Behavioral Health Workforce Projections and Estimates of New Entrants

HRSA’s National Center for Health Workforce Analysis recently conducted analyses on the adult and pediatric mental health and substance abuse disorder workforce.

They have generated national-level projection estimates for the health workforce for the following behavioral health occupations between 2016 and 2030.  Click on the following links to view these estimates.

The Status of the Alabama Primary Care Physician Workforce (2018) – Policy Paper

Produced by the Office for Family Health Education & Research, UAB School of Medicine, this policy paper is designed to evaluate the availability of Alabama’s primary care physicians to Alabama residents using rational service areas (RSAs) for primary care (PCSAs) that are both descriptive and normative, based on spatial accessibility, and meet federal criteria for Health Resources & Services Administration (HRSA) Rational Service Areas.  It is also designed to establish the number of primary care physicians (PCPs) that are needed to allow Alabama’s residents access to a PCP within a 30 minute drive time from their residence location (spatial accessibility).

Policy Paper – The status of the Alabama primary care workforce

Alabama Primary Care Service Areas – Policy Paper

This policy paper, produced by the Office for Family Health Education & Research at the UAB School of Medicine, is designed to create primary care rational service areas (PCSA) for Alabama that are both descriptive and normative, based on spatial accessibility and which meet federal criteria for HRSA Rational Service Areas (RSA).  In addition, it will establish an Alabama statewide network of federally defined PCSAs that serve as geographic units wherein defined populations of Alabama residents have access to primary care physicians at a functional geographic level (spatial accessibility).

Policy Paper- Alabama Primary Care Service Areas

Integrated Residency helps retain students in a regional campus residency program

David L. Bramm, MD;  Paula Clawson

Family Medicine Integrated Residency (IR) at the UAB School of Medicine Integrated Residency (IR) at the UABSchool of Medicine,Huntsville Regional Medicine Campus is designed to attract rural students and to fully prepare them for Family Medicine Residency. It also provides a recruiting method for the residency to retain in-state medical school graduates. The 2017-18 pilot year had 5fourth year medical students enrolled and they all matched in the Huntsville residency.

Since 2005, only 32.2% of the UAB Huntsville Family Medicine Residency has been filled with graduates of Alabama medical schools.  This is concerning because in Alabama, 74.7% of physicians who do both their undergraduate and graduate medical training in-state set up practice in Alabama.  This residency program accepts 12 interns per year. It is housed in the Huntsville Regional Medical Campus of the UAB School of Medicine (HRMC).

The HRMC teaches clinical skills to a cohort of third and fourth year students, approximately 35 in each class. Included in these classes are a special track of Rural Medicine Program (RMP) students who grew up in rural Alabama, expressed an interest in rural family medicine, and have been exposed to a special rural curriculum. EvenRMP students, who would seem likely to train in-state, tend to go elsewhere for residency.The entire UAB medical school graduates about 175medical students annually.

Additionally, 72students graduate from the University of South Alabama College of Medicine. Though it would seem that the Huntsville residency could attract a majority of its intern class from in-state graduates, that has not been the case as of late. It is hard to quantify why in-state students do not choose the Huntsville residency. Perhaps the reason is the successful recruiting the program does at the regional and national level; RMP students may see this as an opportunity to spread their wings outside of Alabama before returning home to set up practice(to date, 96% of the RMP graduates set up practice in Alabama).

In an effort to increase in-state intern numbers and to further cement RMP students in Alabama, the Family Medicine Residency and RMP launched an Integrated Residency (IR) in 2017-18. The IR combines the requirements of fourth year medical school with intern experiences. Although IR students are not obligated to choose the Huntsville Family Medicine residency, all of the IR students matched in this residency in its pilot year. The IR is fashioned after a similar program at the University of Missouri School of Medicine. The Missouri program has operated since 1992and every participant has chosen to match in to their residency.

The Integrated Residency is open to HRMC students from rural Alabama. The rural background requirement is because the funding source is specific to creating rural physicians for Alabama. It is well documented that students most likely to enter rural Family Medicine are those who were raised in a rural area, intend rural practice, intend primary care, and participate in a rural program.5Applications are submitted in the spring of the third year with the interview and selection process duplicating the regular residency selection process.

Selected IR students are notified in May and may begin some IR activities that fit in their schedule prior to the fourth year, which starts in late June. IRs engage in a more rigorous fourth year schedule, which includes a pulmonary medicine/critical care rotation designed specifically for IR students, a family medicine acting internship in UAB’s Huntsville Family Medicine Clinician required rotations in normal fourth year elective offerings of anesthesia, nephrology, emergency medicine, and cardiology.  The fourth-year specialty preceptors in Huntsville are community preceptors which were informed of the Integrated Residency goals. These preceptors expressed enthusiasm for working with students whom they expected to stay in Huntsville for residency.Even with these required rotations, students have time to take some additional electives of their choosing.These students had an acting internship in rural family medicine in the third year, and we hope to add a fourth rural rotation for IR students.

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Governor Ivey Signs Proclamation for Rural Health Day


The Alabama Rural Health Association would like to thank Governor Kay Ivey for once again signing a proclamation declaring November 15, 2018 to be National Rural Health Day in the State of Alabama.

View the Proclamation by clicking here.

The Alabama Department of Public Health’s Office of Primary Care and Rural Health (OPCRH), the Alabama Family Practice Rural Health Board, the Alabama Hospital Association, the Alabama Primary Health Care Association and the Alabama Rural Health Association are proud to recognize the innovation, quality of care, and dedication of health professionals and volunteers in the state during National Rural Health Day 2018.

We appreciate the effort of Governor Ivey and key stakeholders around the state for making this a special day for rural health in our state!


Social Isolation’s Impact on Health Outcomes and Health Spending

Taken from

Research has that found that both social isolation and loneliness increase mortality across age, gender, and country of origin. Specifically, one roundtable participant noted a recent meta-analysis based on a comprehensive literature search (a review of publications from 1980 to 2014 on 3.4 million subjects) that found a 29 percent increased risk of mortality associated with social isolation and a 26 percent increased risk of loneliness, which were both consistent worldwide. Roundtable participants also explored other recent research that compared social isolation with well-established risk factors and that recognized that isolation could be an even bigger public health threat than smoking or obesity and that it could raise the risk of premature death by up to 50 percent.

With these statistics in mind, roundtable participants also discussed the significant impact of social isolation on health care spending. They noted a recent collaborative study by the AARP, Stanford University, and Harvard University that found the Medicare program spends an estimated $134 more per person monthly ($1,608 annually) for every socially isolated older adult, compared with those who were not socially isolated—a level of spending comparable to what Medicare pays for certain chronic conditions, such as high blood pressure or arthritis. In total, the study estimated that a lack of social contact among older adults is associated with an estimated $6.7 billion in additional Medicare spending annually.

Given the significant health and economic impacts of social isolation and loneliness, roundtable participants agreed the time is now to develop collaborative solutions to improve social connectedness, particularly among the nation’s rural and aging seniors.

An Evaluation of the Effectiveness of the Alabama Board of Medical Scholarship Awards

The Alabama Board of Medical Scholarship Awards (BMSA) is an Alabama legislature program that was created as an incentive to increase the supply of primary care physicians (family practice, internal medicine, and pediatrics) and encourage their practice in the state’s rural medically underserved communities. Application for educational loans are available to all students enrolled in medical schools in the State of Alabama. Each loan recipient enters into a contractual agreement with the Board of Medical Scholarship Awards whereby the recipient agrees to practice primary care in a medically underserved community. For default or termination of a loan the recipient is required to repay the principle of the loan plus a penalty of up to 200% of the total principle amount of the loan.

The failure of a loan recipient to perform his or her contractual agreement with the Board of Medical Scholarship Awards or to pay the amount he or she is liable for under this program shall constitute a ground for the revocation of his or her license to practice medicine.

143 primary care residency graduates have completed or are currently fulfilling their service obligations.

The effectiveness of the BMSA educational loan program was evaluated using criteria based on stated intent as expressed in the Alabama legislature and standard metrics for measuring outcomes of educational loans, scholarships and incentives. The criteria used to evaluate the effectiveness this program were:

  • Increase the supply of primary care physicians in the state of Alabama
  • Encourage practice in the state’s rural medically underserved communities
  • Attract young primary care physicians to rural Alabama (replace Alabama’s aging rural primary care physician workforce)
  • Prudent use of state dollars