This election season you’re going to hear a lot about rural healthcare and how to solve the ever-increasing crisis of access to healthcare in rural and poor parts of Alabama. It is a crisis that needs to be tackled head-on, however, most of the solutions you’ll hear talked about won’t actually solve the core problem.
You will hear a lot of politicians talk about and debate the merits of increasing Medicare payouts and expanding Medicaid to cover more people. As a country, we already spend almost 18% of our economic activity on healthcare services, which equates to almost $11,000 per person in this country or $3.5 trillion in expenses. Ensuring that enough of those resources are available to serve the medical needs of our rural communities is important, but throwing more money at those areas isn’t just going to solve the problem alone.
The state needs to come up with a comprehensive, creative, and out of the box thinking to increase the availability in access to doctors and medical professionals that can meet the basic, urgent, preventive, and emergency medical needs of our rural communities.
Certified Nurse Practitioners
The first thing we can do in this state to encourage more nurse practitioners to open up practices and practice medicine in rural areas is getting out of their way and let them do their job.
The state of Alabama requires a nurse practitioner to be attached to or a part of a practice that a doctor is at least a partner in. This really restricts the ability of nurse practitioners to choose where they want to practice medicine and what services they can offer. Many proponents of this restriction will argue that it is necessary to prevent malpractice and ensure that nurse practitioners don’t endanger the safety of patients. Not only is Alabama one of the states with the most restrictive set of regulations on nurse practitioners, but according to the AARP, over 99% of them have a graduate degree, have an average of over 10 years of experience, and a rate of 1.1% of being named as the primary defendant in a malpractice lawsuit.
Even Mississippi has ended the patriarchal practice of requiring doctors, who are mostly men, to ‘oversee’ the work of certified nurse practitioners, who are mostly female.
Next, the state needs to ensure that the infrastructure is in place in rural communities that allows nurse practitioners to actually perform their duties.
One of the reasons why companies like Walgreens, CVS, and Walmart have not expanded their care service options in their stores in Alabama is because of the restrictive nature of our regulations on nurse practitioners. If the state was to loosen those restrictions, as well as offer companies like these tax credits and accelerated depreciation for expanding their walk-in clinic services in their stores in predesignated ‘areas of critical need’ in the state, you would probably see these companies expand those services into the state, and especially into the areas of the state that need it. This would expand access to non-emergency urgent and basic healthcare services in rural and underserved communities in the state.
Finally, one of the impediments to getting nurse practitioners to practice in rural and underserved areas of the state is the cost of the education required to become a certified nurse practitioner.
To encourage more CRNP graduates to go become nurse practitioners in our rural and underserved communities, the state of Alabama should consider creating a grant program that would reimburse CRNPs that complete 5 years of service in pre-designated ‘areas of critical need’ within 10 years of graduating and getting certified. Each person that fulfills the requirements of the grant program could be eligible for up to $50,000 worth of tuition reimbursement grants once they’ve fulfilled the requirements.
The reason why I structured the recommendation for the grant program the way I did, five years of service within 10 years of graduation and certification, is because
Of course, certified nurse practitioners alone will not solve the problem of access to healthcare services in rural communities, and doctors do play a vital role in providing that care. Increasing the number of qualified and trained doctors to serve these rural communities has got to be a vital part of any solution to solve the problem.
In 2015, State Senator Larry Stutts actually had an innovative way to help alleviate this problem. He introduced a bill in the legislative session that year called the Alabama Physicians Initiative, SB 210. It would have provided scholarships for up to 25 medical students that were willing to commit to serve 5 years in areas of the state that are experiencing severe doctor shortages. His bill got derailed in that year’s legislative session due to concerns over the administration of the scholarship program and insinuations of corruption. That doesn’t make it any less of a good idea.
If the Alabama legislature was to revive the Alabama Physician Initiative, that would only require an allocation of around $3 million a year. This $3 million a year investment would provide up to 125 newly minted doctors to be deployed into the rural communities and underserved areas of the state every 5 years. To help increase retention rates amongst the doctors after their service commitment is up, you could give priority consideration to medical students that are from the communities that need to be served. If those medical students can go home and serve in their hometowns, they’re more likely to lay down roots start families and less likely to leave after their commitment time is up than other doctors.
The program that offers these scholarships to medical students could work with the rural health networks, community clinics, and underserved areas to place these doctors in the communities that need them the most. These health networks, like Franklin Primary Care, and Rural Health Network clinics in the black belt, already serve Medicare and Medicaid patients in these areas, as well as patients that don’t have health insurance and do not have the means to afford healthcare services outright. These organizations also have a difficult time recruiting and retaining doctors to serve these communities as well, so I’m sure they would welcome the opportunity to recruit a crop of 25 new doctors every year to their organizations to help meet their service needs.
Telemedicine and Transportation
Alabama already has regulations and rules in place that strongly promote and encourage the use of telemedical services. Alabama was one of the first states to enter into multi-state compacts allowing for doctors in other states to practice telemedicine in the state of Alabama. Also, the state’s Medicaid office reimburses telemedicine visits at the same rate that they do in-office visits as long as the telemedicine visit is conducted through a telemedicine portal that has real-time audiovisual capabilities that allow the doctor and patient to interact in real-time.
Those reimbursements by the state Medicaid office also include services like psychotherapy and psychological consultations over telemedicine portals. About the only other thing the state could do to promote and encourage telemedical service usage in rural and underserved communities in our state is to create a grant program that rural health community health centers and rural hospitals can compete for grants to buy the necessary and approved telemedical equipment necessary to participate in their own telemedical services. They could even work with other grants from other government agencies, and private organizations, to create their own home health services that utilize telemedical equipment and services to enhance patient care and promote total wellness.
In the cases where an in-office visit is required, it will still be difficult on some patients to make it to those appointments and visits, even if they are scheduled in rural communities and rural hospitals. To encourage the
Along with ensuring that the necessary resources and reimbursements are made available to rural healthcare providers, including hospitals, these ideas and a comprehensive strategy to increase the availability and access to healthcare providers in rural and underserved communities in the state can go a long way in improving the overall health of our communities and our state. Because you can throw all the money you want at a problem, but if you don’t have the ideas and the solutions ready to implement, all you’re really doing is putting lipstick on a pig.