In December, 41 of Alabama’s 67 counties made the federal list of designated Health Professions Shortage Areas. “Just to get out of this shortage, we need another 139 family practice doctors right now,” says J.M. “Mickey” Trimm, PhD, associate professor at UAB’s Health Services Administration. “That’s just enough for us to get by; not enough for a good job.”
The goal is to have one provider for every 2,000 people. “For that, we need another 421 doctors right now, today. That would be ideal,” Trimm says.
UAB has found a hopeful and sustainable solution. A federal program enacted in 1971, Area Health Education Centers (AHECs) focus on recruiting, training and retaining health professionals in underserved areas. “The mantra for AHEC is ‘You’ve got to find ‘em; you’ve got to teach ‘em; and you’ve got to keep ‘em’,” Trimm says. Only five states do not have AHECs.
“The stars are aligned for Alabama,” says Trimm, about the timing of their push for an AHEC. With UAB’s new dean at the School of Medicine, Ray Watts, MD, came the required backing of a school to sponsor the program.
“Dean Watts included primary care as an essential part of his strategic initiatives,” says William Curry, UAB’s associate dean for primary care and rural health. “The urgency behind it is that we have a real hole in our workforce.”
North Carolina’s program exemplifies an AHEC success. In play for 40 years, their program has grown into an essential part of their healthcare landscape. “We run all of the primary care residency programs not located in the academic system,” says Thomas J. Bacon, DrPH, program director.
Because of their programs, almost half their AHEC grads remain in North Carolina versus only 34 percent of the university residency graduates. With the family medicine grads, that number rises to almost 60 percent.
Their programs have allowed North Carolina, a state dominated by rural communities, to increase their number of primary care physicians by 39 percent over the last 18 years, topping the national average by 7 percent.
In retaining health professionals, Bacon credits their Quality Improvement Consultants. This program takes continuing education right into rural practices. “AHEC staff work hands on with physicians and staff on how they manage their major chronic illness patients, like hypertension, congestive heart issues, and diabetes,” Bacon says.
In the last two years, practices in the program reported a 25 percent improvement in management of diabetics and 40 percent improvement in pediatric asthma patients. “It’s very significant. We’re now at about 1,000 practices across the state,” Bacon says.
The impact of AHEC to keep physicians within the state derives from students being recruited from and having to do a portion of their education in the rural and underserved areas. “They work with rural providers who are excited about what they do,” says Cynthia Selleck, DSN, ARNP, associate dean at UAB’s School of Nursing. Selleck ran the University of South Florida’s AHEC for 16 years and served as president of the national association.
She says most students underestimate what practicing in a rural or underserved population would entail. “But AHEC students see that the underserved people are so grateful for the care and are a medically complex people because they haven’t had good care,” Selleck says. “It’s a challenging career.”
Primary care physicians form only the tip of the AHEC iceberg. “It’s very multidisciplinary,” Selleck says. The programs cover all the primary care professionals, including nurses, dentists, respiratory therapists and pharmacists.
According to the 2008 report by Alabama Department of Industrial Relations, Alabama will need an additional 1,530 RNs, 660 LPNs, 50 dentists, 40 occupational therapists, and 180 pharmacists over the next seven years. “This does not take into affect the aging of the population, so these numbers are on the low end,” Trimm says.
In Alabama, an AHEC program would create five centers throughout the state. Each center would cover 14 to 18 counties. “Even though it would be run through UAB, we’ll be working with all the educational programs in the state,” Trimm says, including all three medical schools and about 40 nursing programs.
“There are multiple AHEC-like activities going on now in the state,” Trimm says, citing the University of Alabama’s medical health and rural health scholars programs. “They’ve been very successful, but focused on one region. We want to take that model and push it statewide using AHEC.”
UAB submitted their federal AHEC grant request in February and will know whether or not it is approved by September. Unfortunately, a recent overhaul of the funding protocol means every AHEC is applying this year. “So there’s going to be 57 applications,” Trimm says. “But it’s a five-year grant, so if we don’t try now, it’s another five years before we can even think about applying again.”
