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.

Read More

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

New ARHA Church Directory for Healthy Living

Churches throughout rural Alabama have the desire for professionals to come in and provide health fairs, screens, or classes to assist their congregates with physical health.  This directory is designed to allow churches to sign-up to receive such assistance as available, and also to connect those wishing to provide assistance with churches willing to accept it.  There is no cost to participate, and the sign-up form takes less than 2 minutes to complete.

Click here to access the sign-up form and begin the journey of healthy living with us!

Tell Us Your Story

One priority of the Alabama Rural Health Association is to magnify your voice to legislators, policy advisors, and officials.  But to do this, we need to hear your story so that we can tell it for you.

Have you had issues with one of the following?

  • Delayed or incorrect insurance payments?
  • Increased cost due to specific regulatory burdens?
  • Decreased revenue due to funding or reimbursement cuts?
  • Significant delays with enrolling with public or private insurance?
  • Issues with obtaining an NPI number in a timely fashion?

Contact us at to inform us of any issues that you have experienced so that we can assist you and tell your story.  When you reach us, please provide as much detail as possible.

ARHA joins All of Us Research Program to advance precision medicine

Enrollment set to open nationwide for historic research effort

On May 6, the National Institutes of Health will open national enrollment for the All of Us Research Program—a momentous effort to advance individualized prevention, treatment and care for people of all backgrounds—in collaboration with the Alabama Rural Health Association (ARHA) and other partners. People ages 18 and older, regardless of health status, will be able to enroll. The official launch date will be marked by community events in cities across the country as well as an online event. ARHA is a participant at an event at Railroad Park in Birmingham with a variety of engaging activities and speakers.

Volunteers will join more than 25,000 participants across the United States who have already enrolled in All of Us as part of a year-long beta test to prepare for the program’s national launch. The overall aim is to enroll 1 million or more volunteers and oversample communities that have been underrepresented in research to make the program the largest, most diverse resource of its kind.

“The time is now to transform how we conduct research—with participants as partners—to shed new light on how to stay healthy and manage disease in more personalized ways. This is what we can accomplish through All of Us,” said NIH Director Francis S. Collins, M.D., Ph.D.

Precision medicine is an emerging approach to disease treatment and prevention that considers differences in people’s lifestyles, environments and biological makeup, including genes. By partnering with 1 million diverse people who share information about themselves over many years, the All of Us Research Program will enable research to more precisely prevent and treat a variety of health conditions.

“All of us are unique, but today we live mostly in an era of ‘one-size-fits-all’ medicine,” said Eric Dishman, director of the All of Us Research Program. “I’m alive today because of precision medicine and I think everyone deserves that same opportunity no matter the color of your skin, your economic status, your age or your sex or gender. In other words, it will truly take all of us.”

All of Us seeks to transform the relationship between researchers and participants, bringing them together as partners to inform the program’s directions, goals and responsible return of research information. Participants will be able to access their own health information, summary data about the entire participant community and information about studies and findings that come from All of Us.

ARHA President Farrell Turner stated “the ARHA supports better health and healthy lifestyles of all Alabamians, especially those in rural areas.  This project can help facilitate these changes.”

Participants are asked to share different types of health and lifestyle information, including through online surveys and electronic health records (EHRs), which will continue to be collected over the course of the program. At different times over the coming months and years, some participants will be asked to visit a local partner site to provide blood and urine samples and to have basic physical measurements taken, such as height and weight. To ensure that the program gathers information from all types of people, especially those who have been underrepresented in research, not everyone will be asked to give physical measures and samples. In the future, participants may be invited to share data through wearable devices and to join follow-up research studies, including clinical trials.

Also in future phases of the program, children will be able to enroll, and the program will add more data types, such as genetic data. In addition, data from the program will be broadly accessible for research purposes. Ultimately, the All of Us Research program will be a rich and open data resource for traditional academic researchers as well as citizen scientists—and everyone in between.

NIH has funded more than 100 organizations throughout the U.S. to be partners in the program.  On the program’s May 6 launch date, the All of Us Research Program will host special events in diverse communities around the country.

People also may take part in social media activities (#JoinAllofUs) or tune in at to watch speakers across the country talk about precision medicine and the power of volunteering for research.

To learn more about the program and how to join, please visit

“All of Us” is a registered service mark of the U.S. Department of Health & Human Services (HHS).