August 8, 2022By Tehreem Khan
For decades, reports have sounded the alarm about the looming shortage of primary care physicians in the United States.
To mitigate the issue, the University of Alabama Marinex E. Heersink School of Medicine’s Primary Care Track aims to increase the number of students who pursue a medical career in primary care. According to the U.S. Department of Health and Human Services, 62 of the Alabama’s 67 counties do not have enough primary care physicians to meet the needs of its population. The goal of the Primary Care Track, offered at the UA College of Community Health Sciences (CCHS), is to increase the pipeline of primary care physicians, who are often the gateway for patients to achieve better health. Moreover, hopes are that some of these graduates will practice in under-resourced, rural communities.
Primary Care Track
Based in Tuscaloosa, CCHS was founded in 1972 and received its designation as the first regional campus of the Heersink School of Medicine. The Primary Care Track, a four-year MD program for students interested in primary care careers, was approved in 2016 and admitted its first cohort of students in 2018. “The goal was to address the shortage of primary care physicians in Alabama, especially in rural areas,” said Dr. Grier Stewart, assistant dean for undergraduate medical education and associate professor of family, internal, and rural Medicine at CCHS.
“The collaboration between the Heersink School of Medicine and CCHS is important and valuable for many reasons,” Stewart said. “For CCHS, our students come from the Heersink School of Medicine—we can’t do what we do without them. CCHS and other regional campuses support the school by extending the clinical training capacity and providing a training environment that emphasizes primary and community-based care. The Primary Care Track continues to train physicians to return to rural Alabama.”
The track provides students with a strong foundation in clinical medicine through longitudinal experiences with patients, lasting relationships with mentoring physicians, and special programming on leadership skills. In May 2022, the Tuscaloosa campus graduated its first cohort of Primary Care Track students, 65% of which entered potential primary care residencies.
“This track differs from traditional medicine in the sense that students get exposure to more outpatient care and follow their procedures in continuity,” a recent graduate of the program, Dr. Renita Daniels, said. “For example, I got to examine a pregnant woman in family medicine and six weeks later, her baby in pediatrics. Similarly, another classmate examined a patient in family medicine and followed them through their process in surgery.” Daniels started the medicine-pediatrics residency at UAB this summer.
As part of the Primary Care Track, students spend their first two years on the school’s main campus in Birmingham with traditional MD track students, completing the preclinical and basic science curriculum. Years one and two also includes a three-week camp in Tuscaloosa to further enhance the clinical and population health aspect of primary care. This learning experience better prepares students to enter the clinical education years of medical school.
Primary Care Track students spend their third year in a Longitudinal Integrated Clerkship (LIC) on the Tuscaloosa campus. In the LIC clinical education model, students work alongside faculty for a majority of the year to follow and care for patients longitudinally, learning simultaneously across the core disciplines of medicine and in a variety of settings, including outpatient clinics, hospitals, nursing homes and patients’ home. The program also develops enhanced patient-centered attitudes and skills, molding students into attractive candidates for residency positions. “As part of this LIC program, you get to do something different every day,” said Dr. Austin Brooks, who graduated in May 2022 from the Rural Medical Scholars Program, which is also based at CCHS and offers the same coursework as the Primary Care Track. “As a person interested in general medicine and primary care, rotating through different specialties every day was truly the highlight of the program.” Brooks joined The University of Alabama Tuscaloosa Family Medicine Residency Program this summer.
During the fourth year of medical school, Primary Care Track students complete three required four-week rotations: In-patient Acting Internship, Acute Care Acting Internship, and Community Medicine Acting Internship. Primary Care Track students also complete 18 weeks of electives, in addition to a two-week residency preparation course. Brooks completed all of his rotations at the Tuscaloosa campus. “The continuity of physician-patient relationship was the big thing. For example, being a part of delivering a baby and following them through postpartum checkups was very special,” Brooks said.
Another benefit of the Primary Care Track is the mentoring offered. “Generally, students are drawn into the fields of mentors as they serve as role models for them. One of the purposes of the PCT is to keep students exposed to physicians and mentors who work in primary care and community-based medicine. The hybrid LIC accomplishes this goal. By working one-on-one with their preceptors in the ambulatory environment, students have the opportunity to see what it’s really like in primary care,” Stewart said.
Why Primary Care?
Primary care is where care begins. It is nearly impossible to provide quality care without primary care physicians. Not having enough primary care physicians means not having health care access and equity, which can ultimately mean the loss of lives that could be prevented.
Commenting about the current discussions and crises surrounding primary care physician shortage, Brooks says that he considers primary care as the “cornerstone” of any healthcare system. “Primary care is like the quarterback in football—a person who should coordinate people’s care. The key is to be proactive and preventive, instead of reactive,” he said.
According to Daniels, primary care is about the ability to see every point of care in a patient’s journey. “Everything branches through primary care; patients must see their primary care physicians when any symptoms appear. We are ones to treat them firsthand and send them to specialists if needed. Therefore, primary care is the starting point — the focal point of medicine,” she said.
The Primary Care Track program prepares students for the primary care fields of family medicine, internal medicine and pediatrics, and community-based specialties and subspecialties such as OB/GYN, neurology, psychiatry, and general surgery. Historically, more than 40% of PCT graduates have practiced primary care. In the future, the goal is to increase this number to 60% or better, Stewart says. “The PCT has begun and will continue to grow a medical education environment that maintains an exposure of our students to primary care and community-based physicians.”
Currently, CCHS is working on expanding its presence into the medical students’ preclinical years.
“Our preclinical curriculum is being piloted and will expand to all PCT students with the class of 2026,” Stewart says. “We will teach and connect to students through online learning modules and discussion groups and bring them to Tuscaloosa for periodic clinics with a primary care mentor. We are also building a summer ‘camp’ for these students before the second year that will get them involved in the Tuscaloosa and West Alabama community and build on the education they are already receiving.”