Q&A: With federal funding, UAB is addressing PCP shortages in underserved communities

The University of Alabama at Birmingham’s department of family and community medicine has received a $7 million grant to help increase the number of PCPs in rural and urban underserved communities in the state.

The grant was awarded by Health Resources and Service Administration (HRSA), an agency of HHS that works to improve health care for people living in geographically isolated areas and those who are economic or medically vulnerable.

It will allow the university to develop high school and college pipeline programs in addition to programming for medical students. It will also allow the department to create faculty development programs to help enhance their curriculum.

The grant was awarded by HRSA over a 4-year period, with the department receiving $1.75 million each year.

Healio Primary Care spoke with Irfan Asif, MD, chair of family medicine at the University of Alabama at Birmingham (UAB), to learn more about why the department received the grant and how it will improve access to primary care among underserved individuals in the state.

Q: What does UAB hope to achieve with this new grant?

A: This grant is through the HRSA, which is under the department of Health and Human Services (HHS). Essentially, they were looking for where primary care was needed the most. Alabama is in the bottom quintile for the number of primary care providers. We are 612 primary care providers short to meet the need of what we’re going to see by 2030 within our population. Primary care is meant to prevent disease. If you think about going to, say, a mechanic, sometimes your car breaks down and you need help with that, but you also want to do the stuff to prevent the car from breaking down —that’s what primary care does. If you don’t have people preventing the car from breaking down, you end up with a lot of breakdowns — and in this case, it’s a lot of disease and people just trying to take care of it after the fact.

In Alabama, we’re ranked 47 out of 50 for our health metrics, and that’s because we don’t have a good primary care base. This grant is specifically aimed at trying to get more medical students to go into family medicine and primary care as a specialty, and so UAB will get three things. We’re going to create a pipeline program — high school and college programs that give people a chance to understand what family medicine and primary care might look like while helping their applications become more robust — and we’re specifically going to target the underserved, whether that be rural, urban, or other populations to try to help them get into medical school. Part two will be to improve programs within the school of medicine around primary care, and there are six core areas that HRSA wants [us] to work on. The last is [that] we’re going to do faculty development, which is essentially “teach the teachers,” so whoever is teaching the pipeline piece or whoever is teaching the medical school piece, we want them to be better teachers. That’s the third part of what UAB will get out of this is the faculty development program.

Q: What will the newly expanded curriculum entail?

A: HRSA has six core areas that they want us to focus on, and those six core areas include behavioral health — behavioral health could be depression, anxiety, but also substance use — and with the COVID-19 pandemic we’ve actually seen a lot of mental health issues in our community, so this will be big in trying to help the students be prepared for what they might see when they get into practice. [Another is] interprofessional education, so how medical students work in a team to help take care of populations, so it’s not just the medical student. They might be the leader of the team or part of a team with nutrition students, psychology students [and]nursing students to help take care of patients.

It’s not just that people have a medical problem and you need to take care of it, you need to take care of it in the context of that person’s life, and that’s where social determinants of health come in. Cultural and linguistic competency is No. 4 — someone with a rural background, an urban background, someone who’s LGBTQ, a refugee — they have different cultures, and we want the physicians who we train to be sensitive to those cultures. No. 5 is practice transformation, so we want to think of the future of family medicine and primary care. In particular, there’s something called value-based care, where you’re incentivized for trying to prevent disease. And then the last is telehealth, so reaching people through telemedicine or digital monitoring — different ways to think about health care in the future. Those are the six key components.

Part of [what] UAB is going to do differently is that the students who come through the program will start doing clinical work from day one. Usually, people wait until the third and fourth year to do the clinical patient work, but we’ll actually start introducing them to patients from day 1, year 1, and then they’ll get a patient panel. Each of the students will get 10 patients that they follow for all 4 years, and they will serve as health coaches with the other interprofessional students they work with. We’ll pick some folks that need the most help, and we’ll be able to give them a lot of health care by the students serving as health coaches and reaching out to them frequently, and again, following them for a 4-year time period. [Medical students will] get the curriculum that I described, and they will be able to do research related to social determinants and health disparities, for example. They will get leadership training through retreats that we do, as well as cultural competency and bias training, and then there will be community service that they’re required to do as part of the program.

This grant is going to affect not just the Birmingham campus, but [also] our Huntsville, Tuscaloosa and Montgomery campuses. It’s going to enhance some programs that already exist for rural communities. Huntsville and Tuscaloosa have done a really good job of developing some rural programs, and we hope to provide resources to enhance what they do while building up something on the Birmingham and Montgomery campuses. This year, we’re going to pilot the medical school piece — we’ve already released applications and hope to select our first students in the September/October timeframe.

Q: How will this investment in primary care help address gaps in specialty care, such as diabetes management and cancer survivorship care?

A: If we start to think about many of the patients who we see, it usually takes a multidisciplinary team to take care of those individuals, and oftentimes, those people don’t get the social work and care management they need. Forming that team to take care of patients and showing them that that’s part of the model that’s required to take care of particularly the most vulnerable, is going to be the No. 1 thing that the students get and will learn about primary care in the future.

Q: How will this program address social determinants of health in rural practices?

A: We have a pretty robust network through something called the Alabama Area Health Education Center (AHEC), and they’re able to find, within Alabama, different communities where there are students who could benefit from getting an education in the medical field, and then ultimately going back into those communities, which is really nice because they will understand the culture, and those patients’ socioeconomic factors, for example. Our program will teach about social determinants of health, and students will learn about those communities. Part of the project for [students entails] a windshield survey, so they’ll actually have to take a look at the community that they’re going to serve to begin to learn some of those social determinants. This will actually be a big focus of ours, as I mentioned — it’s not just taking care of a patient and whether they take their medication, it’s understanding where they’re coming from and the sorts of things that we can do to help.

Q: In addition to grants like this, what other efforts are needed to increase the primary care workforce, particularly in urban areas?

Similar to rural [areas], I think we have to finds folks from these particular communities and let them know that these opportunities exist. I think just putting it on a website but not going and promoting or marketing or letting them know that, “Hey, this is a particular program that can help you,” I think that those are all some of the things we have to do. We actually have to go to these communities, whether they be urban or rural, underserved.

There has to be mentorship. The students who go into this program are required to mentor the pipeline students to help them figure out if medical school would be right for them. Mentorship is going to be a key component. Long term, I hope to develop a program [to support folks if they don’t meet the criteria to get into medicine, but they’re really close. Maybe over the course of a year, if they needed an extra gap year of training, or maybe we meet people from an underserved background, and we give them some early assurances to get in to college or to medical school by providing some training, and saying “Hey, if you meet some of these requirements, this can help you get in.” Those aren’t necessarily part of the grant, but those are things that I’m hoping to pursue down the road.

References:

Healio Interview

UAB. UAB to train more physicians for rural and urban underserved areas of Alabama. https://www.uab.edu/news/health/item/11476-uab-to-train-more-physicians-for-rural-and-urban-underserved-areas-of-alabama. Accessed August 18, 2020.