Providing Primary Health Care in Rural Alabama

October 6, 2021

Providing health care to Alabama communities, particularly in rural areas, is the mission of The University of Alabama College of Community Health Sciences. Not an easy endeavor in a state where nearly half of the population has a rural address.

“We live in a very rural state, and to deliver a precious commodity like health care is challenging,” Dr. Richard Friend, dean of CCHS and a family medicine physician, said during a Mini Medical School presentation in September. Mini Medical School is a collaboration of the UA OLLI program and CCHS.

Rural areas are burdened with high rates of poverty, less access to health care, fewer financial resources, and populations that are older and sicker. There are currently 4.8 primary care physicians for every 10,000 people in rural Alabama.

All of this makes it hard for doctors to set up shop in rural communities. Often local hospitals have closed, and insurers provide few, if any, reimbursement differentials for rural practices. Then there’s factors like employment choices for spouses and education for children.

With a focus on West Alabama, CCHS works to bring primary health care services to rural and medically underserved Alabama communities by adding University Medical Center locations there. UMC is the multi-specialty community medical practice the College operates.

Along with a main location in Tuscaloosa that provides multi-specialty care, and a location in nearby Northport that offers family medicine and obstetrics care, UMC has expanded in recent years to Demopolis and more recently to Fayette and Carrollton. A Livingston location is planned for 2022.

“We are trying to make an impact in West Alabama,” Friend said.

UMC-Demopolis opened in 2017 and provides family medicine and much needed prenatal and obstetrics care to the area. In addition, UMC physicians are working with Whitfield Regional Hospital to re-open the hospital’s labor and delivery unit, which shuttered in 2015, leaving expectant mothers to travel an hour to Tuscaloosa or Meridian, Mississippi, to deliver their babies.

With the opening of UMC-Fayette in February 2021, the city and surrounding area received additional pre-natal and OB care services. UMC-Carrollton opened in August and has brought family medicine, obstetrics, gynecology and sports medicine care to that community. When UMC-Livingston opens next year, it will provide family medicine and other primary health-care services.

“We have created a nice network of facilities,” Friend said, but added that the goal is to provide “a sustainable solution.” He said CCHS is accomplishing this by centralizing business functions and providing them from the main UMC in Tuscaloosa, including purchasing, medical records, billing and an electronic medical record. “Through economies of scale and other efficiencies, and the support of UA and the state, we are able to do this. Without economies of scale, it’s hard to provide care in rural areas,” Friend said.

He said he hopes the CCHS model is adopted by others so that more rural Alabama communities and their residents will have access to primary health care.

The Mini Medical School program has been put on by faculty and resident physicians of CCHS since 2016. It provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures offer important information about issues and advances in medicine and research.