Photo of Mercedes Barrutia Dodge with patient
UC Davis physician assistant student Mercedes Barrutia Dodge gets hands-on experience with patients at Davis Community Clinic.

As a child, Mercedes Barrutia Dodge spent a lot of time in community clinics — but not as a patient. After her younger sister was born with spina bifida, the Texas native served as a much-needed translator for her Peruvian-born parents and the English-speaking doctors.

“I grew up with the difficult task of trying to translate my mother's queries about my sister's care and the doctors' answers,” she says.

The complexities of the birth defect made the process especially hard. It gave Dodge a real-world sense of how health-care disparities can have a tremendous emotional and social impact on a family.

The experience led Dodge to commit to helping the underserved. After shadowing a physician assistant at the Davis Community Clinic, and with a biology degree already under her belt, Dodge decided to pursue a career as a physician assistant. She chose UC Davis's Family Nurse Practitioner and Physician Assistant Program because of its emphasis on culturally sensitive care for diverse populations.

Nationally recognized program

Part of the  UC Davis Department of Family and Community Medicine, the Family Nurse Practitioner and Physician Assistant (FNP/PA) Program has graduated more than 1,600 health-care professionals from 39 countries. It is the largest program of its kind in California, and the only physician assistant program in the University of California system and other California public universities.

Designed for people who have been working in the health-care field, the 24-month program combines didactic and clinical learning so graduates are prepared to make an immediate difference in the clinics they work. A certificate is awarded to students upon successful completion of the program. Registered nurses with a bachelor's degree may opt to earn a Masters of Science in Nursing degree through an affiliate program with California State University, Sacramento.

Many students are recruited from rural communities and, like Mercedes Barrutia Dodge, are all too familiar with the health-care challenges of underserved populations, such as language and cultural barriers. Thirty-one percent of 2005 graduates are underserved minorities themselves and speak English as a second language. And twenty-four percent were the first in their families to go to college.

Hands-on, intensive training

What makes the FNP/PA program especially unique is that, thanks to the Internet, students take most of their classes from home, allowing them to stay in their communities and practice in clinics there. They attend didactic sessions at UC Davis' Sacramento campus three to five days each month in their first year. When not working in a clinic or in class in Sacramento, students download PowerPoint lectures, take quizzes, and receive their reading and writing assignments online.

That may sound like an easy set-up to some, but make no mistake: By all accounts, the UC Davis program is intensive and challenging. After just three months of rigorous coursework, students spend a minimum of two or three 8-hour days per week in a clinic, working under the guidance of a physician preceptor.

"The program is very intense — a lot of information is put into 24 months," said recent graduate Agnes Warhover, who now works as a liaison between a Vacaville prison and the UC Davis FNP/PA program. "I really liked how we started clinical training early in the program, along with the classroom work. Talking to patients and performing physical exams was reinforcing of what I was learning in class. It was the best way for me to learn."

Associate Program Director Shelly Stewart says the program is designed to prepare students for the dynamic and demanding environment that comes with health care. "We graduate skilled clinicians who are ready to hit the road,” says Stewart, herself a graduate of the program. “By the time students leave the program, they have seen and done it all."

Breaking down social, cultural barriers

Seeing patients not only requires medical proficiency, but also the ability to address cultural and social issues with sensitivity and skill.

"The way you interview a patient helps determine any underlying social problems that might have been inhibiting that person from seeking medical help,” says Dodge. “In addition to training us to recognize and treat illness, the UC Davis program is helping us learn how to address those social problems."

Those social issues have a tremendous impact on both the patient and the state's health-care system. Compared to California's urban regions, rural areas typically have fewer health-care providers per capita and suffer from higher rates of chronic disease, hospitalization and cancer deaths.

Whether it's providing preventive care or treating existing illnesses and disease, UC Davis FNP/PA graduates are helping to close the health-care gaps in California — a win-win situation, as the program provides both important learning opportunities for students and high-quality care for patients in remote areas of the state.

Meeting a growing need

Current predictions estimate that within a decade, California will face a shortage of between 5,000 to 17,000 doctors, especially in rural areas. That means increased demand for family nurse practitioners and physician assistants to fill the void. In fact, the U.S. Bureau of Labor Statistics ranked the physician assistant as the fourth fastest growing profession nationally.

Historically underserved areas such as California's Central Valley will be hard hit by any shortage of health-care providers. By training qualified and skilled family nurse practitioners and physician assistants, UC Davis is well on the way to responding to new and changing threats to health in these regions. As of 2005, 73 percent of UC Davis' FNP/PA graduates practiced in areas of unmet need, as defined by the Song Brown program, an Office of Statewide Health Planning and Development program that provides support funding to family practice, family nurse practitioner and physician assistant training programs.

"The Family Nurse Practitioner and Physician Assistant Program plays an important role in meeting the health system's community service mission," says Thomas Nesbitt, executive associate dean for administration and clinical outreach. "It is a critical part of UC Davis Health System's goal of addressing the health-care needs of California's underserved populations."

Says Mercedes Barrutia Dodge's preceptor, Carla Kakutani, a board-certified family medicine doctor in Winters, Calif., “Looking at the state of our current health system, we need more primary-care providers, no matter what form they take.”