The Alabama Statewide Area Health Education Centers (AHEC) is calling for final comments for strategy discussions aimed towards enhancing primary care delivery for the state. Over 70 attendees, representing 20 institutions from across Alabama, contributed to conversations about workforce shortages, rural and underserved care, and more at the 2024 Primary Care Summit on Thursday, Jan. 25.
A diverse group of panelists offered their perspectives on topics regarding this year’s theme, “Recruiting, Training and Retaining a Healthcare Workforce.” It directly mirrors the AHEC mission, “to recruit, train and retain the Alabama healthcare workforce while increasing diversity among health professionals, broadening the distribution of the health workforce, enhancing the quality of care, and improving health care delivery to rural and underserved populations in Alabama.” Part of Heersink School of Medicine’s Department of Family and Community Medicine, Area Health Education Centers work to adapt national initiatives to address local and regional health care issues, and their programs aim to bridge academia and the community, which, in turn, connects students to health care careers and communities to quality care.
Alabama Rural Health Association President and CEO Farrell Turner says Alabama is now the eighth most rural state in the country.
55 out of the state’s 67 counties are considered rural, according to the Alabama Department of Public Health. That amounts to more than two million residents or close to 44 percent of the state’s population. In fact, the Health Resources & Services Administration (HRSA) reports every county is either designated as a Medically Underserved Area or has areas designated as medically underserved.
Plus, Turner says those living in rural areas are older and tend to have more health problems.
“We are in need of family practice doctors, people who are going to be there, preferably living in our communities,” explained Turner.
Alabama Office of Healthcare Workforce (AOHW) reported in 2021 that Alabamians identified access to a primary care physician as the most significant barrier to receiving health care. Based on 2010 projections from the Robert Graham Center, Alabama needs 3,258 primary care physicians by 2030 to maintain care. According to the Office of Family Health, Education & Research (UAB School of Medicine, Huntsville Regional Medical Campus), there were 2,811 primary care physicians practicing in Alabama in 2022, meaning an additional 447 primary care providers are needed by 2030.
The specialty has an advocate at the Jefferson County Health Department. Health Officer David Hicks, M.D., works in primary care and was appointed to the position after the departure of Mark Wilson, M.D. While admitting his bias due to his background, Hicks told Primary Care Summit attendees decades of facts and figures reinforce the need to increase the footprint of primary care.
“There’s data for many years, since the nineties, that explains why, if you have more primary care physicians… you're going to have a decrease in mortality, an increase in life expectancy, you're going to [see a] decrease in health care expenditures,” said Hicks. “If you look across the world, when you have more permanent care providers, relative to specialists, you have better health outcomes and decreasing health care costs.”
Yet, panelists say primary care doctors are not the only providers in short supply. They also expressed a need for more dentists, mental health professionals, and nurses. Speakers expounded upon ways they and others are working to address workforce training, recruitment, and retention.
“We started our nurse practitioner residency program because we felt that when we were hiring nurse practitioners, initially, [they had a lot of needs],” Hicks explained. “There was a particular knowledge gap.”
Hicks, additionally, touched on the rural medical services awards program, designed to expand primary care access in rural areas of Alabama, but acknowledged there is also a need in urban underserved areas.
“We [must] figure out how we can expand some of the programs we already have,” said Hicks.
Sessions included “Talent Development in Alabama”, “Addressing the Workforce Pipeline” and “Health Care as an Industry.” During their brief presentations, panelists highlighted current challenges to a more robust health care workforce.
When it comes to recruitment and retention, they emphasized the need for greater compensation and ample benefits, like cost-of-living increases, adequate leave time, and sufficient health insurance coverage.
“We have to make an incentive for people to go into these fields,” Hicks said. “How can we go to our young people and say you should consider a career in this or that if they don't see that they're going to get fairly compensated?”
Included in this category are preceptors who take in learners for nothing, or who lose money, when they opt to train aspiring providers. Panelists acknowledged the concern among physicians whose businesses may take a hit if they accept student learners. The Alabama legislature approved the Alabama Preceptor Tax Incentive Program (APTIP) last year. It offers a tax deduction to these community-based, faculty preceptors for what would, otherwise, be unpaid work.
The Alabama Statewide AHEC Program Office administers APTIP. It provides preceptors with a $500 income tax credit incentive for each 160-hour clinical rotation per calendar year. Similarly, the law offers a $425 tax incentive to nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, or physician assistants for each 160-hour clinical preceptorship rotation per calendar year.
Recruitment, they say, also involves educating younger students about the opportunities afforded to them in the primary care health care space, insisting young people may remain unaware without greater exposure. This may include offering them a navigable program by which they can experience these prospective professions.
Though solutions may require not only local intervention but also state and federal changes, speakers reiterated the importance of collaborating and partnering with other stakeholders to combine their efforts, merge programming, and maximize successes. After each panel, a moderated discussion gave attendees a chance to brainstorm and offer suggestions and solutions. AHEC is compiling the results of these conversations for a comprehensive report—tapping attendees for assistance prioritizing topics—to be released in the coming weeks.