As the Tuscaloosa Family Medicine Residency Program grew, trailers were used to accommodate the growing number of patients cared for by residents.

Celebrating 45 Years of Providing Primary Care Physicians for Alabama and Beyond

Just a few short years after the College of Community Health Sciences was established at The University of Alabama in 1972, College leaders launched the Tuscaloosa Family Medicine Residency – a three-year program that would educate and train medical school graduates seeking to specialize in the new discipline of family medicine.

Dr. William R. Willard, the College’s first and founding dean, reached out to the director of a small residency in Daytona Beach, Florida, to direct the soon-to be residency in Tuscaloosa. Dr. William Hubbard accepted and in May 1973 joined CCHS, where he played a crucial role in writing the application for approval of the Tuscaloosa program.

Dr. William Willard (left) with then University of Alabama President Dr. David Mathews.

In 1974, Dr. Michael McBrearty joined the residency, transferring from the University of Oklahoma Family Medicine Residency, and would become the first graduate of the Tuscaloosa program. By November of that year, two other residents joined – Dr. Tim Simmons, who transferred from St. Margaret’s program in Pittsburgh, Pennsylvania, and Dr. Larry Sullivan, a new University of Alabama School of Medicine graduate.

By the time McBrearty graduated in July 1975, the Tuscaloosa Family Medicine Residency had fielded its first full class – 12 residents. At the time, the program was one of 140 such residencies in the country in a new medical specialty that was rapidly growing.

CCHS had created a strong training program in family medicine for medical school graduates using the guidelines of the 1966 report, Meeting the Challenge of Family Practice. The report is known today simply as the Willard Report in honor of the College’s founding dean, who chaired the American Medical Association committee that produced it.

“I hoped we could motivate students to provide human and personalized comprehensive medical care as primary care physicians and engage in significant public service,” Willard said at the time.

The Willard Report defines a family physician as one who “accepts responsibility for the patient’s total health care within the context of his or her environment, including the community. As family physicians acquire continuing relationships with their patients, they become highly effective in dealing with the social dimensions of their illnesses.”

Dr. John Sullivan, 1978 graduate, (left) with Dr. William Willard.

Dr. Richard Rutland, an early CCHS preceptor, dances with late wife Nancy, while son-in-law Dr. Michael McBrearty dances with wife Cynthia at an alumni event.

Distinctive Benefits

From the beginning, it was apparent that the Tuscaloosa Family Medicine Residency would provide an excellent learning environment for family medicine physicians in training. A key benefit of the program was that it was the only residency at DCH Regional Medical Center in Tuscaloosa, where the residents received in-patient training; no other residencies competed for patients or faculty teaching time.

Dr. William deShazo (right) trains with a resident.

Dr. Sandral Hullett, 1979 graduate, during a patient visit.

An unopposed program is what drew Dr. Meghan Bonds to the residency.

“When I was looking for residencies, I was really drawn to unopposed programs, specifically because you get access to the entire hospital – nowhere is off limits,” said Bonds, a 2020 graduate. “Here, we have an open ICU, we rotate through the obstetrics and gynecology service and the pediatrics service, and we get to spend a lot of hands-on time with patients, not on the periphery, not as an add-on to other residents, but as the primary care givers for those patients.”

Added fellow 2020 graduate Dr. Tony Bonds: “You get the best of both worlds, which is very rare across the country, with a program that is unopposed but also university affiliated.”

Dr. William deShazo was tapped in 1976 to direct the Tuscaloosa Family Medicine Residency, and the first class he recruited would be a memorable one. The class included the first African Americans to join the residency, only 13 years after former Alabama Gov. George Wallace’s infamous stand at the schoolhouse door: Dr. Herb Stone, who had recently earned his medical degree from Emory University in Atlanta; and Dr. Sandral Hullett, an Alabama native and recent graduate of the Medical College of Pennsylvania.

Hullett, who was the first female in the residency, went on to have a successful career as a rural practitioner. She was inducted into the National Institute of Medicine, a unit of the National Academy of Sciences, and was named Rural Doctor of the Year in 1988 by the National Rural Health Association.

deShazo, who cared for UA athletes and served as personal physician to legendary UA football coach Paul “Bear” Bryant, also introduced a sports medicine rotation to the curriculum.

“One of the advantages of our residency program is that all residents do a mandatory rotation through our sports medicine program. They get to interact with our (sports medicine) fellows on a regular basis and get active teaching there,” said Dr. Jimmy Robinson, the College’s Endowed Chair of Sports Medicine and director of its Sports Medicine Fellowship. “We emphasize musculoskeletal exam techniques, something that’s going to be very useful to them when they get out in private practice.”

Dr. William deShazo with alumni pictured from left:
Dr. John Brandon (1981), Dr. Michael McBrearty (1976),
deShazo, Dr. Gary Magouirk (1983) and Dr. Jimmy Robinson (1988).

Behavioral medicine was another discipline that CCHS administrators recognized early on would be important for family medicine physicians. In 1977, an affiliation agreement signed by CCHS and the Tuscaloosa Veteran’s Administration Medical Center established the VA’s psychiatric hospital as a training site for residents in the diagnosis and management of psychiatric disorders. The partnership continues today.

Challenging Times

As the 1990s got underway, the Tuscaloosa Family Medicine Residency had graduated 165 residents and of these, more than half were practicing in Alabama, many in small towns and rural communities. The College could claim to have one of the most productive family medicine residencies in the country, being in the top 10% in the number of residents graduated.

But the decade would also prove to be challenging. Medical student interest in family medicine had waned nationwide and with it the number of applications to the Tuscaloosa program. In addition, nearly 100 new residency programs had been established across the country, and even well-established residencies found recruiting more difficult.

By the middle of the decade, the Tuscaloosa Family Medicine Residency was growing again and had graduated 222 residents. The growth was driven in part by a change involving how residents were selected to the program. Residency administrators expanded the recruiting pool to include graduates of osteopathic U.S. medical schools and international medical graduates. As the decade came to a close, the residency had 258 graduates, making it one of the most productive programs in the Southeast.

Dr. Tim Viator, 2006 graduate, works with the electronic medical record.

Survival to Significance

By 2002, the Tuscaloosa Family Medicine Residency had trained 290 family physicians. Nearly 52% were practicing in Alabama, and the availability of health care in the state’s rural and underserved communities had improved. Other graduates had settled in neighboring Southeastern states.

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College of Community Health Sciences building sketch from 2001.

Not content to remain at 12 new residents per year, Dr. Richard Friend, hired as director of the Tuscaloosa Family Medicine Residency in 2013, set out to expand the three-year program from a total of 36 residents (12 per year) to a total of 48 residents (16 per year). Alabama was still far short of the number of primary-care physicians needed, ranking nine out of 50 in terms of the most underserved states based on Health Professional Shortage Area (HPSA) scores. Friend, who served as residency director until 2018, is now the dean of CCHS.

Dr. Richard Friend (middle) with 2014 Residency graduates Dr. Mark Christensen (left) and Dr. J.D. Engelbrecht (right).

CCHS faculty Drs. Drake Lavender and Sara Phillips (right) interact with residency prospects at the annual AAFP National Conference of Family Medicine Residents and Medical Students held in Kansas, City, Missouri in 2019.

“I think we need to continue to respond to the needs of the state,” Friend said at the time. “We need to look at potential expansion as a means to meet the growing demand for well-trained family medicine physicians.”

Prospective residents took note, and the Tuscaloosa Family Medicine Residency saw interest in the program increase. The residency received 2,000 applications for 15 slots in 2013, a 30% increase from 2012. Today, the residency has reached Friend’s goal of 48 residents in training each year.

Friend also worked to include rural experiences for residents.

“When I found out this residency program existed, and when I looked into it a little more, I got really excited because it seemed to hit on all the things that I was looking for in my medical training,” Bonds said. “It focused on family medicine, which was a big draw for me. It was really important for me to be in a program with a rural focus. And what really prepares us for rural isn’t necessarily being out in rural areas. It’s the attitude our attendings have, when maybe your instinct is to refer to a specialist, they are quick to say, ‘No, you can handle this.’”

She added: “They really touted a strong in-patient program and really intense training in a way which was really great because I knew going off into a rural area I wanted to know as much as I possibly could.”

Today, Bonds practices 35 miles down the road from Tuscaloosa, in rural Greensboro, Alabama, with a population of approximately 2,500 as of the 2010 U.S. Census.

“What I’ve seen is that a lot of residents tend to stay after they graduate in the area here. They like the towns, they like Alabama, they like the people, and they have a lot of opportunities for practice,” said Dr. Tamer Elsayed, who currently directs the Tuscaloosa Family Medicine Residency. “I think it’s very helpful to our mission, to the state of Alabama and to the Southeast in general.”

Residency director, Dr. Tamer Elsayed, celebrates the 2020 graduates at the virtual graduation event in June.