Plague and Public Health in the Postbellum South

GEORGIA’S PHYSICIAN CRISIS BY: MUGDHA JOSHI

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The Big Issue

Obesity: The Supersized Problem in Georgia

24 ADDICTION

What’s Your Drug of Choice? Drug Use in Georgia

GEORGIA REAGENTS UNIVERSITY UGA MEDICAL PARTNERSHIP: An Interview with Campus Dean, Dr. Barbara Schuster BY: SHAJIRA MOHAMMED

22 UGA CLUB FOCUS

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25 FOOD FOR THOUGHT

Health of Migrant Farmworkers in Georgia

26 INTERNSHIPS

Medical Internships in the Athens-Clarke Area

HEALTHCARE IN ATHENS BY: SHEILA BHAVSAR

27 PREMED ILLUSTRATED

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Pre-Med “Types”


UGAPreMed

ON THE COVER

Grady College of Journalism and Mass Communication Franklin College of Arts and Sciences

FACULTY ADVISOR Dr. Leara Rhodes

EDITOR IN CHIEF Shajira Mohammed

MANAGING EDITOR Aashka Dave ASSOCIATE MANAGING EDITOR Selin Odman PHOTO EDITOR Heather Steckenrider DESIGN EDITOR Tammy Luke

Graphic representation (per county) of the ratio of population to primary care physicians in the state of Georgia [2010-2011]. Data provided courtesy of

www.countyhealthrankings.org

GRAPHIC DESIGNERS Christine Byun Lauren Foster Tammy Luke Gloria Jen BUSINESS EDITOR Sona Sadselia ASSOCIATE BUSINESS EDITOR David Kupshik ASSOCIATE EDITOR Erica Lee PROMOTIONS EDITOR Kathleen LaPorte PUBLIC RELATIONS Hannah Kim Sona Sadselia Chisom Amazae WRITERS Sheila Bhavsar Laurence Black Carley Borrelli Sarah Caesar Kristen Farley Mugdha Joshi Ahmed Mahmood Emily Myers Cathrina Nauth Ronke Olowojesiku Nina Paletta

www.premedmag.com facebook.com/premedmag twitter.com/UGAPreMedMag

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PHOTOGRAPHERS Janny Liu Jessica Rebaza Heather Steckenrider


|Editor’s Letter|

A MESSAGE

FROM OUR EDITOR This month’s issue is all about health and medicine in Georgia. Our features delve into Georgia’s growing physician shortage, the GRU/UGA Medical Partnership, and examining the state of medicine in Athens. Our writers also explore local internships in Athens for you to get involved and opinions about the controversial issue of providing health care to undocumented immigrants.

The entire staff of PreMed Magazine is working hard to develop the magazine into a pre-professional publication that will inspire and keep students motivated to pursue careers in science and medicine. I hope this issue’s focus on health care in Georgia helps students understand Georgia’s current situation and what is being done to improve health care in our state. Perhaps it may help spark an idea in you. In an effort to engage our readership and encourage dialogue, we will be taking student submissions for letters to the editor. We encourage you to voice your opinion on any of the topics covered, express any ideas you come up with to help mitigate current problems, or even give us feedback on how we can improve PreMed Magazine. I hope to encourage students to become active contributors in the fields of science and medicine.

PreMed Magazine at UGA

Shajira Mohammed Editor-in-Chief

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|Your Voice|

SHOULD HEALTHCARE BE PROVIDED PROS Why Healthcare should be Provided for Illegal Immigrants BY: SELIN ODMAN Recent focus on reforming the health care system this past year questions whether illegal immigrants should benefit from the US health care system. Currently, the majority of Congress is against providing Medicaid or Affordable Healthcare Act coverage to illegal immigrants. They argue that hard-working taxpayers should not have to fund the health care of immigrants who are not even allowed to be in America.

However, the issue is not if Americans should pay for the health services of undocumented immigrants, but whether we should have an official avenue to do this or not. Americans are already indirectly paying for the health services of these undocumented immigrants. Sy Mukherjee from ThinkProgress focuses on the Emergency Medical Treatment and Active Labor Act (EMTALA) passed in the late 1980s. This act states that emergency rooms cannot turn away patients without insurance or legal residency. Most illegal immigrants use ERs for their health care. However, many cannot pay for expensive procedures so their services go unpaid. In return, these ER trips are paid by Americans through the increased taxes and medical costs that every consumer must pay, states Mukherjee. Instead of paying for the healthcare of illegal immigrants through an unofficial, unregulated manner, there should be a special fund in place. Instead of waiting to provide care for those who are sick, I hope to see a shift toward “preventive medicine.” Keeping immigrants and citizens alike out of the emergency rooms will help lower the cost of healthcare. Preventative medicine is a more informative and independent approach to medicine that empowers the public and will help prolong lives without the use of expensive drugs or procedures. Currently, primary care and preventative care are not accessible to illegal immigrants, so they flock to

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emergency rooms for expensive treatments and inflate what the taxpayers owe for healthcare.

A good solution is to implement low-income programs into insurance options that would provide enough coverage to illegal immigrants to keep them out of emergency rooms and hopefully discourage increasing healthcare costs. Isn’t the goal to make healthcare affordable and accessible to everyone in the country? If one group of people resorts to expensive care, then the rest of us also suffer in paying these costs. In addition, I believe not providing health care to all of our residents will lead to a sickly, unproductive population. It’s important to make sure that the workforce, legal or not, is healthy and able to provide for the country. The truth is, illegal immigrants make up much of the labor force. They take the jobs that Americans do not want and are willing to work for much lower wages. In that case, illegal immigrants deserve to benefit just as much from the new healthcare reforms as citizens do.


FOR ILLEGAL IMMIGRANTS? CONS On Illegal Immigrant access to Federal Health Care benefits BY SWAYAMDIPTO MISRA Immigration reform was a hot button issue this past summer as politicians from both sides of the spectrum engaged in heated debates and grandstanding in attempts to please constituents and make lasting changes in American society. Ultimately, nothing significant happened, but the recent focus on illegal immigrants brought many pressing issues back into the public eye, one of them being whether illegal immigrants should have access to federal government healthcare programs like Medicaid. Illegal immigrant access to healthcare is certainly a pressing matter in Georgia, a state that routinely ranks in the top ten states for number of illegal immigrants currently residing in the state.

Illegal immigrants should not have access to federal government health care benefits as their illegal status should disqualify them from being eligible. Legal residents pay money to the government through taxes and fund programs like Medicaid, which is jointly funded by the federal government and states. It is not fair for legal residents to fund healthcare access for illegal immigrants who have not had any part in directly funding government programs. They serve as leeches on the current system and force legal American taxpayers to pay for their medical care. Medicaid currently pays about $2 billion a year for emergency treatment of uninsured patients, a group which, according to hospitals, is primarily composed of illegal immigrants. Much of the money goes to hospitals to reimburse them for delivering babies of women who randomly show up in emergency rooms. It is unreasonable to expect Americans to fund programs which benefit individuals who broke immigration laws and came into the country illegally. Government programs which cover the costs of delivering the children of illegal immigrants, who are born as American citizens, serve as incentive for other illegal

immigrants to try to get into the Unites States to give birth on American soil in order to give their future children better circumstances. The complete abolition of such programs is not viable from a humanitarian standpoint but new laws governing the citizenship of the children of illegal immigrants could help stem the tide of illegal immigrants coming into the country solely for their children’s sake.Even legal immigrants who have stayed in the US for less than 5 years are not eligible for regular Medicaid coverage, so allowing illegal immigrants to use that funding is a slap in the face of legal immigrants. Giving illegal immigrants free access to the American health care system will attract more illegal immigrants to the country, who hope for free healthcare. More immigrants will create a logjam of cheap labor which will drive down wages for lower skilled workers and result in more unemployed, a group whose growth is correlated with increases in the crime rate.

A 2007 study published in the Journal of the American Medical Association found that in a 4-year period, about 99 percent of people who reported using Emergency Medicaid were illegal immigrants. The Center for Immigration Studies estimates the current cost of treating uninsured illegal immigrants to be $4.3 billion a year, mostly allocated towards emergency rooms and free clinics. The clinics which treat illegal immigrants are congested and do not offer as good quality treatment due to factors such as low compensation and the inability of patients to follow through with treatment plans.

Another problem is what happens to illegal immigrants once they wind up in a hospital. Patients who require long-term care, but have no insurance or money to pay for it are usually stuck in limbo until the hospital can designate them as qualifying for Medicaid coverage, a decision which can take many months. Long-term care patients also end up staying in hospitals for longer durations and the cost of treatment rises to hundreds of thousands of dollars because federal law prohibits hospitals from discharging patients without a projected plan for ongoing care. These patients have no relatives, insurance or established address to be released to. Thus, illegal immigrants should not get access to federal health care benefits due to the high economic costs associated with treating them, a burden placed on taxpayers and the problems associated with giving illegal immigrants access to healthcare. PreMed Magazine at UGA

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|Throwback|

PLAGUE AND PUBLIC HEALTH IN THE POSTBELLUM SOUTH BY ERICA LEE At the turn of the century, America was a vastly different place than it is today. In 1911, President William Taft sat in the Oval Office, 10,000 Ford Model T’s puttered along cobblestone roads and Georgia’s Board of Regents first voted to allowed women to enroll in the University of Georgia. However, this America was not an idyllic paradise. Two wars raged in the country for the health and safety of American workers. While the North fought for safe working conditions in factories like the infamous Triangle Shirtwaist factory, the South fought an invisible army of millions lurking in its own soil. The South’s enemy? Necator americanus, the New World hookworm. Most news about hookworms today focuses on preventing outdoor pets from infestation and preventing its spread in third world countries, but in 1911, hookworm infections were a daily nightmare for most Southerners.

Hookworms infest their host when they walk through moist, sandy soil housing feces that carry hookworm larvae. Repeated exposure to the larvae results in “ground itch,” the entry point the larvae take into the host of the skin. These manifest themselves as raised red squiggles usually on the soles of the feet. Many Southerners did not wear shoes, completely exposing them to the hookworm larvae in the soil. Although many were too poor to buy shoes, others grew up barefoot and preferred staying so, and therefore continued to expose themselves to this risk even when they could afford adequate footwear. At this time, approximately 40 percent of the South’s population was infected with hookworms. Once the hookworms enter the skin through the feet, they migrate to the lungs, causing a cough and sore throat. However, their migration to the intestines results in the most severe problems. The hookworms attach themselves to the mucosa and submucosa of the intestine, release an anticlotting fluid and feed on the blood supply there. Severe loss of intestinal blood results in iron-deficiency anemia, a sickly yellow color to the skin, intestinal pain and tenderness, nausea, headache, fatigue and impotence. Coupled with the poor diet typical to the South at the time, hookworms spread anemia throughout the South. Few of those infected found the strength to do much besides lay in bed and attempt to recover, let alone work. With such

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a large part of the workforce crippled, the Southern economy plummeted.

One year prior , parasitologist Charles Wardell Stiles gave a lecture to the Rockefeller trustees, including John D. Rockefeller himself, on his plan to eradicate hookworm disease in the South. Convicted, Rockefeller committed $1 million to create the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (RSC).

With Stiles’s help, the RSC began a brilliantly simple campaign to eradicate the hookworm epidemic in nine Southern states, including Georgia. The plan was as follows: 1. Map the disease in a particular area through surveys. 2. Cure patients at mobile dispensaries. 3. Provide education through illustrated lectures and demonstrations that urged prevention through improved sanitary measures, including the construction of privies [outhouses].

However, not all Southerners welcomed the RSC. Some saw the committee members as Northerners interfering with their way of life or became offended when they suggested they were infected with worms. Others believed the disease did not even exist. However, the RSC reached out to the local press and recruited local Southerners to the committee, and within a year, they began to run tests and treat infected Southerners with Epsom salts and thymol. On January 12, 1911, Dr. Jacobs and Dr. Dobbs brought the RSC to Athens. The Athens Banner celebrated these “Two Hookworm Specialists Spending [A] Week in Athens.” During this week, Jacobs and Dobbs instructed the State Normal School’s student teachers in the mechanics and prevention of hookworm disease, information which they could then pass on to their pupils in their own schools.

Along with tests and treatments, the RSC helped fund outhouses at schools in Athens and throughout the rest of the South. The RSC also raised awareness of the importance of wearing shoes outside. In 1914, the RSC was disbanded and the International Health Division (IHD) was formed in its place, an organization furthering public health worldwide. The IHD immediately turned to eradicating hookworm throughout the rest of the globe. Modern sanitary conditions in the South today have eradicated hookworms as a human disease. Today, wearing shoes, using indoor restrooms and eating more protein have greatly diminished the risk for Southerners today for contracting hookworms. The only time Southerners may give them any thought is when they have to protect their pets from them. In fact, almost a century after Rockefeller began his campaign to heal the South, Athens was furthering the IHD’s goal of globally eradicating hookworm and hosted another hookworm expert on February 8, 2006. Peter Hotez worked with the Sabin Vaccine Institute to found the Human Hookworm Vaccine Initiative and worked with scientists in Brazil to create these vaccines. Although about 740 million people still are infected by hookworms globally, Hotez and the Sabin Institute plan to eradicate hookworm and six other neglected tropical diseases by 2017.


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|Feature|

TO VACCINATE

OR NOT TO VACCINATE?

BY BETHANY WATSON Since 1798 when the first vaccine was developed for smallpox the world has depended on vaccinations to help increase the health and mortality of people. Even before that, as early as 1000 BC, the Chinese were using a form of immunization called inoculation where they would scratch sores from someone who had contracted smallpox into a healthy individuals arm. Major strides have been taken to improve global health following the first introduction of vaccines. This includes not only the eradication of polio, a disease that often crippled children, by 1979 in the United States, but also the eradication of smallpox worldwide by 1980.

While these injectable immunities have been popular over the last few centuries, some are still skeptical to the idea. In fact, there has been an Anti-Vaccination Society of America since the late 19th century. Many of these opposition groups are religious in origin and may be opposed to certain aspects of newer vaccines like MMR (Measles, Mumps and Rubella), rumored to cause autism and opposed by many for origin in embryonic cultures. The claim that MMR caused autism was recorded in a journal called The Lacet in 1998. This journal was not peer reviewed and had falsified evidence. The journal even retracted their own paper in 2010 and the writer had his license to practice medicine revoked. As far as the issue with embryonic cells goes, it is true that the cell strain used for MMR was originally developed from an aborted fetus, but the Vatican has pardoned Catholics to obtain the immunization even if it is morally against their practices because there is no other way to vaccinate this disease.The chicken pox vaccine Varicella is another routinely given vaccines originated from live cultures. Ultra-conservative groups are also against the vaccinations for Human Papilloma Virus (HPV) that prevents the possible development of cervical cancers. Conservatives do not condone this because they are mostly contracted from sexually transmitted diseases. While the drug has proved to be effective there is still issues with its supposed promotion of promiscuity.

Just this year, there were more outbreaks of measles recorded in the United States than in last 17 years due to parents not vaccinating their children. This disease was thought to be eradicated in 2000, but visits to countries with measles have made a slow rise in the number of cases. Recent rarity of this disease may cause younger physicians to have a hard time recognizing it now, hindering care and increasing possibility of death.

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It also brings up the importance of herd immunity with vaccinations. This concept provides protection for those individuals with compromised immune systems, infants and children who may not be able to be vaccinated, by vaccinating everyone else so the disease does not reach those who cannot receive it. By these standards at least 95% of a community must be vaccinated for the other 5% to prevent infection of diseases. In the case of measles, children are not vaccinated until their first birthday. That was not the only recent outbreak: whooping cough has also made a comeback due to large amounts of unvaccinated children.Interestingly enough, in 2010 the Centers for Disease Control (CDC) recorded over 9,000 people contracted whooping cough and 10 infants, who were too young to be treated, died. The disease has not been this common since 1947, and just like the more recent measles outbreak, a majority of these children are not sick because they cannot access or afford the vaccine, but because their parents have decided not to give them proper immunization. So why are these parents still hesitant to vaccinate their children? Aside from the large autism debate, some believe that having so many vaccinations at a young age may hurt their still developing immune system. And while there is no federal mandate, school systems in all 50 states require certain vaccines, which inadvertently combats these hesitant parents. However, the inconsistency of requirements still leaves room for interpretation and as herd immunity lowers in some region there are clearly ways around this.

You may also be thinking about those who have a lower income: how do they get vaccines? In the United States there is a program called Vaccines for Children, a federally funded program that provides vaccines to those who would not be able to afford it. The CDC provides these vaccines to distribution centers where they are given to private physicians and clinics. According to the CDC, the initiation of this program was actually funded in response to a large measles outbreak in 1989 where thousands of cases and hundreds of deaths resulting from lack of immunization occurred. Of these cases over half of the children who were hospitalized had not been immunized, leading to a need to provide services to prevent this situation. The next time you receive a shot, remember to thank yourself for taking one for the herd.


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|Feature|

“The doctor will be with you shortly...”

GEORGIA’S

PHYSICIAN CRISIS

BY: MUGDHA JOSHI

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|Feature|

According to the most recent census report in 2010, Georgia’s population has risen to rank 8th in the nation. However, the Georgia Board for Physician Workforce (GBPW) reports that over the past decade, Georgia’s physician to population ratio, called physician per capita, has tanked, putting Georgia among the bottom 10 states. A report published by the University of Washington School of Medicine on the short supply of physicians says one third of the current physician workforce is expected to retire in the next 10 years, while the population will continue to grow. According to the American Association of Medical Colleges’ Report on Physician Supply, this means that unless something changes in the state medical education system very soon, by 2020 Georgia will be ranked last in the nation for physicians per capita. This physician “drought” has left the state scrambling to expand medical education and residency programs in order to avoid the crisis of never again having enough family physicians in Georgia. Georgia is not alone in this rising family physician shortage. Across the country, health policy leaders have been searching for ways to increase retention in family medicine fields. However with medical school debts rising and the glamorous appeal of complex specialties, more and more graduating medical students are choosing subspecialties that hold more prestige and pay far more than family medicine. Dr. Mark Ebell here at UGA says it is typical for generalists to earn half as much as a specialist, and the differences are continuing to increase. In an interview with the Athens Banner Herald, Dr. Bond, a local family physician expressed that due to the shortage in the workforce, many family physicians, especially in rural areas must work an average of 60-70 hour work weeks just to keep up with all their patients. With the passage of the Affordable Care Act, this demand is only expected to rise as more health care seekers entire the market while the number of physicians does not proportionately increase. Higher paying, less demanding specialties with shorter work hours and fewer hours on call are, naturally, more appealing to young doctors entering the workforce.

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However, Georgia is becoming known for its “medical export problem”. The Athens Banner Herald reports that three fourths of all medical school graduates in Georgia in 2011 went to pursue their residencies out of state. According to a study published by GBPW, 46 percent of physicians who complete their residency out of state do not return. This does not bode well for the future of physician ratios in Georgia. One reason for this mass exodus out of the state is a lack of residency positions in the state. An article in the Georgia Health News states that Georgia needs to create 315 residency positions in order to meet the southeastern average. Furthermore, the 2004 GBPW Fact Sheet shows that Georgia was the largest state with only 1 public medical school until the new GRU/MCG partnership. The remaining of the 10 largest states have at least 3 public medical schools. Creating more options for medical education must be an integral part of the solution to this growing problem.

The full extent of this growing shortage is felt most strongly by rural communities in the state. Georgia Health News reports that 25 counties in Georgia do not have a pediatrician. 34 counties lack an obstetrician. The University of Washington School of Medicine says this problem has increased in large part because the selectivity and expense of a medical education has made it so that most medical graduates are coming from urban areas rather than rural areas. With a low representation of students with rural backgrounds in the entering physician workforce, it is even less likely for trained individuals to serve rural communities. This combined with the overall bias against the primary care field is doubly harmful to rural communities because rural communities depend on primary care physicians much more for the entirety of their care. Thankfully, the state of Georgia has begun taking steps to solve this growing problem. One approach has been increasing class sizes of medical schools throughout the state. The Fact Sheet on Georgia’s Medical Schools published by GBPW in 2012 states that


in the last 11 years, medical school enrollment has increased by 56.9 percent.The University System of Georgia is boosting medical school enrollment through the Medical College of Georgia by 60 percent, hoping to increase enrollment from 745 to 1200 by 2020. This goal involves growth at the MCG campus in Augusta as well as the creation of 2 “clinical campuses” for 3rd and 4th year medical students in Albany and Savannah. The Georgia Regents University/ Medical College of Georgia partnership begun at the new UGA Health Sciences campus is an effort born out of this same initiative. Currently there are just 40 students in each class, but that is expected to increase to 60 in the next year. Alongside the strong push for increased medical school enrollment, there has also been an effort to create more residency programs. However, a GBPW study affirms that residency programs have increased only 31 percent compared to the near 60 percent increase for medical school enrollment. This means that when a new class of physicians graduates in 2015, there will be more graduates than first year residency spots available, forcing students to leave the state. Following with the GRU/MCG partnership, there have been strides made towards establishing a new internal medicine residency program at St. Mary’s Hospital in Athens, close to the medical campus. Furthermore, MCG in Augusta’s clinical experience sites have been expanded to over 100 urban and rural locations. This expansion creates several more opportunities to further medical training that will improve physician retention in the state and may encourage physicians to focus on these areas when they begin their careers.

Another approach to increasing rural physician workforce has been specialized scholarship programs for students who agree to spend some or all of their careers serving a rural community. The State Medical Board of Georgia offers 20,000 dollar, annually renewable scholarships for students who demonstrate a commitment to serving rural populations. The Physicians for Rural Areas

Assistance Program helps to repay loans of physicians who commit to serving 40 hours a week to communities with populations less than 35,000 people. Other states have implemented similar programs. UGA’s Public Service and Outreach department reports a new initiative called the Archway Partnership which pairs medical school graduates with physicians in middle Georgia in order to strengthen middle Georgia’s healthcare systems and encourage the young physicians to return when they finish their training. An expansion of programs like these available to Georgia residents may help to make rural positions seem more appealing to young physicians and increase retention in the state.

Shortage of physicians, especially in the coming years with the retirement of the “Baby-boomer” generation, is a daunting challenge for the new generation of doctors. When coupled with the prospect of universal access to healthcare, the problem is compounded and the situation becomes all the more dire. In rural communities where health outcomes depend on access to primary care physicians because hospitals are far away and specialists are unheard of, this shortage will quickly escalate if it is not contained. Expansion efforts that Georgia and other states have begun to take are a promising start to solving this challenge, which if not taken seriously, will quickly become a crisis.

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|Feature|

GRU/UGA MEDICAL An interview with Campus Dean, Dr. Barbara Schuster BY: SHAJIRA MOHAMMED

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PARTNERSHIP The GRU/UGA Medical Partnership is a collaborative program between Georgia

Reagents University and The University of Georgia. Located in the Health Sciences Campus on Prince Avenue, the Medical Partnership had an entering class of 40 students in 2010 and is expected to grow to a total of 240 students by 2020. By addressing the state’s critical physician shortage, the Medical Partnership hopes to advance healthcare in Georgia The Medical Partnership has been recognized for its quality of student training and contributions to the UGA and Athens communities. PreMed Magazine had the opportunity to sit down with Dr. Barbara Schuster, Campus Dean of the Georgia Regents University/University of Georgia Medical Partnership, to learn more about the collaboration and ask student submitted questions.

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|Feature| Can you describe your journey from doctor to dean? I did a dual degree in undergrad with a bachelor’s in biology and a master’s in secondary education. I actually taught science for a year in a high school right after graduation but I always had the plan of attending medical school. In medical school, I decided to follow general internal medicine and primary care as my clinical specialty. I still, however, enjoyed teaching and got the opportunity to start being an assistant director in a residency program. That is what started me on a career in medical education. So I have been a medical educator from the time I finished medical school.

I did some patient care as well throughout most of my career but rose in the ranks of residency education from an assistant program director to a director. I was a residency director for fifteen years and developed some other new residency programs along the way. After 15 years, I accepted the position of Chair of the Department of Internal Medicine in the Boonshoft School of Medicine in Dayton, Ohio. After 12 years as a department chair and a year of sabbatical leave, I applied, interviewed for, and was offered the job of Campus Dean of the GRU/UGA Medical Partnership. What better opportunity is there for a medical educator than to start a medical campus?

What is the main focus of the Medical Partnership?

The Medical Partnership has at least two main goals which were decided upon by the state of Georgia. The first one is the expansion of the medical school class of the Medical College of Georgia, so that the State could efficiently and cost effectively increase the number of physicians practicing in the state of Georgia. To create more doctors for the state of Georgia, the Board of Regents accepted the creation of the additional fouryear campus in partnership with the state land-grant university (UGA).The BOR also accepted the creation of three two-year campuses to expand educational clinical opportunities. The second reason for the Medical Partnership to be in Athens was to accelerate the expansion of clinical and translational research and connect the medical related research from UGA to MCG in Augusta. The University of Georgia has had a tremendous amount of research in all its colleges but it did not have a strong connection [with the medical school] so research could only go so far. To take this to the next step, the medical campus would be working with all the colleges such as the UGA College of Pharmacy and the College of Veterinary Medicine, to work across all disciplines. The medical campus is an economic driver and plus, we are not far from Emory University and Georgia Tech so we could develop more in the biomedical sciences with the three institutions.

What collaborations do the Partnership students and UGA students have in place? Our students have worked with AWIS (The Association for Women in Science) and served as mentors. The Partnership has a program supported by a philanthropist to do seminars with the Honors Program about four times a year. We also participate in the Dawgtoberfest which is hosted by the pharmacy school. Also, we work with the pharmacy students at Mercy Clinic so

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students can understand each other’s professional skills.

Do you foresee any teaching collaboration in the classroom? Most of the faculty [of the Medical Partnership] is focused on all the medical teaching that we do. There are times when someone is asked to do a class session for a course in another College and that is fine. Most of the faculty have adjunct appointments in one of the UGA departments.. We have a neuroscientist who helps teach a graduate level course in the veterinary school and we have faculty members who do teach regularly in undergraduate courses.

How can undergraduate students get involved with the Medical Partnership?

Well, we are still growing so there are not as many opportunities as I think we would like. I think as we begin to grow, there will be more opportunities for undergraduates to do some research projects with some of the faculty over here. We already have undergraduate students who have been doing research projects in their first and second year with faculty on campus. Some of the outreach places like Mercy, have undergraduates who volunteer there and interact with us. We also have frequent open houses so that they know what we are all about. I think more and more, I see a lot of pre-med students who want to talk about themselves and a future healthcare career.

Does the Medical Partnership offer combined degree programs (ex: BS/MD, MD/MBA)?

It is interesting because we do.We have five students on campus who are doing PhDs with their MDs. We have had one student complete her MPH and two students who are currently pursuing an MBA in conjunction with Terry College. In that sense, they are combined degrees, but not technically ‘dual degrees’ because UGA can not give both degrees. So one degree is from UGA and one is from GRU. We work with the students and colleges to help make it happen and set up a good curriculum so the opportunity to do multiple degrees is there. It is very possible for students to do additional degrees with other colleges as well and pursue unique opportunities such as an MD and M. Ed. or an MA in Communication. We are also encouraging undergraduates to pursue dual degrees so it’s not just the honors students and foundation fellows doing such things but many undergraduate students who have this opportunity before they enter medical school.

Describe your affiliations with local hospitals.

Our affiliation is with all the local hospitals, not a specific one. Our students go to over ten hospitals in Northeast Georgia. That’s one of the reasons why the state put clinical campuses in Savannah and Albany and put the four-year campus up here, so that we can strategically cover all of Georgia and get students to think about returning to those areas.

What should students do to prepare for medical school?

So, this doesn’t necessarily check a box, but I think they should follow their passion because I think they would develop the skills and knowledge they need by following their passions.


Medicine is a career that has lots of pathways and there is a place for almost anybody in medicine. But, you really have to and really want to follow the passion that you have.

Should students have a specific number of shadowing hours?

This is where I separate myself from others. I think you just have to look at the school and what they expect. I would rather have them [pre-med students] pursue what they want to do rather than just shadow. I can’t say there is a set number of hours because we all have different priorities. Some might need to prioritize their job as their source of income in college while some might not. So I think that shadowing is more of an experience that answers the questions, “do you know what you are getting yourself into” and I think to go to med school in this country today, students have to demonstrate that they have learned that. It [the way of demonstrating] can be through what we call shadowing or other ways such as being a nursing aid in a hospital, but you have to frame it in your personal statement and know what you are getting yourself into.

Can you explain the admissions process at GRU?

I am not on the admissions committee. All of the process takes place in Augusta and most pre-meds know that there is an AMCAS application.Everything is reviewed by a very small group of people and then they choose who will be interviewed. There are multiple things that go into those considerations such as MCAT, GPA, probably where you went to college, what other activities you have been doing, where you are from [they are certainly looking for people who are willing to give back to patients in rural and economically disadvantaged communities — small town Georgia, for instance].

We do need to look at the need in the state to be more diversified. So if we think about that, I think we need to look at all our educational systems and how we can keep the best within the state of Georgia. So I think all those factors come into play but we interview many more than we have positions for. For the first time this year, we are allowed to interview students in Athens but students still have to go down to Augusta. For students, it gives them a chance to be able to see both campuses. The admissions decisions are made by the admissions committee after a long discussion. Each student who has been interviewed is presented and individually discussed. There are new admissions interview systems being discussed such as the mini-interviews and the group interviews for a more holistic interviewing experience so the admissions committee doesn’t look at just one aspect of student success.

What is your vision of an ideal medical student?

Now this is my vision, but I would like to have well-rounded students who have a passion for taking care of others. It is important to be well-rounded as well because it is not all about just your grades. Our goal is to educate our students as very good physicians before they become specialists. I want to help educate our students to become great doctors.

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|Feature|

Athens Regional Medical Center Photo courtesy cw2i.com.

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HEALTHCARE in ATHENS

BY: SHEILA BHAVSAR

Athens-Clarke County, which is home to the University of Georgia and 116,714

citizens, is one of the poorest counties in Georgia. Among 159 counties in Georgia, it has the seventh highest poverty rate. In many instances, low levels of wealth correlate with poor health due to unaffordable insurance, which leads to poor access to health care services. Many of Georgia’s other counties with high poverty rates provide substandard health care services; however, Athens-Clarke County defies this correlation. Athens-Clarke County is home to two prominent free clinics and two regional hospitals, making it easier for all socioeconomic classes in Athens to access health care services of the highest quality.

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|Feature| Athens-Clarke County contains many private primary care and specialty physicians. However, many do not accept individuals who are uninsured or those who have Medicaid. This is a critical issue considering approximately 23 percent of Athens’ residents are uninsured and 20 percent have Medicaid. Therefore, other clinics have been established to help those with difficulty getting access to health care such as Mercy Health Center and Athens Nurses Clinic. Mercy Health Center is a Christian-centered medical clinic that opened in 2001. The clinic has a large number of staff, donors, and volunteers who help keep it running smoothly. Furthermore, Mercy provides volunteer opportunities that expose pre-medical students at UGA to a clinical setting. Mercy strives to provide physical, emotional and spiritual care for patients, and the clinic targets low income individuals that have no form of health insurance in Athens-Clarke county and surrounding counties, such as Barrow County and Oconee County. In order to be eligible to become a patient at Mercy, an individual must be at or below 150 percent of the federal poverty level and provide certain documentation stating his or her income level. For example, a two-person household earning an annual income of $23,265 is considered to be at 150 percent of the federal poverty level. Mercy offers many services, all of which are free of charge; however patients must file appointments with the clinic. Presently, Mercy is only able to take approximately nine new patients per month due to the fast growth of the clinic. The health center offers primary medical care, pharmacy services, dental services and specialty medical care in many areas. In addition, Mercy works toward educating patients by providing social service referrals and health education classes, particularly in areas of hypertension, smoking cessation and diabetes. Along with educating patients, Mercy also provides optional prayer services to fulfill the emotional and spiritual needs of patients. Ultimately, Mercy Health Center continues to grow and serve the Athens community by providing health care and other services for over 9,000 patients.

Similar to Mercy Health Center, Athens Nurses Clinic is a non-profit health care clinic that also targets individuals who cannot afford health insurance due to low income or no income. Athens Nurses Clinic has been serving the individuals that live in Athens-Clarke County and contiguous counties since 1991, and they see over 1,000 patients a year. As the name would suggest, registered nurses, nurse practitioners and volunteers run the clinic. Current patients do not need appointments to be seen.

The Athens Regional Health System funds the Athens Nurses Clinic, supplemented with donations and grants. Because of these various donors, Athens Nurses Clinic is able to offer services free of charge. The clinic’s services include: acute care, chronic disease management, laboratory services and blood work, dentistry, women’s health services and prescription assistance. Athens Nurses Clinic recently started a Wellness and Education program to promote personal responsibility and give patients resources to take control of illnesses. The program focuses on combining preventative services with primary care treatment.

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For example, the program contains classes on managing diabetes, smoking cessation and fitness/nutrition, and patients show great excitement about classes.

Many of the patients at Mercy Health Center and Athens Nurses Clinic wonder how the implementation of the Affordable Care Act will affect their care at the free clinics. In the Athens Nurses Clinic Summer 2013 newsletter, the clinic claims that the majority of patients that the free clinic serves will remain uninsured. In Athens-Clarke county and the six surrounding counties, 29,000 individuals earn 138 percent of the federal poverty level, while Medicaid eligibility under the Affordable Care Act is expanding to individuals earning 133 percent of the federal poverty level. Therefore, the two free clinics will need the continued support of donors. Along with free clinics, Athens-Clarke County also contains two regional hospitals: Athens Regional Medical Center and St. Mary’s Hospital.

Athens Regional Medical Center opened in 1960, and it has grown to a staff of over 2,800 with 250 professionals. The medical center is a locally owned and governed hospital that serves 17 counties, and it contains services for primary care, emergency care and numerous specialties, including midwifery. In addition, the medical center offers health and wellness classes, some of which are free of charge. Athens Regional Medical Center provides financial assistance programs through the Medicaid Eligibility Program, which includes applying for regular Medicaid, Right from the Start Medicaid, Emergency Assistance Medicaid, Presumptive Medicaid and Peach Care for Kids. If eligible, patients receive free or reduced cost services based on income level as compared to the federal poverty guidelines. The financial assistance programs strive to provide health care to those with difficult access to care.


St. Mary’s Hospital and Health Care System is a not-for-profit Catholic health care system that, like most hospitals, offers many specialty and primary care services. St. Mary’s hospital is similar to Athens Regional Medical Center in many ways. For example, St. Mary’s holds community outreach events, such as on-site screenings, and offers health education classes as well. Both hospitals are committed to reaching out to the Athens community and educating residents about prevalent health issues and preventative measures. In addition, St. Mary’s offers financial assistance options for all patients. Financial assistance programs include discounts for prompt payments in full, payment plans, partial financial assistance based on family size and income, 100 percent financial assistance based on family size and income and screening for eligibility for government programs.

Although no health care system is perfect, Athens-Clarke County seems to be making prominent steps in ensuring that all residents have basic, primary care needs met at little to no cost. Because a large amount of Athens’ residents are living at or below certain federal poverty guidelines, there is a great need for financial assistance in regards to health care. Through the help of free clinics and regional hospitals, the Athens community is working towards promoting health education and eliminating health disparities amongst different socioeconomic classes.

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|UGA Club Focus|

T H E

BIG ISSUE

By: Laurence Black

Tackling Obesity in Our Community “Obesity is like an elephant in the room because people see it every day, but never know how to address it.” Kelly Paxson, a health promotion student at the University of Georgia, goes on to say, “Everybody knows that obesity is bad, but most feel like there is not anything we can do about it.”

Obesity is a growing problem, especially throughout the United States. Whether it can be blamed on the larger serving sizes of fast food or the increased popularity of video games, obesity is becoming more prevalent in young children. In fact, 1 in every 3 children is considered either overweight or obese according to The Alliance for a Healthier Generation. Further, these children develop diseases that range from diabetes to asthma, even to heart failure. As a result, overweight and obese children are more likely to live shorter lives than their parents. Furthermore, Paxson adds, “Obesity is related to reduced quality of life, depression and disability.”

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The first step to resolving this issue is to accept that obesity is a major problem that needs to be recognized on a large scale. Though it seems like an easy issue to approach, it is important to understand that reducing the prevalence of obesity means completely changing the lifestyle of each person who is affected. So how can we, students at the University of Georgia, address this problem? “Focus on implementing healthy changes in the lives of people who are already obese to help improve their quality of life,” Paxson suggests, “But we must also emphasize the importance of health in the adults and children of the current generation, before they become afflicted with the disease.” Though many are eager to get involved with national organizations such as The Alliance for a Healthier Generation or the Play60 Campaign, many local programs are available in Athens for those who would like to make a lasting impact on our community. Exercise is Medicine is a national organization that strives to improve our nation’s overall health by urging physicians to prescribe physical activity and exercise on a regular basis,

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indicated by Dr. Sallis MD, the organization’s Task Force Chairman, on the organization’s webpage. Exercise is Medicine at UGA is a club on campus that advocates for this cause. Students involved emphasize the importance of exercise and physical activity in the treatment of chronic diseases as well as the prevention of health issues in the future.

However, UGA students do not need to commit to an organization to help raise awareness for the cause. “Those interested in obesity awareness can simply serve as a role model to their family and friends,” Paxson suggests, “Help them get involved in physical activity or simply provide answers to health questions they may have.”

To learn more about how to get involved, please visit www.healthiergeneration.org, www.exerciseismedicine.org and www.fueluptoplay60.org.


O

besity has become the newest subject of conversation amongst healthcare professionals over the past two decades. Obesity itself is not the problem; the increasing number of obesity cases is. In 2009 to 2010, the Center of Disease Control (CDC) carried out the National Health and Nutrition Examination Survey. In this survey, Golden et al. (2009) reported that 35.7 percent of adults 18 and older in the United States were obese—having a Body Mass Index of 30 or greater. The news was alarming, and in February 2010, First Lady Michelle Obama launched the Let’s Move! campaign which was the first national effort to battle obesity. Sadly, this was not enough. The Organization of Economic Co-operation and Development (OECD) reported in their obesity update that there was a 4 to 5 percent increase in obesity in the U.S. from 2009 to 2012.

Desperate times called for desperate measures, so in June, the American Medical Association (AMA) officially declared obesity a disease. Dr. Patrice Harris, a board member of the AMA, told the New York Times, “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans.”. By declaring obesity a disease, the AMA hopes that doctors will pay more attention to the disease. However, some doctors are criticizing this type of approach. Dr. Richard Besser of ABC News believes it matters less what we call it and more what we do about it. He believes that the AMA should be focused on prevention instead of reaction. Whatever the solution may be, as citizens of the U.S., we should be aware of this growing epidemic. Should we, as citizens of Georgia, be concerned? How does Georgia fare in this war against obesity, and what is the state doing to help us become and remain physically fit? The short answer: we do not fare too well, but the state is providing a light at the end of this wide tunnel.

OBESITY:

The

to residents within low-income communities across Georgia to help eliminate obesity stemming from poverty.

A minor setback to Georgia’s goal of decreasing obesity is that the Georgia does not have legislation that details a farmto-school program, which would require schools to provide only locally produced, farm-fresh foods on their school menus. Organizations like Strong4Life and the Children’s Healthcare of Atlanta make up for the inactivity on the state’s part by vigorously pushing for a healthy lifestyle for children believing that eliminating childhood obesity is the key to significantly decreasing obesity in adults. Our own University of Georgia has an obesity initiative that focuses on reducing obesity in facilities, such as senior centers and the workplace, while also researching obesity prevention tactics. One innovative obesity-awareness project UGA is working on deals with creating virtual reality environments that can show students how everyday food choices can develop into serious health problems later in life. Many criticize that obesity isn’t the problem; being a glutton is. For some extent, that is true. The basic formula of weight gain is to take in more calories than you burn. Eating a massive quantity of food without proper physical activity will result in rapid weight gain. However, it is not the so much so the quantity of food you take in that matters but the quality or contents of the food. Having only two cans of soda in one day is not recommended but it won’t kill you. Having two cans of soda every day for the rest of your life may lead to various kidney and heart problems which, if left improperly treated, can definitely kill you. What can we as Georgians do to combat obesity?

SUPERSIZED

According to “F as in Fat,” a 2011 report issued by the Trust for American’s Health (TFAH), Georgia is the 17th most obese state in the nation. A 2012 CDC statewide obesity profile titled “Overwieght and Obesity,” further detailed that almost 30 percent of adults in Georgia were obese. The CDC believes that there is a link between

PROBLEM in Georgia By: Ahmed Mahmood the soaring number of obesity cases and eating habits and physical activity. The Division of Public Health and the Governor’s Office launched the Live Healthy Georgia campaign to increase awareness about the chronic diseases that stem from obesity. The campaign emphasizes becoming physically active and maintaining physical activity while following a low-fat diet with fruits, vegetables, and whole grains. The Cooking Matters program in Georgia offers nutrition, hands-on cooking and household budgeting classes

We can first start with ourselves and make sure we don’t bite off more that we can chew, so to speak, and make sure that we are physically active. We can then spread the wealth and introduce that healthy lifestyle to our family and friends. Finally, we can voice our opinions to our state representatives and let them know that obesity is a genuine problem and legislative action must be taken to prevent the quality of life of many Georgians from going any lower.

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|Addiction|

What’s Your Drug of Choice? // DRUG USE IN GEORGIA BY: CARLEY BORRELLI Our wonderful peach state has some shocking trends when it comes to substance abuse. According to the Georgia Control Update in 2007, approximately 7 percent of Georgia residents reported past-month use of illicit drugs compared to the national average of 8 percent. At first glance, drug use in Georgia does not seem like a pressing issue. We’re below the national average, so it seems safe to say that drug use in Georgia is a decreasing trend.

91% Meth lab seizures have risen 91 percent from 2007 to 2009 in Georgia. 24 November | December 2013

However, while we’re below the national average for illicit drug use, meth lab seizures have risen 91 percent from 2007 to 2009 in Georgia. Across the nation, meth has become the popular drug of choice, and it’s easy to see why. Methamphetamine is a type of psychostimulant that can be used to treat individuals diagnosed with ADHD. For individuals with ADHD, methamphetamine provides a sense of calm. In individuals not diagnosed with ADHD, however, methamphetamine causes increased wakefulness and decreased need for sleep. Many high school and college students choose to take meth to help them stay up and pull that all-nighter studying for a test or finishing that last-minute essay. Users often don’t realize the detrimental longterm effects of taking methamphetamines such as paranoia, hallucinations, delusion of insects crawling under the skin, stroke, heart attack and in some cases death. The higher percentage of lab seizures in Georgia is reassuring, as the state and nation are taking this drug trend very seriously and cracking down on production and distribution of methamphetamine.

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Another surprising drug-related issue in Georgia is in abuse of prescription medication. Prescription drug abuse is the fastestgrowing drug problem in the nation and is a serious issue that is endangering users as well as non-users. In 2007, The National Highway Traffic Safety Administration found that one in eight nighttime weekend drivers tested positive for one or more illicit drugs. In comparison, 17 percent of nighttime weekend drivers are operating vehicles under the influence of alcohol. Driving under the influence of drugs or alcohol is extremely dangerous and seriously endangers other drivers on the road. Georgia is one of 17 states that has adopted the Per Se Law to combat illegal drug influence while driving. Under Georgia’s Zero-Tolerance Per Se Law, a person shall not drive or be in actual physical control of any moving vehicle in Georgia while under the influence of any drug, glue, metabolites and derivatives in the person’s blood or urine. This law aims to more clearly prosecute individuals who drive with drugs in their system. While these facts can be disconcerting to the growing drug problems in Georgia, it is important to note that this update occurred in 2007. Five years is a long time for new drugs to become popular and others to die down in use. Unfortunately, this is the only published data there is to go on for state drug trends. National drug trend data is published yearly through the National Survey on Drug Use and Health. In the future, hopefully the state will publish a yearly drug control update to more effectively address the popular drugs on the market.


| Food for Thought |

Health of Migrant Farmworkers in Georgia BY: RONKE OLOWOJESIKU On the reverse side of the Great Seal of the State of Georgia are words that speak to one of the major industries of the state: agriculture and commerce. Georgia is one of the top states in the nation in terms of agriculture production, with an agricultural industry generating around 69 billion dollars. An industry of such magnitude relies on the work and effort put forth by farmworkers manually planting, harvesting, packaging and processing crops on farms throughout the state. This farmworker class includes a large subset known as migrant farmworkers, workers who, by definition, are employed primarily in the agriculture industry on a seasonal basis, living in temporary housing. Migrant workers work under harsh conditions and subsequently, often face serious health concerns compounded by limited access to health care. This occurrence is by no means unique to the state of Georgia as it is echoed across the country through the plights of the over 3 million migrant farmworkers in the United States. The response to this concern has also been uniform: the creation of farmworker health clinics.

fessionals from academia and healthcare along with students and interpreters, the program takes place in the south Georgia city of Moultrie for two weeks over the summer. Volunteers during those weeks perform physical examinations and health screenings on the workers and their families, assisting local organizations such as the Colquitt County Health Department and the Ellenton Clinic.For many of the 1,000 individuals, this visit with a volunteer will be the only time in that year that they receive medical attention. The need, therefore, for physicians and health professionals caring for these workers is great. Currently, 158 migrant farmworker health centers serve around 807,000 individuals in over 42 states. As there are over 3 million migrant farm workers nationwide, the need for more medical professionals serving this population is great. With time, hopefully the number of these clinicians will increase, not only in Georgia, but across the United States.

Farm work is considered one of the five most dangerous occupations in the country, with threats such as occupational hazards, infectious disease, pesticide exposure, heat stroke, and stoop labor being described as contributing factors. A large number of these workers live in abject poverty and as a National Agricultural Workers Survey (NAWS) reports, almost half of the nation’s farmworkers are undocumented. Therefore, it is evident that many migrant workers have limited access to health care to counteract the tasking effects of the labor they perform. Regardless of one’s political opinions in relation to the facts presented, addressing this health issue is necessary in order to improve the situation of migrant farmworkers, who are among one of the most marginalized and underserved populations in the United States. Over the years, individuals across the nation have come together to create farmworker health clinics to serve this population. In the state of Georgia specifically, one such program addressing the needs of migrant farmworkers and their families is the Farmworker Family Health Program. Enlisting the help of pro-

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|Internships|

MEDICAL INTERNSHIPS IN THE ATHENS–CLARKE AREA By Tyler Daugherty

Medical and medically related internships can have dual benefits for those looking to pursue a career in health care. For one, they can help to reaffirm or debase your plans. Although the medical field offers reputable and lucrative careers, the path is not for everyone and internships in the field can allow you experience on which to base your decision. Additionally, if you discover that the medical world is the path you wish to pursue, medical internships are wonderful to have on your résumé, showcasing experience and real interest in the field. With all that in mind, let us look at three of the most accessible, outstanding medical internship programs you can pursue here in the Athens–Clarke County area.

Athens Regional Health System Job Shadowing Program (ARHS) Application Available: November 18, 2014 www.athenshealth.org/shadowing

The Athens Regional Health System Job Shadowing Program offers observatory positions for adults (over 18) seeking a career in health care. The program offers many areas for shadowing, including nursing and radiology, but they do not currently facilitate internships with any MDs, PAs, or NPs; to remedy this, the ARHS encourages those interested to make personal arrangements with a local MD, PA or NP, and then proceed through the ARHS.

Homestead Hospice Medical Office Internship Program Application: Available: Year-round www.internships.com/administration/Medical-Office-Intern-I6128214

The Emory Clinic Summer Internship Program Application Available: Later Part of 2013/Early Part of 2014

www.emoryhealthcare.org/employment/career-programs/tec-summer-internship.html

“Through The Emory Clinic Summer Internship Program, currently enrolled undergraduate and graduate students receive practical experience in health care administration, as well as the opportunity to make a positive impact at The Emory Clinic through innovative and creative project work.”

Boasting over 950 physicians with wide varieties of specialties, Emory Clinic allows interns to gain experience in a score of different areas. The application process for this internship occurs in three successive steps: a general review of the primary application, a review of writing samples and project intents and telephone interviews. While this is a daunting process, Emory Clinic offers an incredible internship experience—certainly one worth considering.

Homestead Hospice offers opportunities for medical interns to gain experience “by working with medical records, marketing support and hospice regulations”. This internship can give you experience dealing with a multitude of areas, instead of the narrowed experience that an internship with a specialist would give. Additionally, you can apply for this internship year-round. To conclude, ARHS Job Shadowing, the Homestead Hospice Medical Office Internship and the Emory Clinic Summer Internship Programs all offer highly beneficial opportunities to medically interested undergraduates and graduates in the Athens-Clarke County area. Look for each of these applications to become available online in the coming months. The applications can be intimidating, but the experience is well worth the trouble. Put your name out there, and see what experiences you can have.

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|PreMed Illustrated|

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PreMed Magazine Volume 2 Issue 3