Peering in the darkness toward the murky image of a 22-week-old fetus on a computer screen, Dr. Fabio Paes pointed to a tiny bump that, to a layman's eyes, appeared indistinguishable from the undulating shapes around it.
"That's the nose," the radiologist said, explaining the bulge on the sonogram's image. "And those are the lips. We're looking for cleft palates."
Sitting next to Paes, riveted by the pictures, was Dr. Andrius Lescauskas, 28, an aspiring family medicine physician enrolled in a new residency program run by Community Health of South Florida Inc., a not-for-profit health care company catering to a low-income population.
Lescauskas and a dozen other doctors under CHI supervision are the first in Florida to be accepted into residencies as a result of a provision in the Affordable Care Act that estab
lishes grants for training primary-care physicians. The aim is to address a severe shortage of such doctors nationwide.
Moving on to images of a 58-year-old woman who had complained of swelling in her neck, Paes pointed to a shape on the screen and asked his pupil: "Do you know what that is?"
Lescauskas identified it as the woman's trachea.
"That's right," the radiologist said, evidently pleased with his younger colleague's progress.
Lescauskas, a Lithuanian who graduated from the Chicago College of Osteopathic Medicine, is one of four residents specializing in family medicine under the program at CHI, which began July 1. Another four residents are focused on obstetrics and gynecology and five on psychiatry.
The training, much of it at the Doris Ison Health Center in Cutler Bay, costs $1.95 million a year, a grant administered by the U.S. Department of Health and Human Services.
The money given to CHI is part of a package of $83.4 million in grants nationwide to train new primary-care doctors next year under the Teaching Health Center Program, which expands residency training for medical students in community-based settings. CHI and other organizations must apply for the grants every year.
"This is a huge step forward," said Dr. Saint Anthony Amofah, chief medical officer at CHI. "The physician shortage is becoming more and more real -- it's worsening. So this becomes a pipeline. By doing this, they increase the chances that there will be more doctors staying in health centers in underserved areas. I thought it was genius, actually. It showed incredible vision."
A driving impetus of the residency provision, Amofah said, was the certainty the number of insured patients would rise following enactment of the ACA, and the shortage of primary-care physicians would be even more keenly felt as a result.
"The patients are so happy to see us, which makes learning easier," said Dr. Alison Dubin Goldberg, a 29-year-old family-medicine intern from Miami Beach who spent a month in the pediatric unit at Doris Ison as part of her rotation through the center's various departments and affiliated hospitals. "I didn't know I liked pediatrics until now."
Goldberg, a graduate of Nova Southeastern University's College of Osteopathic Medicine, said she was thrilled to be accepted in CHI.
In August, Goldberg's residency will take her to the surgery unit at Larkin Community Hospital in South Miami, followed by a month of night shifts there. She will be back in pediatrics at Doris Ison in October. The month after that, Goldberg will hone her skills in radiology, under Paes, and she will see the year out in Larkin's emergency room. Goldberg and her fellow family medicine residents will keep up that kind of schedule for three years, while their psychiatry and ob-gyn colleagues are looking at four.
Officials at CHI, founded more than 40 years ago with a focus on the uninsured, say they treat almost 300,000 patients every year. The organization runs 10 health centers -- CHI officials prefer to not use the term "clinic" --- in Miami-Dade and Monroe counties, and operates also in 42 public schools.
Tiffani Helberg, CHI spokeswoman, said the organization "gets a lot" out of having the 13 residents in its system. "We have more doctors to see patients," she said. "We also increase the quality of our care, because when you teach you really have to be on top of everything, a master of your craft."
Helberg said CHI officials hope once the residents become full-fledged specialists in their respective fields, they will join CHI's staff.
Hilary Gerber, an ob-gyn resident and a single mother of two boys, said it was "a dream come true" to be placed at Doris Ison less than a mile from her home. Two years ago, as a fourth-year medical student at Nova Southeastern, she did a rotation at the facility. "I said at the time that I wanted to work here," Gerber recalled.
"There's only one other obstetrics residency within 500 miles, and they have hundreds of applicants," she said, referring to a program at Jackson Memorial Hospital in Miami.