Alabama’s Physician Workforce Act is now in effect. The bill was first introduced by the Medical Association of the State of Alabama earlier this year before receiving unanimous support from both Alabama House and Senate committees in late April. Governor Kay Ivey signed the bill into law this June.
The bill has three major components. The first component removes a testing requirement for out-of-state doctors looking to relocate their practice in Alabama. Previously, to get licensed in Alabama, physicians who had not taken a written test in 10 or more years had to receive another written, in-person exam to receive their state license.
“The challenge is if you’re actively engaged in high-quality medical practice in another state [already], it becomes a burden for you to take another test just to move to Alabama,” said Dr. Don Williamson, president of the Alabama Hospital Association. “For physicians who are looking to change practice locations, this becomes, I think, a very important component of the law. It will allow physicians in Mississippi, Georgia, Tennessee, Florida [and other] nearby states to come to Alabama without that added burden. I think this is, frankly, a very positive development and maybe the single-most important component of the act in terms of increasing the physician supply in Alabama.”
The law also allows international medical graduates to apply for a license one year sooner. For physicians who are trained in the U.S., to get a license in Alabama, they must first finish medical school and complete at least two years of postgraduate training. The previous requirement was three or more years of postgraduate training. According to the Association of American Medical Colleges (AAMC), in 2018, more than 18% of active physicians in Alabama were international medical graduates. And Dr. Williamson said that number is only going to rise.
“International medical graduates make up an increasing percentage of the physicians practicing in Alabama,” Dr. Williamson said. “So, this law will allow some international medical graduates who may have only done two years of postgraduate training to be licensed in Alabama, who before would not have been able to do so. It will also allow some international medical graduates who are currently training in Alabama to be licensed earlier.”
Dr. Williamson said this will positively impact the state’s medical industry, though the size of this impact remains to be seen.
“I think that it’s going to have an effect. How large of an effect [though], I think we’ll have to see,” he said. “Most physicians now, when they do receive postgraduate training, complete a residency or a fellowship. All of those are going to take, generally, more than two years. But for those who want to be licensed now, after two years, it will allow them to be fully licensed and enter into practice in Alabama.”
The third component of the law benefits medical graduates who do not currently match into a residency. Once fourth year students complete medical school, they must receive postgraduate training through a residency program. The student will visit and interview with residency programs. Medical students discover which programs they prefer, and residencies decide which students they want to enroll. Then, a computer algorithm attempts to match the student with the residency, thus creating a match. However, Dr. Williamson said this process is not always perfect.
“Every year, around the country, some number of medical students don’t match with a program that they want to go to,” he said. “Those students then are left with no opportunity, really, to move toward full licensure [since] they’re not in a residency program. They lose a year when they could be contributing to health care.”
Instead of keeping medical students in limbo for a year, the Physician Workforce Act creates an apprenticeship program for these graduates.
“What this [act] would do is allow those students, who for whatever reason don’t match [with a residency], to continue to provide health care services, having finished medical school,” Dr. Williamson said. “They would do this under the supervision of another physician.”
Dr. Williamson said while this will benefit the state’s hospitals, Alabama has been fortunate in the last year.
“Over the last year, every medical student in Alabama matched in a residency program,” he said. “The number of people [this component of the law] is going to impact in any given year is probably small, but for those students, it gives them an opportunity to continue to engage in health care provisions and allows them to be productive in the year that they’re waiting to reenter the match.”
Whether physicians are from out of state, international medical graduates or just looking for work after graduation, Dr. Williamson said the Physician Workforce Act will address Alabama’s historic shortage of health care workers.
“If you look at a map, called Health Professional Shortage Areas, what you find is that every county in the state has a health care shortage,” he said. “Sometimes it’s the entire country. In a few of our counties, it’s only certain populations such as the uninsured or rural populations. But there is a severe shortage of health care providers throughout Alabama. We have a significant number of counties that do not have delivering physicians. We have a significant number of counties that don’t have pediatricians. What this law will do, hopefully, is increase the number of physicians, you’ll get more geographic coverage and patients won’t have to go as far to get their medical care.”
Dr. Williamson said the law will also address the state’s aging physician population. AAMC reports that in 2018 the percentage of active physicians who were 60 years or older was 34.4%. That is more than three of every 10 active physicians in the state.
“The average age of physicians in Alabama is actually going up,” Dr. Williamson said. “That obviously does not bode well [for us], as those of us who are baby boomers now enter the age group where we are likely to consume more health care. If you have a declining number of physicians and an increase in demand, that will exacerbate the shortage over the next 20 to 25 years.”
All in all, Dr. Williamson said the Physician Workforce Act is a good first step toward addressing these labor shortages, but it is not the be-all, end-all solution. In fact, he said there is still more the state and nation can do.
“[For] Alabama, to be competitive in recruiting and retaining physicians, we’ve got to increase the desirability of people going into these [rural and] underserved areas,” Dr. Williamson said. “We’ve also got to address the inequities in reimbursement that occur in Alabama. For the same procedure provided in Mississippi, physicians make more money from Medicare than they do in Alabama. There’s [also] a lot of conversation about how we train physicians. Are we doing it the right way? Those are national issues that are going to get worked out over the next [few] decades. But there’s not going to be a short-term fix to increasing health care provision by physicians around the state.”
To read the Physician Workforce Act in full, visit the Alabama Board of Medical Examiners’ website.
