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Alabama’s primary care shortage is greater than thought

The federal Health Resources and Services Administration (HRSA) directs the determination of Health Professional Shortage Areas (HPSA) in the United States.  According to data provided by HRSA in early 2017, Alabama needed an additional 157 primary care providers placed where the need was the greatest to provide only the minimum (not optimal) service that our population needed.

In determining primary care provider shortages, normally one-quarter of Alabama is reevaluated each year, taking four years to reevaluate the entire state.  However, HRSA requested a complete reevaluation in all states to be completed in late 2017.  Following this complete reevaluation in Alabama, it was learned that our shortage of primary care providers was much greater than was thought.  We needed 321 additional providers placed where the need was the greatest to meet the minimum needs of our population.  This shortage was more than double what had been thought.

The shortage of primary care providers is greater in our rural areas.   Of the 54 counties considered as being rural, only Coffee, Escambia, and the northern part of Covington County are considered to have the minimum service available.  Thirty-eight entire rural counties and five portions of other counties do not have the minimum level of primary care service available to serve the needs of the population.  Seven entire rural counties and four portions of other counties do not have enough primary care service available to meet the needs of the low-income or Medicaid population.

The shortage of primary care providers in our rural areas was already considered to be a crisis.  Knowing that the shortage is more than double what had been thought creates a situation requiring intense actions.  Especially considering the fact that a disproportionate number of our actively practicing primary care physicians are getting older and closer to retirement.  At the same time, our total population is aging, with chronic diseases that require more care increasing.

Alabama’s 2019 Legislative Session is going to be very important to the future of primary health care in this state – especially in rural areas.  Alabama must be innovative in better using our health care resources and technology.

A very innovative concept was proposed in House Bill 20 during the 2018 Legislative Session.  This legislation would have authorized the state to pay the tuition for 25 medical students in Alabama medical schools each year in return for a five-year obligation to practice in an underserved area following the completion of residency training.  This concept would produce a larger number of primary care physicians each year to deal more aggressively with our large primary care physician shortage.

HRSA has a local partner in each state to help gather local primary care practice information used in determining shortage areas.  This partner in Alabama is the Office of Primary Care and Rural Health in the Alabama Department of Public Health.  For determining shortage areas, primary care includes family medicine, internal medicine, pediatrics, obstetrics/gynecology, and geriatrics.

For additional information on primary care shortage area determination, please visit HPSAfind.HRSA.gov or contact Alabama’s project director, Niko Phillips, at (334)206-3807 or niko.phillips@adph.state.al.us.

Dale Quinney is the founder of Operation Save Rural Alabama, www.osral.net, and a past director of the Alabama Rural Health Association