Primary Care

Meeting Needs with New Opportunities

By Charles Buchanan

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Even subspecialists should worry about the growing shortage of primary care physicians, says William Curry, M.D., FACP, associate dean of rural programs and primary care. Population trends indicate that the current drought of physicians—a major problem in Alabama—will worsen drastically in the next 20 years, creating complications for everyone. “Good, effective primary care is the foundation of all medical care and required for good coordination of care,” he explains. “It’s essential for our patients’ health and safety.”

For that reason, every Alabama physician has a stake in UAB’s primary care strategic plan, the first in the school’s history, Curry says. The aim is to provide students with more—and earlier—exposure to community medical practice, giving them a clearer picture as they begin mapping out their careers. “It’s a satisfying life,” says Curry, who practiced primary care himself. “It can be done so that hours and coverage are reasonable, and the reimbursement is adequate for the work.”

Curricular Changes

All students will begin learning about primary care “on the first day of the first year,” Curry says. Primary care physicians also will play a greater role in teaching the Introduction to Clinical Medicine course, which will expose students to primary care practice settings.

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The size of the first-year class will rise by 10 to 186, making room for students who may want to focus on primary care. Some may be members of the newly established Primary Care Scholars program, a four-year pathway, patterned after the rural scholars programs and the M.D./Ph.D. program, with an enriched curriculum covering topics such as population-based care, quality measurement and management, and health economics, law, and policy. Service-learning activities, leadership training, and a scholarly research activity focused on primary care will prepare these students for a variety of challenges, from the responsibilities of rural practice to the transitions of health-care reform, and train them to become health-care advocates.

The plan also calls for increasing the number of slots in the school’s Tuscaloosa- and Huntsville-based rural scholars programs and expanding the available primary care residency positions. Already, the Huntsville campus is adding an internal medicine program with a primary care slant, and a third branch campus in Montgomery will multiply the opportunities for students and residents to experience community medicine.

Scholarships and Leadership

The cost of medical school can be a barrier to primary care as a career choice, Curry says. “If that burden is not there, it removes the strong incentive to pursue additional subspecialty training and higher reimbursement.” The school, which has added a full-time major gifts officer for scholarships, will work with potential donors and partners to increase the pool of scholarships available, both from UAB and through the Alabama medical scholarship program. The school already is matching gifts from alumni for scholarships through the 2011-2012 academic year.

For faculty, a Primary Care Leadership Academy will help cultivate “teaching and leadership skills and a better understanding of the health-care system and public policy,” Curry says. The goal is to turn UAB primary care clinician-educators into role models for students and other physicians.

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A Network for Alabama

Through an Area Health Education Center (AHEC) network, UAB will encourage communication and collaboration with physicians and other health professionals statewide. “It’s part of what’s been missing here for primary care,” Curry says, noting that Alabama is one of the few states without such a system. Launched with a federal grant, the network eventually will include four or five AHECs, run by medical centers and educational institutions around the state, linked to a UAB coordinating center. “Everyone is welcome—and needed,” Curry says.

The setup promotes a mutual flow of information and services. “Communities around the state can access our resources, and our educational programs will improve because we will understand the health-care needs of those communities,” Curry says. “It’s an infrastructure on which we can lay all kinds of networks for better education and training, recruitment, referrals, and research, and give back to the hundreds of physicians in community practice who help us teach and train.” he says. AHECs also enable young people to explore health careers, linking them to educational opportunities and helping to place students and residents in community rotations.

Curry says that most of the plan’s initiatives will be under way in the next 12 to 18 months, and he is eager to see the results. “We want students to see good models of care, and we want to be part of creating the new model for primary care,” he says.