With only 73 physicians per 10,000 residents, a 2012 survey ranked Alabama 45th in the country in primary physicians per capita. In rural areas, where transportation can also be a problem, the nearest primary care can be even farther. Some counties have no doctors and eight have no hospitals.
To address this shortage, the School of Medicine at UAB and the school's Tuscaloosa regional campus at the College of Community Health Sciences are launching a new primary care track in a four-year medical degree program. The first class begins July 23.
Interest in the program has been strong, receiving more applications than anticipated.
"The new track will take an innovative approach in medical education," Senior Associate Dean of Medical Education at the UAB School of Medicine Craig Hoesley MD, said. "Instead of the rotations by specialty that are typically done in a hospital, students will have an opportunity to follow a diverse range of patients longitudinally while working in a primary care environment."
The primary care track will provide students with a strong foundation in clinical medicine focused on preparation for residency training in primary care and other community-based specialty fields. In addition to special programming on population health and physician leadership skills, the longitudinal experiences with patients and time working with mentoring physician will add a real world perspective to the students' understanding of primary care.
"After completing their first two years learning the basic sciences in Birmingham, third year students will begin a longitudinal clerkship," Hoesley said. "Our Tuscaloosa campus has taken the lead in building the longitudinal model, which embeds students in a primary care setting within a community.
"In a sense, the student is helping to care for a community in all its diversity. Instead of studying pediatrics one month and geriatrics the next, and perhaps seeing a patient only once, students see a broad range of patients. From new pregnancies to the diseases of middle age to end of life care, they are there to follow treatment and see how relationships between patients and physicians are built."
The challenge in implementing a longitudinal model is finding enough preceptors to guide and mentor students.
"Our alumnae have been wonderful, and we've welcomed primary care professionals around the state who have been very generous in sharing their expertise," Hoesley said.
Advances in medical science and changes in how care is delivered are also changing the skill set new doctors must learn.
"Delivering the best quality of care today requires the ability to communicate and work effectively with other health professionals as a team," Hoesley said. "In addition to physician assistants, nurses and nurse practitioners, our future primary physicians will be working with pharmacists, physical therapists, nutritionist and a range of specialists and health related professions.
"We simulate this interaction in team-based learning activities that bring together students from different disciplines. As they work, they learn what different disciplines and different perspectives have to offer and they can practice their listening skills and hone their ability to express themselves clearly."
The primary care office will also be ground zero for the shift in emphasis from curing diseases to preventing them as health care moves toward personalized medicine.
"Practicing good medicine is much more than taking a history and assessing symptoms," Hoesley said. "There are also sociographic and lifestyle determinants that can factor into whether and how diseases develop. Effective evidence-based strategies for intervention and counseling patients are tools our students need to learn. Helping to prevent a disease is as important as accurate diagnosis and prescribing treatment after it happens.
"Life-long learning is another emphasis. I tell students, you are never done. As new research findings about topics like genomics move personalized medicine toward more individualized treatment, physicians will need to continue learning so they can put advances into practice to help their patients."
The initiative to innovate primary care education and encourage more students to go into the field is already bearing fruit even before the first class in the new primary care tract begins this summer.
On match day in March at UAB, the number of students matching for a residency in family medicine was up by 50 percent over the previous year.
"That is good news for everyone who is hoping to see more primary care physicians in Alabama's future," Hoesley said.
