Family Medicine Elective through Michigan State AHEC Rekindles Medical Student's Dream of Service

Fourth year medical student Sarah Graff completed the new Family Practice subinternship at the Sparta Health Center in western Michigan. This rotation was through the Michigan State Area Health Education Center and gave visible form to her dreams of providing medical care to the underserved.

Sarah Graff’s desire for a life of service led her to the MSU College of Human Medicine. Now a fourth year student, Sarah says of her medical school rotations, “I loved every single one.” And precisely because she found each of them so rewarding, she realized that her goal was to become a family physician.

“I knew that I wanted to work with underserved populations before I entered medical school. I didn’t know exactly what specialty, but I knew I wanted to do mission work. I thought family practice would be a good way to do that, because family physicians get to do everything. I could see the kids, the moms, the dads, everyone,” she recollects.

Holding onto that dream through three years of hospital-based education proved challenging. While she enthusiastically soaked up all of the knowledge she could, there were some who advised her that she was being unrealistic in her desire to become a family physician. They believed that the kind of medicine she hoped to practice no longer exists and that malpractice costs would prevent her from doing obstetrics.

So when Sarah received an e-mail describing a community based family practice elective, she jumped at the opportunity. As a National Health Service Corps (NHSC) scholar, she has committed to practice in an underserved area for four years after her residency. This elective might give her a sense of what NHSC service would be like.

Fluent in Spanish, Sarah was particularly drawn to a rotation site that served a predominantly Spanish-speaking clientele. She was told, “Dr. Barbara Stanford at the Sparta Health Center is really great and has the month of October open. We’ll put you with her.” The Sparta Health Center near Grand Rapids is part of a network of community health centers throughout Michigan.

Sarah recalls her first day at the clinic in West Michigan, “I was excited, but I had no idea what I was getting into. I knew I was speaking Spanish and that the area was underserved; that’s all. The first day in the clinic was such a surprise! It was everything that I wanted my life as a doc to be in the future. Dr. Stanford was awesome. She was who I wanted to be. She spoke Spanish; the whole clinic did. The population was about 80 percent Spanish speaking. There was a migrant population, which I had never worked with before.”

She learned that Dr. Stanford did obstetrics and that the entire staff was dedicated to meeting the special needs of the migrant community. Sometimes this involved house calls, or sometimes the clinic stayed open late to accommodate a patient who could not arrive during regular hours. A special effort was made to send medical records along with the patients when they continued their travels as migrant farm workers. “They made the effort, and that was really amazing. They really cared about the people,” Sarah noticed.

The rotation came at the perfect time, right before Sarah’s interviews with potential residency programs. “It gave me affirmation that the things I want to do in family practice are possible. It’s possible to speak Spanish. It’s possible to deliver babies and be compassionate toward people. Everyone in the Sparta clinic was so committed to that population. I was so excited about family practice because I could see an example of the kind of place I would want to work.”

As added benefit, Sarah was introduced to practice based research during the rotation. She compared Dr. Stanford’s Cesarean section rate with that of broader populations and explored some possible reasons why hers were lower than that in the general population. She recalls, “I was kind of nervous. I didn’t know what a research project would entail and I was dreading it a little bit. But after I actually did it, it was fun. I presented a PowerPoint to Dr. Mary Noel and Dr. Stanford. It was a very friendly environment. The presentation was good practice for later on when the environment is not so friendly.”

The rotation at Sparta Health Center helped give shape to her future plans, “I didn’t find out until I was there that it was a National Health Service Corps payback site. Then I heard about the Michigan State Area Health Education Center (AHEC) and what that was. It gave me a lot of confidence to know Sparta was the kind of clinic I would be working at when I do my NHSC payback.

“Now I’m convinced that I don’t have to go abroad to do mission work. The month that I spent in Sparta was my idea of a mission trip. It was the same kind of population I was seeing in Nicaragua when I go down there. Not as extreme, though; there are many different issues that come up. The attitude of the staff in the clinic was very serving-oriented. I thought, ‘I don’t have to go abroad to serve. It’s right here.’

Her advice to fellow students: “If medical students have any idea that they would like to do something other than they are used to, I would totally recommend it. It helps renew your sense of why you went into medical school in the first place. It’s so easy to get lost; it’s so easy to get discouraged. You have an idea of the kind of thing you want to do, but then you are just overwhelmed with everything in the hospital. By the third year, it just kind of gets lost. This is a good experience to see a whole different side. It brought me back where I started from.”