Like most of the United States, Alabama is facing a shortage of doctors in both urban and rural areas.
"There is a lack of physicians, but really providers in general," says Ryan Kelly, executive director of the Alabama Rural Health Association. "Of course, post-COVID, the nursing shortage has been pretty tremendous. That caused a major capacity issue in our rural areas. Many other disciplines now, oral health, so dentistry, mental health is still a huge issue, [and] maternal health is becoming a major crisis."
Kelly says that although the physician shortage is a nationwide problem, Alabama's relatively few residency slots make it harder for students to stay in-state.
"So, when students are going through one of the various medical schools in the state, they will have to perform a residency, either a family practice residency or any specialty that they have," Kelly told 1819 News. "And typically, when you go into a residency, you're most likely to stay in the area where you perform that residency. So, if we don't have that residency spot, students are often lost to other states."
Kelly advised that one way to increase the number of health care providers is to allow registered nurses and physician assistants to perform additional procedures and tasks.
"I think we are in a crisis time when it comes to workforce," Kelly warned. "And I strongly encourage our legislators and our governing board to rethink their stance on the scope of practice issues and to make it as loose while safe as possible. Obviously, we don't want somebody to do something beyond what they are trained to do, but right now, we are largely limiting what many of our professions are trained to do."
According to Kelly, a provider's scope of practice, or what they are allowed to do, is set by a governing body for various reasons, but given the circumstances, they may need to be loosened.
"There's a variety of reasons why scope of practice is limited," he outlined. "One of which is a concern for safety. One of which is a concern that the norms of the industry will become disrupted. And I'm sure an element of that deals with dollars and cents, meaning if a nurse practitioner or someone of a mid-level is seen to be taking a patient away from a doctor, then that doctor loses money. So it's a little bit of an amalgamation of both."
"I'm not going to go on and say that our medical board is greedy and not allowing nurse practitioners or PAs to take their full scope because they think it's a cash grab," Kelly added. "I'm not going to say that at all. I don't believe that's the case, but I think there's an element of that in addition to concerns over safety which may or may not be founded considering those mid-levels, whether appropriate or not, have been trained to do more than they're allowed to do in the state."
The struggle to recruit new doctors prompted Alabama lawmakers to pass the Physician Workforce Act in April. The bill accelerates licensure and boosts recruitment in hopes of bringing more out-of-state doctors to Alabama.
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