Physician Workforce Act Addresses Alabama’s Doctor Shortage So Patients Get the Care They Need

By Julia M. Boothe, M.D.

If it seems you are having to to wait longer to get a doctor appointment than you used to, it’s not your imagination. Alabama is experiencing a physician shortage, and the results can be far worse than a mere inconvenience for your schedule.

The physician shortage means patients are experiencing delays in access to medical care for a range of prevention, wellness and treatment options. When patients have difficulty accessing care, their health problems worsen. Most eventually end up in already crowded hospital emergency departments. This puts extra strain on overworked hospital staff and ends up increasing health care costs for everyone.

Fortunately, there is legislation before the Alabama Legislature that would help address the physician shortage of today and build the physician workforce we need for tomorrow.

This legislation is the Physician Workforce Act – House Bill 243 sponsored by Rep. Paul Lee and Senate Bill 155 sponsored by Sen. April Weaver. Patients and physicians across the state can be grateful these two leaders are proactively dealing with this looming health care crisis.

The Physician Workforce Act focuses on three key areas: cutting red tape to boost physician recruitment, better utilizing our existing physician workforce, and establishing an apprenticeship-like program for future physicians.

Alabama does a great job recruiting industries to our state with incentives. But when it comes to recruiting doctors, we throw up unnecessary barriers and red tape. Physicians licensed to practice medicine in other states can’t relocate to Alabama and practice medicine unless they take an additional test. And we make this test even more burdensome by requiring that it be taken in-person. So, a fully licensed physician from Georgia, Florida or any other state who is thinking of moving to Alabama must physically show up to take this test.

This requirement is unnecessary, outdated and a barrier to better health care. The Physician Workforce Act repeals this red tape. Doing so won’t lessen standards because all other medical licensure requirements will stay the same. But removing this bureaucratic barrier will make Alabama more competitive when it comes to recruiting physicians.

As Sen. Weaver has said, if we want more doctors in Alabama, we need to make Alabama more welcoming to doctors. With this important change, the Physician Workforce Act does that.

In addition to recruiting physicians, we need to do a better job utilizing the physician workforce we already have. International Medical Graduates (IMGs) currently make up 20 percent of Alabama’s physician workforce. They are required to complete three years of training in a residency program to become eligible for an initial medical license. By contrast, U.S. and Canadian medical graduates must complete only one year of residency to become licensed.

IMGs are subject to the same rigorous credentialing standards as any other U.S. physician and are held to the same demanding educational standards as students attending medical schools in the U.S. and Canada. Alabama’s licensing requirements need to reflect that.

Therefore, the Physician Workforce Act would allow IMGs to apply for an initial medical license after two years of residency. This would enable IMGs to begin working more quickly in Alabama and allow our busy clinics and hospitals to utilize these highly trained medical professionals for hard-to-staff overnight shifts in emergency departments.

If a medical graduate is looking to apply for a residency, they will go to states where they can work as soon as possible. And if these physicians are allowed to work sooner in Alabama, the higher the chances they will stay in Alabama when their residency training is over.

Twenty other states already follow this accelerated route toward a medical license for IMGs. Alabama should join them.

Lastly, the Physician Workforce Act would create an apprenticeship-like program to help bolster the physician workforce of tomorrow. If this were to become law, Alabama would join nearly 10 other states that allow medical graduates who do not match into residency programs to increase their knowledge and skills under the supervision of licensed physicians as they prepare to reapply for residency.

With physicians serving as their mentors, these medical graduates would receive additional training that will benefit them tremendously in the future and help to ease pressure on our health care system today.

Legislators should make passage of the Physician Workforce Act a priority. It would significantly expand the pool of trained physicians practicing in our state, it would increase the number of patients getting the medical care they need and it would improve health outcomes for Alabama’s sick and injured. For these reasons, it has earned the support of the Medical Association of the State of Alabama, the University of Alabama at Birmingham (UAB), the University of South Alabama, Federally Qualified Health Centers, and numerous medical specialty groups.

The sooner the Physician Workforce Act becomes law, the sooner we’ll put Alabama on the path toward a healthier future.

Dr. Boothe is a primary care physician caring for patients in Reform, Alabama. She serves as Immediate Past President of the Medical Association of the State of Alabama.

Discussions with Decision Makers: Rep. Susan DuBose

Representative Susan DuBose (R -Hoover) is the newly elected representative of district 45. Rep. DuBose worked as a residential, commercial and construction loan officer and business development officer for Compass Bank for over 12 years before becoming a stay-at-home mom to raise her two children in 1997.

She is president of the Republican Women of North Shelby County, is on the Governmental Affairs Committee and Women’s Business Council for the Shelby County Chamber of Commerce and is a member of the Shelby County Republican Party Executive Committee. Rep. DuBose will serve as committee member on the House Health Committee.

What First prompted you to consider running for office?

I felt my District 45 was not adequately represented by someone who was active and engaged in the community. We are a diverse district that stretches from Irondale to Chelsea and includes three counties- Jefferson, Shelby and St. Clair. We are also an area experiencing considerable growth, especially Chelsea and surrounding areas of North Shelby County. We also have a very politically informed electorate that deserves a representative that will be involved and available.

How does your background help serve you in the Legislature?

For about the last 12 years I have been very involved in a support role in the Republican Party. I was President of the Republican Women of North Shelby County when I decided to run for office. I was also a member of the Shelby County Republican executive committee. As a member of those groups, I was often asked to be a conservative female voice in Montgomery at committee meetings and press briefings. The transition to running for office was easy for me because I had spent so much time in the political arena. I also consider myself a policy nerd. I love studying bills, current policy issues and comparing model legislation with other states. My degree is in finance, and I started my career in real estate and construction lending with Compass Bank. Years of analyzing financial statements should be an asset when navigating our state budgets.

What are some of your legislative priorities next term?

School choice, Women’s Bill of Rights, Womens’ Sports Bill (HigherEd), Workforce Participation Rate- (Only 57%!), Mental Health, Fentanyl Crisis, ESG.

What are some health-related issues important to your district and your constituents?

By far the most heart wrenching stories I have heard from constituents involve overdoses from Fentanyl/opioids. Usually, the story involves losing a child and the parents are pleading for help to stop this crisis. Secondly, mental health is the issue I heard most about. Law enforcement has been the most vocal, more patient facilities are needed. Teachers and principals want more help for students. Mental Health of students is becoming a larger and larger concern in today’s culture. My third concern is the impact of marijuana dispensaries opening all over the state. Even though this is supposed to be “medical marijuana” the conditions that qualify for a marijuana card are vast and most people will be able to obtain a card if they want one. The industry will continue to push until recreation marijuana is legalized. I am very concerned about the detrimental health and safety impact this will have on our state.

What do you think people understand the least about our health care system?

I should be asking you guys this question. I have a lot to learn about our health care system myself.

If you could change anything about our health care system, what would it be?

Take out the bureaucracy and make it more about relationships with doctors and their patients. I’m always about less regulation and less interference from the government. When the government is involved, more controls are placed on physicians, and patients suffer. I believe doctors should have the freedom to make medical decisions they feel are best for the patients without undo mandates from our government.

How can the Medical Association- and physicians statewide- help you address Alabama’s health
challenges?

Open and honest communication will help me. I am not a health expert; I’m not trained in any health field, but I care about the people in the State of Alabama. We all need to work together to address vital issues in our state. I asked to be on the Health Committee because I believe the most pressing issues facing our state are tied to our health.

What is the one thing you would like to say to physicians in your district?

I have the upmost respect and admiration for physicians. I know the sacrifices you made for many years to obtain the advanced education and training it takes to be a physician. Medicine is a true calling, and you are a public servant to your communities. Thank you all for your continued service and your dedication to your fields. May God be with each of you.

2023 Advocacy Agenda

As the professional association for some 7,000 physicians of all specialties in Alabama, the
Medical Association of the State of Alabama exists to serve, lead, and unite physicians in
promoting the highest quality of healthcare for the people of Alabama through advocacy,
information, and education

General Policies Supported

The Medical Association supports the physician-led health team model and maintaining the highest standards for medical care delivery across all specialties of medicine.  The Association  supports prohibiting deceptive healthcare advertising and requiring health professionals identify their license to patients.

The Association supports physician autonomy in patient care and medical practice decisions, fair reimbursement for services and reducing the volume of administrative tasks required by insurers which increase annual health spending and negatively impact patient health.     

Further, the Association supports increasing health insurance options for Alabamians, including expanding Medicaid.  The Association supports increasing access to quality mental health care and continued state funding for the Maternal Mortality Review Committee and the Infant Mortality Review Committee.  Recognizing the long-term effects of social determinants of health on individuals, families and ultimately communities, the Association supports comprehensive solutions to addressing these challenges, with emphasis on pipeline programs, tax credits and loan forgiveness proposals benefitting rural and underserved areas.

Finally, by ensuring medical liability environment stability and pursuing further civil justice reforms, the Association believes Alabama can continue to attract highly-qualified physicians.

Specific Policies Supported

For 2023 , the Association specifically supports:

• Streamlining the prior authorization process for physicians and patients
• Initiatives to grow Alabama’s physician workforce
• Increasing access to physician-led care in rural and underserved communities
• The ability of medical practices to set patient practice policies
• Increasing physician representation on state healthcare boards, task forces and committees

General Policies Opposed

The Medical Association opposes any scope of practice expansion for non-physicians that would fracture the physician-led health team model, lower quality of care and/or increase costs.  The Association also opposes any interference with the physician-patient relationship and attempts to reduce a physician’s autonomy in patient care or medical practice decisions.

The Association opposes legislation or other initiatives that could increase lawsuit opportunities against physicians, including the establishment of statutory standards of care or any statutory dictums for medical care delivery.  The Association also opposes any state-level increase of requirements for Maintenance of Certification.  Finally, the Medical Association opposes tax increases disproportionately affecting physicians.

Specific Policies Opposed

For 2023, the Association specifically opposes:

• New lawsuit opportunities against physician employers and medical practices over employment policies
• Efforts to reduce and/or politicize physician involvement in health regulatory affairs
• Expanding Prescription Drug Monitoring Program (PDMP) access for law enforcement
• Statutory requirements for mandatory Prescription Drug Monitoring Program (PDMP) checks

Discussions with Decision Makers: Rep. Frances Holk-Jones

Representative Frances Holk-Jones, a native of Foley, is the newly elected representative from the 95th district in Baldwin County. She is the first 4th generation State Farm agent in the country and is president of Frances Holk Insurance. Frances learned the importance of public service at an early age while watching both her grandfather and father serve as Mayor of Foley. Frances will serve as a committee member on the House Health Committee.

What first prompted you to consider running for office?

Politics has always intrigued me.  I learned the importance of public service, economic development, and community involvement at an early age watching both my grandfather and father serve as Mayors of my hometown of Foley, Alabama. 

How does your background help serve you in the Legislature?

Throughout my forty-four year career in the insurance industry as well as in my leadership roles on numerous federal, state, and local nonprofit and civic organizations, I’ve worked diligently to ensure that programs are available to enhance the quality of life for all Alabamians.

What are some of your legislative priorities next term?

Youth mental health is very close to my heart.  In my legislative role, I will advocate and work to improve the resources available for those with mental illness.  I would also love to see some progress made with our South Baldwin Workforce Development Authority to make sure we’re finding ways to have a substantial workforce and affordable housing so we can keep our great economic engine running.

What are some health-related issues important to your district and your constituents?

Not to sound like a broken record, but the issue of youth mental health is certainly a focus of mine.  Despite major strides within the mental health community, there remains a shortage of available resources, including mental health professional workforce and lack of coordinated systems of care. 

What do you think people understand the least about our health care system?

Just how crucial it is to have quality health care; access to good health services leads to better patient outcomes with less impact on our economy. 

If you could change anything about our state’s health care system, what would it be?

Ensuring that quality health care services are more accessible for those that live in the rural areas of our state.

How can the Medical Association – and physicians statewide – help you address Alabama’s health
challenges?

By working together with their legislators to advocate for public health-related policies which will help ensure quality health care services are provided throughout the state.

What is the one thing you would like to say to physicians in your district?

Thank you for being an advocate for your patients and your commitment to providing quality care despite the changes in health care delivery you see every day.

Stopping the Optometric Surgery Bill

For the 4^th installment of an in-depth look into each of the Medical Association’s “Top 10 Highlights” from the 2022 regular session, we will look at the Association’s opposition to allowing optometrists the ability to perform eye surgeries using scalpels and lasers as well as performing eye injections. 

Outgoing Senator Jim McClendon, an optometrist himself and chairman of the Senate Healthcare Committee, partnered with former Senate Pro Tem President Del Marsh to attempt to pass the optometric surgery bill. The bill would have allowed optometrists, who have not been trained in eye surgery, to perform surgeries and injections on the eye and would have given the Alabama Board of Optometry the sole power to define and regulate what is considered to be the practice of optometry. 

In the Senate, the bill was “passed” out of committee on a voice vote called by Sen. Jim McClendon despite opposition from the majority of other Senators on the Senate Healthcare Committee.  Weeks later, in the Upper Chamber, the bill was allowed to be voted on the Senate floor where after a few hours of contentious deliberation, the bill passed 17-12 and moved on to the House of Representatives.  

In the House, the bill was placed in the House Health Committee where the optometry group, including optometrists, inundated the State House on a regular basis – lobbying legislators and also bringing down many optometry students from UAB to fill the halls of the Legislature.  In the last month of the 2022 Regular Session, the Medical Association who partnered with the Alabama Academy of Ophthalmology and Alabama Dermatology Society throughout the Session, made countless phone calls, sent numerous emails and came to the State House to express the dangers this bill poses to patients in Alabama.  By the last two weeks of the Regular Session, an ophthalmologist was at the State House every day speaking with legislators against the legislation. On one of the last days of the Regular Session, the bill had a public hearing where ophthalmologists spoke against the legislation and the bill ultimately failed because the legislation was not seconded for a vote in Committee during the public hearing.

The Association would like to thank the many ophthalmologists and dermatologists who volunteered their time to come down to the State House, make phone calls and send emails to legislators.  The Medical Association’s grassroots effort against this bill was a big success and without this value of advocacy this dangerous “scope creep” bill may have become law.  The Association fully expects to see this bill filed again in the 2023 Regular Session and we will continue to work with Lawmakers in ensuring that patient safety be held to the highest standard of quality care in Alabama.