Note: This article was written by Joan Lebow, communications consultant for Family Health Centers at NYU Langone. (Photo Credit: Taken by Joe Carrotta, Dr. Luan Garcia arrives on day one of his residency, coffee in hand).
While there’s much to learn and many choices to be made on the arduous road to becoming a doctor, 26-year-old Luan Garcia finished medical school in 2022 knowing one thing above all; he wanted to continue his education in a community setting. “Hospitals should be a ‘last resort’ not a ‘first resort’ for patients,” explains Garcia. “Providing preventative medicine and good mental health care with a community-based approach can make a big difference.”
Raised in Miami, Florida, and fluent in Spanish, Garcia now has the unique opportunity to act on his beliefs and pursue his psychiatry residency in an under-resourced section of Brooklyn, New York, where the immigrant population is large, incomes are low, and demand for behavioral health care far outpaces access—a gap made even wider by the pandemic. He is one of three inaugural residents in the Psychiatry Residency program launched in July 2022 at the Family Health Centers at NYU Langone. FHC provides the same services as other Community Health Centers, but does not receive health center federal funding, so is considered a ‘Look-Alike’ health center.
The Family Health Center’s new Psychiatry Residency is made possible with $3.7 million from the Health Resources and Services Administration (HRSA) and is one of only four programs of its kind in the country. The funds are part of a $155 million national program that includes American Rescue Plan dollars and other funds aimed at expanding community-based medical training in “high need” areas. By its fourth year, with the support of nearly $7 million in federal investment, the Family Health Center’s new Psychiatry program will grow to include 12 residents. HRSA funds for community-based medical training also support an expanding Family Medicine program at the FHC.
In announcing the community health investment on July 1, the traditional start day for residents everywhere, officials cited the importance of psychiatry training to address the nation’s growing mental health crisis.
“Across the country only 28 percent of people in need of mental health services have sufficient access to care, and in New York State that’s just 23 percent,” says Isaac Dapkins, MD, FHC’s chief medical officer. “To fully meet that demand, we’d need more than 200 additional providers, a reason why it’s vitally important to start, and expand, this new program.
“The HRSA investment is hugely important for community health because it supports more than training, it helps to create a diverse workforce that reflects the community,” says Larry McReynolds, FHC’s executive director. “This not only increases access to care, it’s a critical piece of workforce development for federally qualified community health centers, such as the FHC, where we train hundreds of students and residents in our community health centers.”
A 2016 NIH-funded study of health training centers found that residents that train in community health centers are 30% more likely to stay working in an underserved community. Adds McReynolds, “This reduces disparities and brings more health equity to underserved communities.”
Garcia’s psychiatry training at the FHC, for example, will immerse him in a neighborhood-based outpatient clinic in the heart of Brooklyn’s Sunset Park community known for large Latino and Chinese populations. Patients often speak little or no English and tend to be uninsured or underinsured. Many live in multi-generational households, have lost jobs, are under stress and are experiencing heightened anxiety and depression.
Says Samuel Stroupe, MD, program director of the newly launched Psychiatry Residency, “Mental health disorders have increased dramatically in the past two years, so we have created a program that enables residents to train in innovative, community-focused care settings where primary and behavioral health care are often integrated into the same location.”
Garcia and fellow medical residents will see patients in a recently renovated clinic that sits mid-block on a tree-lined street with rows of three-and-four-family limestones and brownstones. He and his colleagues will treat other patients virtually via increasingly popular telehealth programs, or on site in several nearby homeless shelters where continuity of care is always a challenge. The residency also includes traditional hospital rotations in New York Health and Hospitals/Bellevue on the east of Manhattan. Bellevue is part of the City of New York’s public hospital system and affiliated with the NYU Grossman School of Medicine.
For Garcia, studying Psychiatry where people live, work, struggle and thrive makes a lot of sense. The new doctor, who majored in English Literature when an undergrad at the University of Miami, explains “Behavioral Health is where science and the humanities meet.” And for the physicians in this new training program, community health is an important avenue that crosses that same intersection.