Nationwide, the overburdening of the health care system, particularly in rural or urban underserved areas, makes it more difficult for patients to access timely, high-quality care. Last month, Irfan Asif, M.D., professor and chair of the University of Alabama at Birmingham Department of Family and Community Medicine and associate dean for Primary Care and Rural Health in the UAB Heersink School of Medicine, shared strategies with “The Hill,” a Washington D.C.-based media company, for improving access to health care in the United States.
In Alabama and elsewhere, a shortage of primary care physicians halts the access to timely care.
“Access to health care is a major issue,” Asif said. “Some of the things we need to think about are how we can increase the pipeline of folks who are able to increase access and the pipeline of primary care providers.”
UAB’s Comprehensive Urban Underserved and Rural Experience is designed to do exactly that. By providing support, training, clinical experience and other resources specifically for medical students who want to pursue a career in primary care and practice in underserved areas, the program is developing a future generation of primary care physicians. The program supports and hopes to grow pipeline programs that reach students in college, high school and even earlier to build interest in primary care and family medicine.
Looking at the business side of American health care, Asif emphasized the importance of moving from a fee-for-service model to a capitated or value-based model.
In a capitated model, providers are paid a fixed amount per patient by an insurer or physician’s association, regardless of how often that patient seeks care. In a value-based model, providers are paid based on improvement in patient health outcomes and the quality of care they provide.
“If we have a fee-for-service model, we are not actually incentivizing providers to prevent disease, and we are incentivizing people to go into professions where they are treating disease rather than trying to prevent it,” Asif said. “We need a system where primary care is incentivized. I think that is the backbone of what we need to work toward.”
Capitated or value-based payment systems, Asif says, might compel more physicians to pursue primary care and family medicine as specialties, helping to address current shortages of primary care providers in the United States.
Although COVID stretched and reshaped the health care workforce, Asif points to an increase in the use of telemedicine as a silver lining.
“COVID has allowed us to do some unique things, and through telemedicine we have been able to extend more access to people in other parts of the state or country,” Asif said.
UAB expanded its telehealth offerings during the pandemic and has continued to offer telemedicine as a quick and convenient option for patients. Medical students also receive training in conducting telemedicine appointments. However, Asif also says that telemedicine can create new types of disparities, such as gaps in access to fast, reliable internet. Addressing those needs is another way to improve access to care.
Team-based care that includes a whole team of providers who can help patients, including physicians, nurse practitioners, physician assistants, pharmacists, psychologists, behavioral health specialists, nutritionists and social workers, can positively influence the landscape of health care in the United States.
UAB’s Department of Family Medicine emphasizes a team-based approach both in care offered to patients and in educational and clinical programs designed for medical students. Medical students are taught from the beginning about the importance of working within a care team and see firsthand in clinic how collaboration contributes to patient care. In addition to numerous physicians and advanced practice providers, the department has a clinical dietitian as well as a clinical health psychologist and a clinical scientist to serve patients.
The department includes the Office of Interprofessional and Continuing Education, which aims to educate students in multidisciplinary patient care that works across various health care professions.
Training providers in the communities where they are going to live and work is crucial to reforming the health care system in the United States, according to Asif. Often, training happens in places with access to a big medical system, he says.
“It is important to get out into rural and other parts of the state to provide training, so that faculty, staff and students get to know those communities and become part of those communities,” Asif said. “As someone who is serving in that community, they start to understand issues that patients commonly face and can address those issues firsthand.”
Family medicine students at UAB can complete clerkships or residencies in many different parts of Alabama and in both rural and urban underserved communities. Opportunities include the Cahaba UAB Family Medicine Residency in Birmingham, hosted by the Federally Qualified Health Center Cahaba Medical Care, the Selma Family Medicine Residency, family medicine programs in Huntsville and Tuscaloosa, and many more.
Students can also enroll in the department’s Pathway Program, a four-week elective experience in rural ambulatory medicine for MS1, MS2 and pre-matriculation students. Students work directly with preceptors practicing in rural areas of Alabama, focused on areas with a population of 25,000 or less. Students in their third or fourth year of medical school can enroll in clinical experiences in a rural family medicine practice facilitated by community volunteer faculty.