A Milestone Year for Rural Medicine in Alabama

John R. Wheat, MD, MPH
Professor of Community and Rural Medicine
The University of Alabama

A major step in the fulfillment of Alabama’s educational mission to produce doctors for everyone in the state is now realized, as the first class of Rural Medical Scholars — eight physicians specially selected and educated to become doctors to serve rural Alabama — has graduated at The University of Alabama. This is a milestone event for Alabama.

Around the world, as in Alabama, producing rural physicians is extremely difficult. As society evolves, advancements in education, economics, entertainment, and medicine have generally drawn resources to the larger populated cities. Typically, the aspirations of the highly competent students who succeed in medicine are urban.

Alabama continues to be in need of rural physicians.

Over the past 25 years, the University of Alabama School of Medicine in Birmingham has been supplemented by branch campuses in Huntsville and Tuscaloosa, and the University of South Alabama College of Medicine in Mobile. Residency programs were established around the state to produce family physicians — the type of doctor that is most likely to decide to practice in rural areas and small towns.

But while more rural physicians have been produced, a doctor shortage continued in rural Alabama due to retirements and relocations of small-town doctors. The shortage became so acute that the Alabama Legislature declared a rural health crisis in the state in 1989.

In 1991, the Dean of the College of Community Health Sciences at UA, the Tuscaloosa campus Chairman of Community Medicine, and the Dean of the University of Alabama School of Medicine in Birmingham jointly supported a proposal to start a special program to develop more rural physicians for Alabama. This proposal was a result of a study of programs around the United States, which included recommendations from rural physicians, and encouragement from an impressive array of health care and rural groups, including Alabama Women Involved in Farm Economics, Rural Alabama Health Alliance, Alabama Farmers Federation, Alabama Hospital Association, Alabama Primary Health Care Association, Alabama Academy of Family Physicians, and Medical Association of the State of Alabama.

Participants in this effort recognized that the fundamental challenge was identifying students who would like careers in rural health care, and then to provide them with the special skills needed to succeed in rural and small town practices.

The requirements of rural medical practice are very different from urban practice. With a scarcity of other local health professionals, the rural physician has a greater responsibility to meet the variety of needs of a diverse rural community.

In addition to providing clinical care for all comers, the rural physician responds to broader community health issues, such as those related to schools, occupations, and environments. Care for farm families, isolated elderly, and uninsured school children are of particular concern to rural physicians.

In recognition of these factors, planners developed a strategy to identify rural high school students who showed interest in health care careers, while boosting their interest and academic skills with a special summer program, and later, select such rural students for slots in medical school and to train them for rural practice. This plan led to creation of the Rural Health Scholars Program in 1993, and in 1996, the Rural Medical Scholars Program was created to select rural students for medical school and train them in rural aspects of medicine.

The Alabama Family Practice Rural Health Board and the Alabama Legislature endorsed this plan with grant funding.

Now after eight years, 226 rural high school students have participated in the Rural Health Scholars Program, and many of them have chosen health care careers. And after five years, the Rural Medical Scholars Program has admitted 50 rural students to the University of Alabama School of Medicine and the special educational program that exists on the Tuscaloosa campus in the College of Community Health Sciences.

These students have an extraordinary commitment to rural practice. The normal medical school curriculum is four years. But to prepare students for the extra demands of rural practice, the Rural Medical Scholars Program requires a fifth year of medical study, which is taken the year before starting the regular medical curriculum. In addition to these special studies, the Rural Medical Scholars use the year to develop a peer group that supports them through medical school.

This week, the first eight Rural Medical Scholars to enter medical school will be awarded their M.D. — Doctor of Medicine – degrees.

Founders of the College of Community Health Sciences envisioned a medical educational program that would produce physicians, with many choosing rural practice.

The Rural Medical Scholars Program is a major step toward that vision. The graduation of the first eight Rural Medical Scholars reflects the determination of these outstanding students to serve the people of rural Alabama, and the commitment of The University of Alabama, the University of Alabama School of Medicine, and the College of Community Health Sciences to help the people of rural communities around Alabama have their own doctor.

These charter Rural Medical Scholars are: Angela Clifton of Etowah County; Anne Davis of Talladega County; Kevin Ellis of Marshall County; Tom Holt of Coffee County; Drake Lavender of Greene County; Stephanie Morgan of Cherokee County; Elizabeth Smith of Monroe County; and Paul Tabereaux of Colbert County.

While these young physicians have taken a major step in their own careers and represent a landmark for Alabama’s rural medicine programs, they still have a way to go.

Each must maintain the dream of becoming a rural physician during residency training. This will be made easier as family, friends, and leaders from their home communities continue to affirm their value as future rural community leaders and engage them in plans for local practices that will sustain them economically, intellectually, and socially.

As these students graduate, they deserve not only congratulations — but also thanks. They carry not only the hopes and dreams of themselves, their families, and their friends, but of their communities and a state where rural physicians are so sorely needed. They have shown the way for those behind them in the Alabama rural physician pipeline.