Medical Association of the State of Alabama

All in the Family with the Smiths

All in the Family with the Smiths

LINEVILLE – The City of Lineville is a small, rural community of about 2,500 residents in Clay County. At the heart of the community lies Lineville Clinic, home of the Smith family medical practice.

Patriarch George Smith Sr., M.D., graduated from Howard College with a Bachelor’s degree in Pharmacy and worked for three years with Eli Lilly as a pharmaceutical representative, but something was missing.

“I felt like I could do more than I was doing as a pharmaceutical rep, so I applied to medical school,” Dr. Smith said. “My wife and I really wanted to come back to Lineville, but I wanted to come back here as a doctor. I’m a fourth generation Smith. My great grandfather helped settle the area. This is home.”

In 1966, Dr. Smith came back to Lineville and bought his practice from a physician who wanted to focus more on nursing homes than private medicine. His first day in his new practice was July 1, 1966 – the first day of Medicare.

“I got this survey asking what my office fee was, and I answered truthfully. It was $4, and that stuck with me for another 10 or 12 years because they wouldn’t let me change it. When I first started out it was $2. Can you imagine if I hadn’t changed it?” Dr. Smith laughed.

Since then, Dr. Smith has seen not only his community grow, but also his practice. In 1986, his son, Buddy Smith, M.D., joined the practice.

“I grew up going on house calls with Daddy, carrying his doctor’s bag. He did a lot of house calls in the 60s and 70s, and I was impressed with how people treated my father, how he was respected by his patients and the community. There’s a reason why he’s Dr. Smith and I’m Dr. Buddy. There’s only one Dr. Smith. He’s a legend,” Dr. Buddy said.

Dr. Buddy said one of the things that has contributed to the longevity of the practice, given that it is not affiliated with a large hospital or company, is its reputation largely due to his father. With patients willing to drive up to 50 miles to visit the clinic, and some patients who have been with the clinic since the beginning, there’s something to be said for small town reputations.

“In a small town, everyone knows you,” Dr. Buddy said, “so it’s important to remember why we’re here. We have patients who come a long way to see us because of our reputation. The patients are the reason why we’ve been in practice here for so long. We never forget why we’re here.”

And, that’s just one of the reasons why Dr. Buddy’s daughter, Ashley Smith Lane, M.D., joined the practice in October 2016. Dr. Smith’s Lineville Clinic officially became a family affair with three generations of physicians practicing under the same roof.

“I grew up here and already knew a lot of the people,” Dr. Lane said. “This is a great, established practice, and having these two, amazing mentors during a time when medicine is changing so quickly definitely makes being a young practicing physician a bit easier.”

Dr. Lane said she was prepared for a bit of inconvenience after finishing her residency in Huntsville, where tapping into the medical pool for specialty consults was as easy as picking up a phone. But, her heart was calling her back to Lineville…back to her home.

“Being a young doctor today is already complicated by all the changing rules and regulations, but add in being in a rural setting makes it more complicated because we don’t have the ease of getting our patients to the proper specialists as quickly as we would like,” Dr. Lane explained. “Coming from my residency in Huntsville where all the specialists were pretty much right there at our fingertips to a rural situation that allowed me to be a more well-rounded family doctor…it’s fulfilling and challenging all at the same time. I knew in residency I wanted to come back home, and I knew I would need these skills when I came back here. I loved my time in Huntsville, but this is home.”

Part of what Dr. Lane said she loves about practicing with her father and grandfather is the true partnership she has in the practice.

“It’s been a lot of fun working with both my father and grandfather – it’s actually pretty cool! Of course I’m learning a lot from them, but they also let me do my own thing and be myself. That means a lot, too, to allow me to be myself in the practice as a partner,” she said.

Together, the trio face the challenges of medicine together.

“We have to balance the demands of a health care system with a rural small business. And, everything is more difficult when you’re in a rural setting from communication to referrals to transportation…it’s all challenging,” Dr. Buddy explained. “The biggest challenge is to incorporate all the changes in medicine, such as MACRA, MIPS, advanced payment models, quality incentives, into an independent practice in a rural setting when none of them necessarily translate to my situation. These new rules are written for large practices with large IT departments, not small practices or independent practices like ours. It’s a huge challenge to try to meet these guidelines when you don’t have these resources. It takes more and more of my time away from patient care to do these other things. I would say now it’s 50/50 split between sitting at a computer and sitting with a patient. It’s about equal when we should be caring for our patients more than working computers.”

Another change? Alabama’s prescription drug abuse problem. It’s an issue Dr. Buddy was willing to tackle as one of the architects of the Medical Association’s Opioid Prescribing education course.

“We could see the need was growing because of the lack of prescribing education among our physicians. It was a need that had to be addressed, so we created the Opioid Prescribing Course,” Dr. Buddy said. “Doctors were closing their doors and quitting their practices because of what they were seeing happen in their communities. We needed to find a way to educate our doctors so they could keep their doors open and understand how to prescribe these medications effectively and efficiently. I think we have been successful in educating physicians about the dangers of opioids, but I’m not so sure if we’ve been as successful about continuing to practice pain management. It’s scary out there, but it’s rewarding if done correctly.”

With all the changes in medicine throughout the years, from Medicare to electronic records, Dr. Smith said looking back, he would not have done things any differently.

“I’ve been so happy to do what I do for all these years. It was never about the money. It was always about our patients. I’m sure I could have done better somewhere else, but that’s not why we do what we do, is it? It’s been very rewarding. You know you’ve done some good, and that’s the main thing. I’ve done what I call ‘rounds at the Pig’ at the local Piggly Wiggly where someone might stop me and ask about this or that. I still enjoy stopping to chat,” he laughed.

When Dr. Smith opened the doors of the clinic in 1966, he never expected having three generations of his family practicing medicine under the same shingle, but he can’t hide the smile when you mention his son and granddaughter.

“It’s special,” he said. “I know how rare this kind of thing is, especially for two physicians to choose family medicine and to come back home to a rural practice in a small town…that’s very special.”

The 2016 entering students of the Rural Medicine Program (RMP) were awarded their first clinical white coats, a stethoscope and a book stipend on August 16, 2016, during a dinner at the East Alabama Medical Center in Opelika.

The RMP is a pre-matriculation year at Auburn University prior to entering UAB School of Medicine for students who were raised in rural Alabama. The program is designed to support and guide students who will return to rural Alabama as primary care physicians. The first class started in 2006 and to date 82% of the students who have completed all their medical students practice family medicine in rural Alabama.

This year’s class of 8 students will spend the 2016-17 academic year at Auburn doing course work that address the unique needs and experiences of rural Alabama and its residents. They will then enter the UAB School of Medicine for 4 years of studies which include emphasis on the medical needs of rural Alabamians.

The students, their undergraduate schools and hometowns are pictured as follows (left to right): Anmol Ahuja, UAB, Clanton; Morgan Read, Auburn, Wellington; Dusty Trotman, Univ. of Alabama, Rainsville; Joe McIlwain, Auburn, Tuscumbia; Sara-Elizabeth Cardin, Univ. of Alabama, Rogersville; Ben Chappell, Auburn, Alexander City; Alicia Williams, Fort Payne, Mercer Univ.; and Candace Clemmons, Auburn, Geneva.

White coat Class of 2021

April 5, 2016

The Alabama Rural Health Association has adopted a policy definition of Rural for Alabama. This policy brief was developed by ARHA President William H. Coleman, M.D. and researchers with the Office for Family Health, Education and Research (OFHER) at the UAB Huntsville Regional Campus. (Dr. Coleman is the director of OFHER). The ARHA Board of Directors officially approved this definition for the use of health policy in Alabama at its March meeting. This definition considers all areas except for those identified as being in "Urbanized Areas" as defined by the U.S. Census Bureau as being RURAL.
The definition has been used by the 2016 Alabama State Legislature in language to revise the rural physician tax credit bill.  


 AAFP student officers .2                                                                                                                                                                                                                                                                                                           The 2016-17 elected medical student leaders for the Alabama Academy of Family Physicians, left to right: Paul Strickland, Megan Gibson, Andrea Pittman, Daniel Weeks, Victoria Clay, C.C. Linder, Jessica Powell and Will Griffin.


Six UAB School of Medicine students were elected to student leadership positions for the 2016-2017 Alabama Academy of Family Medicine (AAFP). The election took place during the AAFP annual meeting at San Destin, Florida, June 16-19.

Officers are:

President, Daniel Weeks, MS4, UAB School of Medicine, Rural Medicine Program member, Huntsville campus;

Vice President, Andrea Pittman, MS2, UAB School of Medicine, Rural Medicine Program member, Huntsville campus;

Communications Chair, D. Paul Strickland, MS3, UAB School of Medicine, Rural Medical Scholars Program member, Tuscaloosa campus;

Communications Liaison Birmingham, Megan Gibson, MS2, Rural Medicine Program member, Birmingham campus;

Communications Liaison Tuscaloosa, Jessica Powell, MS4, UAB School of Medicine, Rural Medical Scholars Program member, Tuscaloosa campus;

Communications Liaison Huntsville, Will Griffin, MS3, UAB School of Medicine, Rural Medicine Program member, Huntsville campus.

Also, C.C. Linder, MS2 at the University of South Alabama College of Medicine, was elected communication liaison for Mobile.

Victoria Clay, the immediate past President, presided over the elections. Ms. Clay is an MS3 in the Rural Medicine Program at UAB School of Medicine, Huntsville campus.

The AAFP membership includes more than 900 active family physicians and more than 430 family medicine residents and medical students. The chapter provides educational programming for its members as well as representing family physicians and their patients in the legislative, regulatory, and public arenas.

Wednesday Mar 12, 2014

Barriers Impede Telemedicine's Potential

Editor's note: During the AAFP's Scientific Assembly in San Diego, a panel discussion on practice transformation generated far more questions than the panelists could answer in the time allotted. This is the fourth post in an occasional series that will attempt to address the issues members raised -- including payment for telemedicine -- during the panel.

We know that telemedicine, the use of technology to deliver care at a distance, has the potential to expand access to care in underserved areas, reduce ER visits and save patients time. Questions remain, however, about how we can best expand telemedicine's use in primary care.

Telemedicine already is used in subspecialty care, including dermatology and radiology. But in our current fee-for-service model, can telemedicine be integrated into primary care without significantly increasing health care costs?

Kimberly Becher, M.D., left, the resident member of the AAFP Board of Directors, accompanied me on a trip to Capitol Hill while I was a visiting scholar at the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care. I interviewed more than a dozen representatives of federal government health agencies and congressional staff about telemedicine for my project.
I recently spent a month in Washington researching telemedicine and the barriers to its expansion as a visiting scholar at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. Participating in the Larry A. Green Visiting Scholars Program was an invaluable educational experience, and I acquired skills that will help me for the rest of my career. The Graham Center staff provided me with in-depth training on research, including how to plan a project from beginning to end, proposal writing, information and data gathering, manuscript writing and more.

The training actually started months in advance as I worked with Graham Center staff to define what my project would be so that I could hit the ground running when I arrived in Washington for one month of intense work.

I picked telemedicine as my topic, in part, because the Graham Center was already in the midst of a research project on the subject. Funded by a $200,000 grant from WellPoint, the project produced a literature review, a report from the meeting of an expert panel, and -- coming later this year -- a survey of AAFP members about our knowledge and use of telemedicine.

It is hoped that the member survey results and my manuscript will be published in peer-reviewed journals. The Academy also intends to share the report from the expert panel.

For my project, I interviewed 14 representatives from government health care agencies and congressional staff to gauge their understanding of telemedicine and to identify barriers to its expansion in primary care and what is required to move beyond those barriers.

Barriers, it turns out, are not in short supply. One of the biggest issues is payment because of the constrained rules that exist in the current payment systems. There are certainly ways that telemedicine can be integrated into care delivery now, but I hope with alternative payment models on the horizon -- where physicians are paid based on quality and value -- we will see more physicians use it to deliver care at a lower cost for their patients.

Reimbursement for telemedicine services vary widely by payer and state. Ten states require Medicaid coverage of telemedicine, and 43 states require Medicaid coverage for some telemedicine services. Eighteen states mandate private payer coverage for telemedicine, and 14 other states have legislation pending.

But telemedicine is complicated in many other ways. According to the American Telemedicine Association, more than half the state legislatures are considering bills related to telemedicine. One of the most prevalent issues is licensure.

In Florida, for example, the state medical association has said that it supports the expansion of telemedicine, but the association is lobbying against a bill that seeks to create statewide standards and establish reimbursement requirements for telemedicine. The association is fighting the bill, which also would create a system for registering out-of-state physicians, because it opposes the idea of physicians licensed in other states treating Florida patients via telemedicine.

That's a significant issue in Florida because of the annual migration of people who spend the winter months in the Sunshine State.

What's at stake? A nonpartisan, nonprofit public policy research institute released a report this month that said reducing costly interventions, such as ER visits, by as little as 1 percent could reduce the state's health care costs by $1 billion a year.

Among my interview subjects, there was broad recognition that telemedicine is an important issued related to access to care. But another barrier we must overcome is that many rural and underserved parts of country still don’t have access to broadband internet. That's important because although the "tele" in telemedicine might prompt people to imagine a physician on a telephone, there's much more to it. Telemedicine can involve video conferencing with a patient from his or her home, electronic monitoring of chronic conditions and so much more. The fact that telemedicine means different things to different people could be a barrier as well. There's no consensus on what the term actually means.

That's unfortunate because more than 50 percent of U.S. hospitals already are using telemedicine in some manner. Incorporating the use of this technology in care delivery is happening, and it will continue to expand, so we have to figure out how it fits in primary care.

A good step forward would be finding a way to expose medical students and family medicine residents to telemedicine. I'm a fourth-year medical student and have yet to experience it. Medical school and residency is where we get our feet wet, and the models we train in influence how we will practice later.

We have the technology and the ability to extend ourselves, improve access to care and save our patients time and money, but there are many questions left to answer. I hope that when the Graham Center's survey lands in your in-box later this year, you will take a few minutes to give us your thoughts on telemedicine. The more people who participate in this important survey, the more valuable our data will be.

Tate Hinkle is the student member of the AAFP Board of Directors.

Posted at 12:30PM Mar 12, 2014 by Tate Hinkle  |