Retired physician Jimmy Adkisson, D.O., of Brewton, knows firsthand how hard it is to keep physicians in rural communities.
Adkisson worked as a family physician and practiced emergency medicine in Brewton for 40 years and says he saw the number of physicians in the area dwindle over the years as they have moved to larger, more lucrative cities or retired with no younger physicians to take their place.
“We’ve had a loss of two physicians over the last year-and-a-half,” Adkisson says. “Primary care is the thing that we need more than anything else.”
“People coming out of medical school are wanting to go to the big cities. But there’s got to be some folks training for rural medicine. What we’re really interested in is getting them to come into a town like Brewton or Escambia County where the quality of life is great, the practice of medicine is wonderful, the standard of living is good, and it’s just a great life to be in medicine,” he says.
Health care providers, academics and lawmakers across Alabama are developing innovative initiatives to improve access to health care in rural and underserved communities.
The truth is, in rural towns across Alabama, health care can be hard to get.
The population-to-primary care physician ratios are often smaller in rural Alabama counties than in metropolitan counties like Jefferson County, where the ratio is 900-to-1, and Madison County, where it’s 1,120-to-1, according to the University of Wisconsin Population Health Institute Program’s County Health Rankings & Roadmaps report.
But in rural Wilcox County, there is just one doctor for every 10,450 people, and in Washington County, it is one for every 15,150 residents.
Moreover, statistics show that people in farm towns are more likely to die prematurely from heart disease, stroke, cancer, accidental injuries and chronic lower respiratory disease than people living in urban communities.
Patients in rural areas also often must travel longer distances than urbanites to reach a hospital, specialist and other health care services, says a 2023 U.S. Government Accountability Office study titled, “Health Care Capsule: Accessing Health Care in Rural America.”
And the University of Southern Maine, Muskie School, Maine Rural Health Research Center finds that more than 95% — 64 out of 67 Alabama counties — are listed as “ambulance deserts,” where it can take up to 30 minutes or longer for help to arrive, compared to about five minutes in urban areas.
Proposed cuts to Medicaid in a reconciliation bill, under consideration in Congress at press time, could also leave many Alabamians without health insurance.
The Alabama Hospital Association reports that many rural Alabama hospitals, which provide care to some 2 million Alabamians annually, are struggling financially due to lower reimbursements from Medicare and private insurance companies and the high volume of uninsured and underinsured patients.
Danne Howard, the AHA’s incoming president and CEO, says that as many as 22 rural hospitals in Alabama are at imminent risk of closure or under unsustainable financial strain.
And, since 2005, eight rural hospitals in Alabama have closed their doors, a report by the Center for Health Care Quality & Payment Reform says.
“Seventy-one percent of all hospitals in Alabama have a negative operating margin, and for 83% of the rural hospitals, the median operating margin is negative 19.5%,” Howard says.
“A lot of hospitals never had robust reserves to begin with,” says Howard, “but that pretty much dried up and was used during the pandemic.”
Some rural hospitals in Alabama have discontinued services like OB-GYN due to depleted reserves and high costs, Howard says.
The Lawrence Medical Center in Moulton, for example, closed its emergency room on May 23 to become an outpatient-only facility offering imaging, EKG, lab, respiratory and physical therapy services. It also kept its primary care clinics and urgent care center open.
And another facility, Grove Hill Memorial Hospital in rural Clarke County, recently ended labor and delivery services.
As a matter of fact, 28% of women in rural Alabama have no birthing center within 30 minutes of their homes, the state public health office says.
“Labor and delivery services are very expensive to maintain,” says Howard. “Then, add on top of that the difficulty of recruiting and retaining medical staff in OB-GYN to rural areas where it’s difficult to make a living when a great percentage of the patients in that area are uninsured or on Medicaid and there aren’t a lot of private-pay patients.”
The American Medical Association says burdensome administrative tasks such as prior authorization requirements, along with cuts to Medicaid and low reimbursements from Medicare and commercial insurers, make it harder for small-town primary care physicians to maintain private practices and pay for office overhead costs, equipment and medical devices and staff salaries.
To address the shortage of primary care physicians in rural communities, the Alabama College of Osteopathic Medicine in Dothan offers clinical rotation for third-year students at rural clinics to help encourage them to consider careers practicing in rural and underserved communities, says Dr. Justin Hovey, who is associate professor of internal medicine and pediatrics at ACOM.
ACOM students can fulfill their rotations in rural towns across Alabama, Mississippi, the Florida Panhandle and Georgia.
In addition, ACOM, in partnership with Southeast Health, operates the Southeast Health ACOM Ashford Clinic in Ashford and a second clinic in Taylor.
ACOM students and faculty staff the academic clinics and offer internal medicine, family care, pediatrics, osteopathic manipulative medicine, nutrition and other services, says Hovey, who is also medical director at Southeast Health ACOM Ashford Clinic.
“We also give students the advantage of spending time with the nursing staff and with the front office so they can see the business side of medicine and the way the clinic flows,” Hovey says.
Hovey says that through the experiences in rural clinics, ACOM students also learn about the social determinants of health and what food deserts, poverty and the lack of transportation and the internet can have on health outcomes.
Another effort to help boost the number of physicians in rural communities comes through a partnership between the UAB Heersink School of Medicine, the University of Alabama and Auburn University, which offer two, five-year programs for students interested in careers in rural primary care medicine.
One program is the Rural Medical Scholars Program, where students can earn a master’s degree in rural community health from the College of Community Health Sciences at the University of Alabama and complete four years of medical school followed by clinical training at the Tuscaloosa Regional Medical campus.
The other is the Rural Medicine Program, where students can earn a post-baccalaureate degree at Auburn University, followed by medical school and clinical training at the Huntsville Regional Medical campus.
And through Auburn University’s own Rural Health Initiative, the tech company OnMed has teamed up with them to bring telehealth to rural counties in Alabama.
The OnMed Care Stations are stand-alone booths where visitors can talk with a live clinician through a telemedicine interface. The stations are equipped with diagnostic tools that can check patients’ blood pressure, pulse, temperature, weight, oxygen levels and other vital signs.
Lori Marine, with Auburn University’s Outreach and Office of Public Service, says there are OnMed stations in LaFayette in Chambers County, the town of Catherine in Wilcox County, Boligee in Greene County, Gainesville in Sumter County and Akron in Hale County.
Alabama Gov. Kay Ivey recently signed into law a bill to help bolster financially strapped hospitals in the state.
The new legislation, known as the Rural Hospital Investment Act of 2025, will let individuals, companies and other entities earn tax credits toward their state income, excise, premium and utility tax liability when they donate to eligible rural hospitals. Hospitals can then use the donated funds to pay for operational expenses and direct care.
“We couldn’t be more supportive of this bill. We worked very hard with the bill sponsors,” Howard says.
The legislation is modeled after the Georgia HEART Hospital Program that went into effect in 2017, and it has been “wildly successful,” Howard says.
The new Alabama law goes into effect in 2026, and the annual cap on tax credits will start at $20 million for that tax year and increase in subsequent years.
“That’s not huge dollars if you think about the 53 rural hospitals that we have in the state,” says Howard, “but it’s a start.”
Gail Allyn Short is a Birmingham-based freelance contributor to Business Alabama.
This article appears in the July 2025 issue of Business Alabama.
