An Interview with Robert T. Trachtenberg

Robert Trachtenberg is the Executive Director of the National AHEC Organization (NAO), a position he has held since 2010. Prior to that, from 2005-2011, he was the Associate Director of the Rhode Island Area Health Education Center (AHEC) Program Office at Brown University in Providence. Other previous posts include Acting Executive Director at the Southern Rhode Island Area Health Education Center, Acting Executive Director of the Northern Rhode Island Area Health Education Center, and Executive Director of the Champlain Valley Area Health Education Center, St. Albans, Vt.

In his spare time, Trachtenberg enjoys training for and participating in long-distance running races. Family time on weekends is a top priority—he and his wife, Catherine, and their two children, Sam, 13, and Carsen Cate, 11, enjoy spending time hiking, biking and exploring natural areas in the woods and ocean.

In a few words, can you explain what an AHEC is and how they benefit rural (and other) communities?

The goal of the Area Health Education Centers (AHEC) Program is to enhance access to high quality, culturally competent healthcare through community-based interprofessional and interdisciplinary training, continuing education, and health careers outreach activities. We work to ultimately improve the distribution, diversity and supply of the primary care health professions workforce who serve in rural, frontier and underserved healthcare communities.

There's a wide range of activities that AHECs do. Many of our AHECs work with hundreds of elementary, middle and high school students as a means of opening up health care as a career path—we work on the entire pipeline. There's a lot of connectivity with school guidance counselors, school nurses, science teachers. It's a big part of recruitment and retention (R&R), to expose them to healthcare careers as an overall leg of our strategy.  Supported activities offer an introduction to health care careers starting in middle school and high school, as well as for college students. For example, lots of community-based AHECs coordinate medical camps for high school students in the summer, and offer after-school health clubs during the school year. The medical camps (like MedQuest in Vermont) are like a summer camp where students come and stay overnight. During their one-week or two-week session, it gives them deep exposure to health care careers. They can do a learning project, learn CPR, do a community project as a group, and do some journaling (to reflect on what it's like to work a health care career).

There are key AHEC activities for college students that also work on the introduction to health care careers, but, in addition, when students are identified as medical, allied health or nursing students, there are AHECs that support and coordinate service learning activities that offer them shadowing experiences in urban, frontier and rural clinics and hospitals. The AHECs engage students through a variety of mechanisms, getting them to the rural health clinics, community health centers and free clinics, exposing them to what it's like to serve in a setting that works with the underserved. Through those experiences, the idea is to get our hooks into them—especially first-generation college students, so after they conclude clinical training, they're more apt to go back and practice professionally in those areas.

So AHECs work on all ends of the health workforce pipeline, from recruitment to the education/experiential side. AHECs help coordinate medical school rotations and clerkships in primary care in underserved communities. Once those folks are out in the field practicing, AHECs help them complete continuing education requirements. AHECs also work with federal and state loan repayment programs to keep those professionals in underserved communities and help them pay down their medical or nursing school debt. So, essentially, AHECs act as broker and convener to help foster continuing education of health professionals working in primary care in underserved communities around the country.

Are there any AHEC programs that are especially targeted at building the rural workforce?

Overall, 80 percent of our AHECs work in rural areas around the country. They all are engaged in building and retaining the rural primary health care workforce. AHECs range in staff size from two per center to a few hundred (per the North Carolina model). AHECs can cover rural and frontier areas, as well as urban areas, depending on the size of the state. For example, the Vermont AHEC covers Burlington as well as the western area near Canadian border.

All AHECs are engaged with key state- and community-based partners—the offices of rural health, the state departments of health—as well as community-based hospitals and community health centers in those rural and underserved communities. They don't see patients directly, they don't provide clinical care. But throughout the country, there is a lot of work that goes into R&R—as well as the policy side, supporting programs that help pay for and advance rural health care.

NAO was formed in 1997—how did it come to be, or what need did it intend to address at the time? How has it evolved/changed over the years?

The AHEC program started in the early 1970s. There are two types of AHECs: "program offices" (AHECs in medical schools) and "centers" (community-based AHECs, which are away from the medical schools). Today there are 55 program offices and 248 centers nationally, just over 300 combined. It's taken close to 40 years to get all of them up and running. There probably won't be too many new starts in the coming years. NAO is there to support networks throughout country, and act as an association that supports its members. Ninety-two percent of all AHECs are members of NAO (each AHEC is a member, vs. individual staff members).

In the beginning, the AHECs operated very independently. Then in the late 1990s, NAO was formed as the member organization to support the AHEC network, especially for advocacy in bringing medical school AHEC programs together with the centers on a national basis, to build a national model. From the time of incorporation to 2009, the association was staffed by the board of directors, with the president acting as a de facto executive director. Through a strategic planning process, we decided we needed a full-time executive director. The board asked me to do it. I was half-time for six months then went full-time April 2011. We also utilize volunteer community members made of AHEC staff throughout the country, with 13 active committees. Our long-term objective is to develop more of a staff model, and reduce the burden of the work that the volunteers do.

The mailing address of your organization is in Wisconsin, but you are physically located in Rhode Island. How does that work?

Our association management company is in Wisconsin (they manage our website, help with conference development, manage our books, etc.,) and I work from home as the only full-time NAO employee. I commute to D.C. regularly (to the Hill and elsewhere, such as meeting with partner organizations). We have a few contractors outside of our association management company that work for us as well.

Do you think this a trend among rural health and health care advocacy groups—for the directors to be home-based? If so—what are the benefits?

I'm not sure if it's a trend. There are definitely some lifestyle/family benefits and some challenges, as well. Sometimes late in the week I can get a little cabin fever. All week, there are lots of webinars online, writing emails, phone calls, and a lot of conference calls. But, of course, the upside is being able to work from anywhere!

My family is amazingly supportive (and great at holding down the fort when I travel); we're an extremely close family. By virtue of working at home, they understand (I think) the value of the work that NAO and AHECs do. It makes for good dinnertime dialogue!

Can you discuss some of NAO's current collaborative partnerships—what the partnerships aim to do and what your involvement with them entails?

That's a growing component of NAO's work—it's part of building our organization. In 2009, NAO received a five-year contract from the Health Resources and Services Administration (HRSA). The first part of the contract was a two-year focus on building AHEC Training and Consultation Centers (ATCCs), to provide technical assistance for federal reporting requirements for AHECs. It was essentially a virtual center. But in Year Three, the folks at HRSA and SAMHSA got together and said instead of focusing solely on technical assistance, we want to utilize the AHEC network to train non-VA based health care professionals on issues service members and their families cope with post-deployment.

We trained nearly 14,000 health care professionals throughout the country. Through this work, our national network understood that we have the capacity to reach into rural and underserved communities and train providers in a comprehensive manner on a particular issue. We did that in Year Three and Four. In Year Five, which just concluded, we did state-by-state training on the Affordable Care Act and Medicaid expansion. It was a non-partisan effort to provide education to providers and their staffs related to offering information to their patient base on insurance and benefits. We reached over 10,000 health care professionals, using about 50 percent of our AHECs in every state. That's another example of how our national network was deemed as an organization that has the ability to creatively adapt national issues to address local and regional health care issues.

We are looking at other partnerships now. These include projects that have focused on tobacco cessation, and the opiate crisis—we had 32 AHECs recently that did education on proper opiate prescribing.

Other projects include developing a community health worker (CHW) initiative that we call "C3"—we're trying to coalesce the many networks and create a single network. The project aim is to offer recommendations for adoption related to CHW core roles/scope of practice, including CHW core skills and sub-skills, and CHW core qualities and attributes.

We're also working with the George Washington University Cancer Institute—to support the Institute and the comprehensive cancer coalitions that exist in every state. Many AHECs were already doing this individually in their states. From a national perspective, we're trying to tackle things in partnership with organizations that have a national scale.

How can other rural organizations collaborate with AHECs?

In a wide variety of formal and informal ways, around health care workforce and funding, as well as regarding national-scale health care issues. We work with the National Rural Health Association, the National Association of Minority Medical Educators, the American Academy of Family Physicians, the American Association of Colleges of Osteopathic Medicine, the Association of Clinicians for the Underserved and many, many other organizations that are similarly missioned, all with the focus on expanding access to quality health care for underserved communities. We greatly value our national partners and we're able to accomplish so much more as we work collaboratively.

Before you worked with AHECs, you were a Head Start coordinator. How did this lead you to your current work?

I coordinated a program called the Family Service Center, the organization that oversaw the Head Start program. I thought the parent organization could have been more effective, so it was a catalyst for me to get training and a Master's degree in organizational development.

I then became the regional coordinator in Burlington for Vermont Adult Learning, with a staff of 15, which had a workforce program, and offered GED prep and English as a Second Language. In 2000, an AHEC job opened up in northwest Vermont. I had never heard of an AHEC before, but it felt like a nice integration of health care and health care training and organizational development; I did that for four years. Then Brown University AHEC got its award in 2005—I did that for six years, until the board said we need a national director.

What do you like best about living in New England?

Beyond going to college at UW-Madison, I've lived in New England all my life, despite the occasional effort to leave the area and go West. I like the seasons, the people and the fact that the ocean and the mountains aren't too far from each other. There's lots of history and never a lack of places to explore.

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.

Back to: Fall 2014 Issue