Archive for Advocacy

Gov. Ivey Hosts Bill Signing Ceremony for MAT Act

Gov. Ivey Hosts Bill Signing Ceremony for MAT Act

Wednesday, Gov. Kay Ivey hosted a formal bill signing ceremony at the Alabama Capitol for this year’s Medication Assisted Treatment Act (“MAT Act”). Flanked by an array of both state and national leaders, the signing of this legislation represents another step Alabama is taking to combat the drug abuse epidemic and help those struggling with addiction.

Passing this bill was no easy feat, however. Introduced just six days before the 2019 Legislative Session ended, the Medical Association worked closely with Sen. Larry Stutts, M.D. in drafting the language for the bill and was instrumental in pushing it to final passage.

“It really is extraordinary what we were able to get done in such a short timeframe,” said Association President, John Meigs, M.D. “I know this was a priority for Senator Stutts, and we were proud to see it become a priority for all legislators. MAT has already been proven to help reduce drug addiction and I am anxious to see its impact in Alabama.”

The Alabama Board of Medical Examiners, with the guidance from a panel of industry stakeholders, is developing rules for medication assisted therapy in Alabama. If you would like to learn more about MAT and the federally-required qualifications for physicians, go to SAMHSA.gov. The Alabama Department of Mental Health also has information about MAT listed here, and a list of current grants for addiction treatment can be found here.

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Help Us Address “Surprise Billing” Issues

Help Us Address “Surprise Billing” Issues

Last week, the U.S. House Energy and Commerce Committee advanced a legislative package (HR 3630) to address the ongoing “Surprise Billing” issues affecting patients and physicians.

While this is not the same bill the Association and other medical societies were supporting, the committee did agree to adopt an amendment establishing an independent dispute resolution (IDR) process for out-of-network (OON) claims of $1,250 or more. Arbitrators leading the process would be permitted to consider things like median contracted in-network rate, provider’s level of training, experience, quality and outcomes, and acuity of care/services rendered.

Although HR 3630 still has flaws, the Association views this as progress from where we were – there was no IDR language in the original bill. Also, with HR 3502 still awaiting a hearing, it appears HR 3630 will most likely become the primary piece of legislation moving forward in the U.S. House.

With this in mind, we have slightly revised the wording of the previous letter to legislators. Still touting HR 3502 as the model we support, these new revisions more broadly address the need for IDR language to be included in whatever bill goes to the floor. Click here to read our letter to our Congressional Delegation in which several other medical specialty societies have also signed.

What can you do? Contact your legislators! We have prepared an email and guidelines in order to make this process as easy as possible for you. Simply click the button below, enter your information, and stand up for a solution that best addresses the needs of patients and physicians.

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Why I Give: Dr. John Meigs

Why I Give: Dr. John Meigs

As president of the Medical Association, I want to thank you for your membership in our organization. While membership is essential to our success, so too is advocacy. Past President Dr. Underwood recently said, “It’s amazing how politics can determine the direction of medicine.” He’s exactly right.

Yet, instead of waiting until politicians are about to make a decision impacting you and your patients, physicians should be involved long before those decisions arise. Be proactive, not reactive. Choosing not to participate in the political process – when it’s known the decisions of lawmakers directly affect medicine – is akin to getting sued, consciously sitting out of jury selection and letting the plaintiff’s lawyer pick the jury.

I know you’re busy; I know how valuable your time is. But there’s other ways you can participate besides making a phone call or sending an email – you can give to ALAPAC. Membership dollars cannot be used for elections purposes, and so separate political action committees must be established to help elect candidates physicians can work with on health care important issues.

For me, giving to ALAPAC ensures that my voice, and the voice of all Alabama physicians, is heard. I truly believe it is incumbent upon physicians to join the organizations fighting for them, to get to know their elected officials and to contribute to PACs supporting the objectives of such organizations.

Right now, ALAPAC is in the midst of its year-end fundraising campaign and trying to raise $75,000 in 75 days. When it comes to contributions, even a small donation can have a big impact. So, I challenge all of you – those who have already contributed and those who have not – to give to ALAPAC to increase medicine’s voice.

Simply text ALAPAC to 91999 or donate here.

With thanks,

John S. Meigs, M.D.
President
Medical Association of the State of Alabama

 

Disclaimer: Contributions to ALAPAC are not tax-deductible as charitable contributions for Federal income tax purposes. Voluntary political contributions to Alabama Medical PAC (ALAPAC) are not limited to the suggested amount. The Medical Association will not favor or disadvantage anyone based upon the amount or failure to contribute. A portion of the contributions may be used in connection with Federal elections. Corporate funds will be used in either state elections or for education purposes. Federal contributions are subject to the limitations of FEC Regulations 110.1, .2, and .5.

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ALAPAC Launches $75K in 75 Days Campaign

ALAPAC Launches $75K in 75 Days Campaign

Earlier this month, ALAPAC kicked off its year-end fundraising campaign and is seeking to raise $75,000 in 75 days. As the official political action committee of Alabama physicians, ALAPAC provides financial and technical support to candidates medicine can work with on the myriad of health care issues affecting our state.

It may not be a normal election year, but that doesn’t mean there are not elections. In fact, there are two special elections for the Alabama House of Representatives going on right now. What’s more is that in one of these special elections, Charlotte Meadows – the wife of a physician and a former practice manager – is on the ballot and has already made the runoff with 44% of the vote!

Consider this: there are only two physicians in the Alabama Legislature, both of whom serve in the State Senate. This means there are zero physicians in the House of Representatives. Yet, the members of these bodies make decisions directly impacting you, your families, and your patients.

This is why electing quality candidates is so vital. With so many interest groups with objectives that are not in line with increasing access to quality care and maintaining a positive practice environment in Alabama, having elected officials who understand and respect physicians’ needs crucial. A contribution to ALAPAC can help elect this kind of candidate.

When like-minded people pool their resources good things can happen. So get involved! Making a contribution has never been easier. Simply text “ALAPAC” to 91999 or donate here.

 

Disclaimer: Contributions to ALAPAC are not tax-deductible as charitable contributions for Federal income tax purposes. Voluntary political contributions to Alabama Medical PAC (ALAPAC) are not limited to the suggested amount. The Medical Association will not favor or disadvantage anyone based upon the amount or failure to contribute. A portion of the contributions may be used in connection with Federal elections. Corporate funds will be used in either state elections or for education purposes. Federal contributions are subject to the limitations of FEC Regulations 110.1, .2, and .5.

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Call for Nominations: Senior Services Advisory Board

Call for Nominations: Senior Services Advisory Board

The Alabama Department of Senior Services has an advisory board, and one member of the board must be a representative of the medical profession appointed the Governor. The Senior Services Advisory Board typically meets twice annually and members are reimbursed for travel and other expenses actually incurred in the performance of their official duties.  Interested physicians should submit their CV here.

The purpose of the Senior Services Advisory Board is to:

  1. Collect facts and statistics and make special studies of conditions and problems pertaining to the employment, health, financial status, recreation, social adjustment or other conditions affecting the welfare of the aging people in this state.
  2. Keep abreast of the latest developments in this field of activity throughout the nation, and to interpret its findings to the public.
  3. Provide for a mutual exchange of ideas and information on national, state and local levels.
  4. Give a report of its activities to the Legislature, and make recommendations for needed improvements and additional resources to promote the welfare of the aging in this state.
  5. Serve as an advisory body in regard to new legislation in this field.
  6. Coordinate the services of all agencies in this state serving senior citizens and request and receive reports from the various state agencies and institutions on matters within the jurisdiction of the board.

Interested physicians should submit their CV here.

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STUDY: Does Capping Residency Hours Hamper Physician Training?

STUDY: Does Capping Residency Hours Hamper Physician Training?

When new rules capped training hours for medical residents at 80 hours per week in 2003, critics worried that the change would leave physicians-in-training unprepared for the challenges of independent practice.

Now, new research published July 11 in BMJ and led by scientists in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School, shows that these dire warnings were largely unjustified.

The analysis — believed to be the first national study examining the impact of reduced hours on physician performance — found no evidence that reduced training hours had any impact on the quality of care delivered by new physicians.

Following a series of high-profile patient injuries and deaths believed to stem from clinical errors caused by fatigue, medical accreditation agencies initiated a series of sweeping changes to the regulations governing resident hours and other aspects of training. These efforts culminated in 2003 with the U.S. Accreditation Council for Graduate Medical Education capping the training of medical residents at 80 hours per week.

“This is probably the most hotly debated topic in medical education among physicians,” said Anupam Jena, the HMS Ruth L. Newhouse Associate Professor of Health Care Policy in the Blavatnik Institute, a physician in the department of medicine at Massachusetts General Hospital and lead author of the study. “Many doctors trained under the old system think that today’s residents don’t get enough training under the new system. You hear a lot of senior physicians looking at younger doctors coming out of training and saying, ‘They’re not as prepared as we were.’”

The findings of the study should assuage these fears, Jena said.

The researchers found no significant differences in 30-day mortality, 30-day readmissions, or inpatient spending between physicians who completed their residency before and after the residency hour reforms.

“We found no evidence that the care provided by physicians who trained under the 80-hour-a-week model is suboptimal,” Jena said.

Given the changes in hospital care over the past decade, the researchers knew that they couldn’t just compare the difference between outcomes of recently trained doctors before and after the cap, since overall outcomes have improved thanks to better diagnoses and treatments, better coordination of care and new digital tools designed to prevent harmful drug interactions and other human errors.

Comparing new physicians trained before reform with those trained after would confound the effect of changes in training with the effect of overall changes in hospital care. To avoid conflating the two, the researchers compared new physicians before and after the reforms with senior physicians who had trained before the reform.

The study analyzed 485,685 hospitalizations of Medicare patients before and after the reform.

The training hour reforms were not associated with statistically significant differences in patient outcomes after the physicians left training.

For example, 30-day mortality rates among patients cared for by first-year attending internists during 2000-2006 and 2007-2012 were 10.6 percent (12,567/118,014) and 9.6 percent (13,521/140,529), respectively. In comparison, the 30-day mortality among patients cared for by tenth-year attending physicians was 11.2 percent (11,018/98,811) and 10.6 percent (13,602/128,331) for the same years.

Further statistical analysis to eliminate the unwanted effects of other variables showed that these differences translated into a less than 0.1 percentage point gap between the groups. The difference in hospital readmission rates was similarly minuscule: 20.4 percent for patients cared for by first-year physicians in both 2000-2006 and 2007-2012, compared with 20.1 percent and 20.5 percent, respectively, among patients treated by senior physicians.

Taken together, these findings suggest that U.S. residency work hour reforms have not made a difference in the quality of physician training, Jena said.

As a way of magnifying any possible gaps in care stemming from a difference in training hours, the researchers looked specifically at outcomes for high-risk patients, in whom even small differences in quality of care would become apparent.

“We looked at patients who were particularly ill. In these cases, one little mistake could mean the difference between life and death,” Jena said. “Even for these sickest patients we found that the reduced training hours had no effect on patient mortality.”

Monica Farid of Harvard University, Daniel Blumenthal of HMS and Massachusetts General Hospital and Jayanta Bhattacharya of Stanford University also contributed to this study.

This research was supported by a grant from the Office of the Director, NIH (1DP5OD017897). The authors reported no competing interests or financial ties that might be related to the subject of this research.

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Senate Committee Tackles Surprise Billing

Senate Committee Tackles Surprise Billing

The Senate Health Committee finally passed a major health care package, which could bring an end to surprise billing for patients by capping out-of-network charges at a rate already negotiated by insurers. However, the legislation could see more changes before it sees a full Senate vote.

Wednesday, the Senate Health, Education, Labor and Pensions (HELP) Committee debated S. 1895, the Lower Health Care Costs Act, which included provisions related to protecting patients from surprise medical bills. Included in the bill is language that addresses a variety of other issues, including prescription drug pricing, provider network and pricing transparency, mental health and substance abuse parity, and tobacco regulation. The bill was voted out of committee 20-3.

The surprise billing provisions of the bill are problematic because they would tie out-of-network payments to average in-network rates in situations where a patient did not have the opportunity to choose an in-network provision. It also omits the independent payment arbitration process that the Medical Association of the State of Alabama and the AMA and other physician organizations support.

Physician Sen. Cassidy, (R-LA) offered an amendment to require insurers to post information on network adequacy so that patients can find out in advance if their doctor is in network, which was passed unanimously. Committee Chair Alexander also made a commitment to continue working with members of the Cassidy Working group to address physicians’ concerns about the lack of an arbitration model to address payment disputes. Sen. Cassidy also made strong comments against the surprise billing section in the underlying bill, noting that is it skewed heavily in favor of insurance companies. He warned that letting insurance companies set rates will have dire consequence for rural and critical access hospitals that are already closing due to inadequate payments and it will exacerbate health care market consolidation problems. Sens. Hassan, Romney and Murkowski were also outspoken, expressing concerns with the contracted in-network rate benchmark and speaking in favor of including of an independent dispute resolution mechanism.

The HELP committee is hopeful the bill will be considered on the Senate floor by the end of July. We will continue working with the principals involved to try and get our concerns with the legislation addressed through the amendment process.

Separately, Congressman Ruiz, MD (D-CA) and a significant number of co-sponsors from both sides of the aisle introduced surprise billing legislation Thursday in the House that is based on the New York model.  This is the bill that most physician groups including the Medical Association and the AMA have been waiting to support. This bill includes an independent dispute resolution process with benchmark rates tied to charges.

The Medical Association will continue to monitor developments on the surprise billing legislation and will keep the membership apprised.

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Trump Executive Order Seeks to Put Patients First

Trump Executive Order Seeks to Put Patients First

With high health care costs now a rare bipartisan issue and lawmakers on both sides of the aisle demanding action, President Trump issued an executive order on June 25 to increase transparency in hospital prices, physician fees and other health care providers to disclose more information about their billing and pricing.

Read the Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First and the White House Fact Sheet

The purpose of the order, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” is to direct federal agencies to issue regulations to improve the transparency of health care prices and quality in order to create a more competitive marketplace and provide consumers with the information they need to make informed purchasing decisions.

More specifically, the executive order:

  • Directs the Secretary of Health and Human Services (HHS) to issue regulations within 60 days that would require hospitals to publicly post standard charge information, including information based on negotiated rates, in an easy-to-understand format.
  • Requires the Secretaries of HHS, Treasury, and Labor to issue an advance notice of proposed rulemaking within 90 days seeking comment on proposals to require health care providers, insurers, and self-insured group plans to provide consumer access to information about expected out-of-pocket costs before they receive health care services.
  • Requires the Secretary of HHS, in consultation with the Attorney General and the Federal Trade Commission, to issue a report within 180 days on ways the federal government or private sector impede health care price and quality transparency for patients, with recommended solutions.
  • Directs the Secretary of HHS, within 180 days and in consultation with other federal departments and agencies, to increase access to de-identified claims data from taxpayer-funded health care programs and group health plans for researchers, innovators, providers, and entrepreneurs to facilitate the development of tools that empower patients to be better informed purchasers of care.
  • Requires the Secretary of the Treasury, within 180 days, to propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care and health care sharing ministries, as eligible medical expenses for Health Care Savings Accounts, and to increase the amount of funds in flexible spending accounts that can carry over at the end of the year without penalty.
  • Directs the Secretary of HHS to submit a report to the President within 180 days on additional administrative steps that can be taken to address the issue of surprise medical bills.

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Can We Fix Alabama’s Rural Physician Shortage?

Can We Fix Alabama’s Rural Physician Shortage?

It takes up to 10 years to train a physician. That decade of training is just one contributing factor for the reason the United States is facing a serious shortage of physicians. Other factors include the growth and aging of the population and the impending retirements of older physicians. While medical schools have increased enrollment by nearly 30 percent since 2002, the 1997 cap on Medicare support for graduate medical education has stymied increases in the number of residency training positions, which are necessary to address the projected shortage of physicians.

A 2019 study conducted for the Association of American Medical Colleges by IHS Markit predicts the United States will face a shortage of between 46,900 and 121,900 physicians by 2032. There will be shortages in both primary and specialty care, and specialty shortages will be particularly large.

Unfortunately, the State of Alabama is already experiencing a physician shortage, most notably in rural areas, and to make matters worse Alabama ranks in the last five of 50 states in health status categories.

Even with Alabama’s medical schools working to educate and nurture a future crop of physicians, there’s no guarantee these medical school graduates will remain here through their residencies or return to Alabama to practice medicine should they complete residencies outside of the state.

In 2018, the Pickens County Medical Society introduced a resolution at the Medical Association’s Annual Business Session to create a planning task force to develop and restore adequate health care manpower with a specific focus on Alabama’s rural areas. The resolution stands as a reminder that while primary care medicine is effective in raising health status, supporting hospitals and improving the economic status of disadvantaged communities, the state’s aging population is also causing an escalation in need for primary care physicians.

“The task force has brought together physicians from across the state with various practice situations to work with the many entities that comprise our health care system,” said Beverly Jordan, M.D., a family and sports medicine physician from Enterprise, Ala., who chairs the task force. “Both long
and short-term goals are being developed, and we look forward to expanding our work to non-physician groups that play an essential role in the development and sustainability of physicians in rural Alabama. A variety of barriers to physician practice in rural Alabama have already been identified, as well as several amazing programs that address those barriers and ideas for innovative solutions.”

Members of the task force met in person for the first time in August 2018 and discussed a number of issues but focused on the importance of fully funding the Board of Medical Scholarship Awards, scope of practice, physician pipeline programs, education and the possibility of GME expansion, recruitment and retention of physicians through meaningful tax credits and rural community support, and start-up business models.

Medicaid Commissioner Stephanie Azar and Dave White from the Governor’s Office joined the meeting to hear the concerns of the task force and take their report back to Gov. Kay Ivey.

“Because this was the first face-to-face meeting of the task force, we had a lot of ground to cover,” said Executive Director Mark Jackson. “Naturally there are a lot of concerns about health care shortages in rural areas, but our goal is a long-term solution. The members of the task force realize this isn’t an easy fix, which is why they were willing to express their concerns openly and honestly to the Governor’s staff.”

This year during the Annual Business Meeting the task force offered a report of its first year’s work including a number of initiatives to improve the rural primary care workforce, new and proposed initiatives, and future recommendations.

 

What Are We Doing NOW to Improve the Rural Alabama Primary Care Physician Network?

There are already a number of initiatives in place designed to improve the rural physician workforce in Alabama. These have proven successful in the past, yet given the growth trends in population and fewer physicians are choosing to locate to rural settings, these initiatives will not be enough to sustain adequate access to care for our residents living in rural areas:

Alabama Board of Medical Scholarship Awards  Amended in 1994, this legislative program was funded at about $1.4 million in 2018. Funding currently allows about nine recipients a year (full cost of medical school attendance), with a significant waiting list. As a result, 96 percent of recipients practice in Alabama; 98 percent in primary care (78 percent family medicine); 90 percent in rural Alabama; 73 percent continue in their original communities after completing the scholarship obligation.

Physician Tax Credit Act  The State of Alabama allows a state income tax credit of $5,000 for up to five years for a physician or dentist in rural practice. Legislation is currently being considered to enhance the tax credit. The Medical Association staff will report on any changes to this legislation as the Regular Session of the Alabama Legislature continues.

Rural Medical Scholar Program (RMSP)  Since 1996 this program has enjoyed statewide and national acclaim as a successful model for rural college students through medical school. On average, 11 students are admitted to this highly selective five-year medical education program of The University of Alabama and the University of Alabama School of Medicine. The Rural Medical Scholars Program includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree in Rural Community Health and early admission to the School of Medicine. Undergraduates may qualify after their junior year if they have met most of the requirements for their undergraduate major. In the year prior to entry into medical school, students take courses related to rural health and the practice of primary care in rural areas, and participate in special seminars, field trips and community service programs. Since its founding in 1996, more than 200 students have participated in the program, and of the graduates, 81.8 percent practice in Alabama while 62 percent practice in rural Alabama.

Rural Medical Program (RMP)  The Rural Medical Program began in 2005 and is modeled after the RMSP. This five-year medical school curriculum’s sole purpose is the training of physicians to serve in the areas of greatest necessity. RMP is a jointly sponsored program by the Auburn University College of Sciences and Mathematics and UAB School of Medicine Huntsville Regional Campus. The RMP curriculum promotes family medicine by providing for students to attend the annual meetings of the Alabama Academy of Family Practice and the National Student American Academy of Family Practice. Students also participate in the Medical Association’s Governmental Affairs Conference in Washington, D.C. The program has 79 percent of graduates that are family physicians, 90 percent are in primary care practice, and 74 percent are rural.

Early Medical and Other Health Professions Pipeline Programs  Rural Health Scholars, Rural Minority Scholars and others have sought to provide high school and community college student recruitment and guidance. Tuscaloosa’s Rural Minority Health Scholars has had 200 members and 15 have gone to medical school. Of the 650 Rural Health Scholars from 1993-2018, 56 have gone to medical school. These programs are aimed at all health care occupations and serve to raise awareness of medical opportunities for hundreds.

Huntsville Rural Premedical Internship (HRPI)  Since 2004, by bringing college students with rural backgrounds to the UAB Huntsville medical campus for a summer experience including clinic shadowing, didactic sessions, field trips, and medical skill workshops. With 74 percent of available graduates being accepted to medical school (125/169); 67 percent of participants having completed medical school and residency are in primary care; 67 percent are in Alabama with 46 percent rural. Of those in HRPI and a rural track such as RMP or RMSP, 75 percent are rural Alabama family physicians.

Alabama Area Health Education Centers (AHEC)  Started in 2012, five centers across Alabama focus on improving access and workforce in rural and underserved communities. AHEC engages in student recruitment and support and physician education and retention activities, partnering with medical and other health professions schools to link students to positive clinical rotations in underserved areas. Revised HRSA funding directions have decreased support for this level of activity by AHEC, through its centers continue to address these goals through other support. Improved networking, information and digital resources may provide leverage for these important but challenging activities.

Medical School Admissions Committees  Important factors include student recruitment, school policies and priorities for recruiting rural and underserved students, and committee membership (particularly rural and family physicians). The Medical Association can provide opportunities for expanded dialogue with our medical schools about how to increase the number of rural medical students, utilizing successful models from our own state and others. Using these current programs and initiatives as benchmarks, the task force began to work outward searching for changes and new models to reinforce what was already working and expand opportunities for new physicians in rural areas.

“The most important fact about this rural task force is that the Medical Association is stepping up to the plate to address the wide range of problems and challenges facing rural health in our state. That’s a highly responsible and even courageous act. The last time our Association did this was more than 20 years ago, and the outcome was the modern version of the Medical Scholarship Act and our current collaborative model for advanced practice providers such as nurse practitioners and physician assistants,” said Bill Curry, M.D., Dean of Rural Programs for University of Alabama Birmingham School of Medicine and one of the chairs of the Manpower Shortage Task Force. “This time, Dr. Jordan and the Board have taken a comprehensive and long term approach. We’re looking at everything from the physician workforce pipeline – reaching from rural schools through college, medical school, residency, and practice recruitment and retention – to the plight of rural hospitals to the responsibilities of our medical schools and state agencies to partner with communities and professional societies across all that’s involved in rural health. It’s a very full plate, and it’s important to identify initiatives with impact and to set priorities.”

The Next Step

Fact: During the last five years nationwide, applications to and enrollment in medical schools have increased.

Fact: While there is a projected shortage of primary care physicians, there is also a projected shortage of specialists.

Fact: Fixing the physician shortage requires a multipronged approach including innovations in team-based care and better use of technology to make care more effective and efficient.

Facing the facts of a physician shortage is the first part of the battle. The members of the Manpower Shortage Task Force had the opportunity to define new initiatives to begin to create a path to move the state forward and away from a deficit of physicians in rural areas.

Practice Incubator Models  Multiple partnerships involving existing or new practices, health systems and local governments, with or without initial support through the Alabama Board of Medical Scholarship Awards, the National Health Service Corps, or other scholarship programs. The incubator process involves recruitment of mentee doctors (frequently just out of training) to rural practices established by mentors. The mentee then learns private practice and is subsequently enabled to move to another rural location by the mentor or the mentee may simply buy into the existing practice if sufficient growth has occurred. The benefit to the mentor is a return on investment of satellite practices or income realized above the salary of the mentee.

Improved Workforce Database  Traditional sources of information about the Alabama physician workforce include the Alabama Board of Medical Examiners, the American Medical Association physician database, the American Academy of Family Physicians, the National Rural Health Association, County Health Rankings, the Center for Medicare and Medicaid Services, and information from the Alabama Department of Industrial Relations. Recently the UASOM Huntsville Office for Family Health, Education and Research (OFHER) has combined, analyzed and displayed data from various sources into more usable and interactive formats, and the Alabama Rural Health Association has collaborated in this effort also.

Improve and Standardize the Designation of Primary Care Shortage Areas for Alabama  HRSA has established a work directive for all state Offices of Primary Care (PCOs) to establish a state network of rational service areas for identifying local and/or regional shortages and developing rational and reasonable solutions to eliminate identified shortages. The Alabama medical community must be a major player in the development of Alabama’s Rational Service Areas (RSAs). There is a major concern if the Medical Association and the medical community are not involved in the formation of state RSAs, then private practice primary care providers and physician mental health providers and rural hospitals will be left out.

Scholarships  Graduate medical education programs in primary care need more scholarships. Some scholarships expect recipients to enter primary care while others require rural service. Currently, the BMSA is the most successful program in the state, and possibly the nation, for providing physicians to rural areas. The scholarship is repaid by rural service of four to six years depending upon the size of the underserved town.
Changes in Undergraduate Medical Education Students most likely to enter rural practice are those from rural areas. Selecting students from rural Alabama, expanding rural premedical programs, and expanding the rural tracks will provide a larger pool of applicants to the state’s family medicine residencies. Other options include allowing early admission as college juniors providing they achieve predetermined academic and MCAT standards; and placing third-year students with primary care physicians, which serve to increase student familiarity and comfort with the practice.

Changes in Graduate Medical Education  Data shows the physician most likely to practice in Alabama is one who is from Alabama and who attends medical school and residency here. Also, the person who is from a rural area in the state is the most likely to return to a rural area. The most important mission is to fill the current family medicine slots with the Alabamians most likely to enter rural practice. New residency programs are also an option. These programs are beginning to pop up across the state from Madison County to Baldwin County in a variety of specialties.

Transition from Residency to Practice  The final chapter of the process is moving from a residency to a medical practice. The expansion of the BMSA is the surest and fastest method of attracting physicians (which has solid, objective data proving its worth). Out-of-state physicians may be attracted to rural Alabama because of the advantages in cost of living and professional satisfaction. Physicians may move from states ranked as the worst in which to practice medicine (IL, CA, MD, OR, MA, DC, NY, RI, NM and NJ) to Alabama, which was ranked the third best in the U.S. behind NC and TX. (Medscape Physician Survey, 2016).

Targeting the Black Belt Communities  According to the Black Belt Solutions/Community Engagement Subcommittee’s Co-chair John Wheat, M.D., engagement and partnerships among communities and resource agencies for this area will be the lynchpin for its success.

“This population and region desire doctors and other health professionals who understand their life, identify with them, and want to live and practice among them,” Dr. Wheat explained. “It is apparent such physicians are far more likely to be from the Black Belt than elsewhere, their course through medical education must be supported in many ways, that practice facilities must be on par with urban counterparts, that social and professional contexts must be prepared for them, and patients must be able to afford to come to them. Our first and continuing task is to engage the knowledge, trust and commitment of multiple groups with varying perspectives and influences for making changes required to succeed in these efforts.”

Dr. Wheat and co-chair Brittney Anderson, M.D., are originally from Alabama’s Black Belt and have begun reaching into the community to contact local ministers, county commissioners, physicians who grew up in the region, and other community activists with strong commitments to the region for opinions and ideas about how to better serve the area.

“We have been well received and encouraged to continue toward setting up a planning structure that will be inclusive and unify multiple groups and agencies. We look forward to having a planning group that will receive enthusiastic invitations from various Black Belt communities asking us to partner with them in producing and maintaining the health care professionals in their community,” Dr. Wheat said.

The Long Road Ahead…

The Medical Association and the members of the Manpower Shortage Task Force realize there is a long road ahead to finding the best solutions to Alabama’s physician shortage in our rural areas, but we are working toward solutions…and there will be many solutions and many partners to take part in the process.

“We recognized that without a viable rural health system – which has to include either a hospital or a freestanding facility with after-hours and emergency coverage – it’s difficult or impossible to have effective primary care and other services in a rural community,” Dr. Curry said. “The Association’s reaching out to the Alabama Hospital Association and other partners is a huge step, and I hope the regulatory or other changes needed will happen soon.”

Dr. Jordan agreed, adding that help from established physicians is always welcome.

“Our work has just begun, and we look forward to continued efforts to both develop and sustain excellent health care communities in rural Alabama,” Dr. Jordan said. “As we expand our workgroups to include educational, business, political and religious leaders in our state, we welcome the involvement of our physician members. Please don’t hesitate to contact us if you are willing to help – we need you!”

If you would like to be involved with the task force, have questions, or would like to contribute an idea, please email Association Executive Director Mark Jackson.

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Alabama Physicians Represented at AMA Annual Meeting

Alabama Physicians Represented at AMA Annual Meeting

CHICAGO – Physicians from Alabama were well represented at the American Medical Association’s meeting last week where discussions ranged from physician and medical student suicide to transparency in drug pricing.

Jorge Alsip, M.D., Delegation Chair, said the Medical Association’s members were represented by its eight-member delegation as well as by representatives from the state’s Medical Student Section, Resident Fellow Section, Young Physician Section, and Senior Physicians Section along with physician representatives from several specialty medical societies.

“During the five-day meeting, our delegation reviewed more than 250 reports and resolutions and offered testimony on issues of particular interest to Alabama physicians.” Dr. Alsip said.

Among the policies adopted or reaffirmed during the meeting were:

  • Eliminating the barriers to appropriate pain management created by insurers and pharmacy benefit managers, which make it more difficult for physicians to provide appropriate care to patients living with pain
  • Reaffirmation of the AMA’s strong opposition to physician-assisted suicide after the House of Delegates rejected a proposal by supporters of physician-assisted suicide to change AMA policy and have the organization take a neutral stance on the issue
  • A report calling for the AMA to conduct a study to identify the systemic patterns and risk factors that lead to burnout, depression and suicide among physicians, residents, and medical students and ultimately help prevent it.
  • New policy to improve the Affordable Care Act (ACA) while reaffirming the Association’s strong opposition to a single-payer approach to health system reform.
  • Strengthened the AMA’s long-standing support for transparency in drug pricing by adopting new policy to support the active regulation of PBMs under state departments of insurance and increased PBM transparency, including utilization, rebates and discounts, and financial incentives.
  • The need for the AMA to work with relevant stakeholders to support the extension of Medicaid coverage to 12 months postpartum to help address the rising maternal mortality rate.

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