Rural Alabama Health Alliance Position Paper
 
 

Alabama has many counties that are “medically underserved.”  The state legislature addressed this shortage of primary care providers in 1972 by establishing branch campuses of the UA School of Medicine to focus on training primary care physicians for practice in these areas.  The program in Tuscaloosa, the University of Alabama College of Community Health Sciences, has developed a number of programs to encourage the recruitment and preparation of rural doctors.  This effort has been described a  “rural health pipeline” and begins with the Rural Health Scholar (RHS) program for high school students.  There is also a Rural Medical Scholar (RMS) program for premed students from rural backgrounds that includes an early admission to medical school and a rural medicine track.

The rationale for establishing these programs is that most rural physicians have a rural background, and therefore rural students are most likely to return to these areas after becoming physicians.  Rural students often need special preparation and mentoring to enter and succeed in large urban medical training facilities without losing their rural identity and focus.  Stable ongoing funding for sustaining, even expanding, programs like the RHS and RMS programs is important for assuring that rural students get this support.  In the past, medical schools have not done a good job training and encouraging students in ways that make them feel comfortable choosing rural primary care as a career option.  Along the same lines, even the way the UA School of Medicine calculates the number of their primary care graduates makes discussions with them on this issue very confusing.  (UASOM figures include not only those who go into family practice residencies but also graduates who choose residencies in pediatrics, obstetrics, and internal medicine.  These new graduates, who may subspecialize after their three-year residency, are not tracked to document whether they enter primary care practices.)

 Several factors negatively impact placing rural primary care physicians:

• Recently UAB has decreased the number of students per class, and this will preferentially decrease the number of Alabama students, particularly rural Alabama students, who will enter medical school.
• out-of-state applicants come here when they have little desire to stay in Alabama to practice.
• The traditional interview process chooses Alabama and out-of-state residents who have a low percentage of choosing primary care rural practice.
• State dollars originally appropriated by the Legislature to support family practice residency training programs in Anniston, Gadsden, and Montgomery are not now being received by the programs in Anniston and Montgomery.  The Gadsden program has closed.

Recommendations:

1.  Fund Rural Scholar programs adequately.
2.  Encourage rural/primary care exposure for medical students early on--before they make
     career choices—through rural rotations and agromedicine experiences.
3.  Develop AHECs (Area Health Education Centers, a federally funded program)
     to encourage training in local communities.
4.  Alter tuition policies for out of state residents.
5.  Allow branch campuses to choose their own population of students.
6.  Link primary care provider production to state funding for medical schools.