I spent the weekend working on an inventory of health workforce development activites in Alabama and was struck by some very clear needs that we have to deal with as a state if we are going to provide adequate healthcare to Alabamians, regardless of what happens in DC
1) It is incredibly important to develop a health careers infrastructure at the K-12 level on a state wide basis. Many counties are only likely to have physicians return if they were born or spent a significant amount of time in that county. In most of these programs, the children who are trained may take advantage of the opportunity to leave so the programs have to train above need and replacement to take that into account. IN Alabama, we currently have less than 100 students engaged in programs such as this annually.
 
2) Once rural students and students interested in caring for the underserved are enrolled in medical school, there needs to be predictable funding for the medical school infrastructure at UAB, USA, and possibly AMEC to offer instruction and support in rural and underserved medicine. The current funding strategies in medical education are neither sufficient nor predictable enough to in its current iteration accomplish this.
 
3) We do not have adequate Family Medicine residencies in Alabama to replace physicians who are retiring, much less address the shortage. These positions should be increased independently of other health manpower activities as residencies predictably place graduates near the program “hub”.
 
4) Community recruitment and retention efforts and payment reform will need to be accomplished as well to retain these docs in Alabama and not lose them to neighboring states. If there is insufficient reasons for physicians to move to or stay in an area, they will move away
 
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