Dr. John B. Waits and Dr. Lacy M. Smith have raised a banner for innovation and success in rural health care and family medicine in challenging times over Centreville, Alabama and they are being noticed in the healthcare industry for their efforts. Cahaba Medical Care has recently entered into a new agreement with UAB to train primary care physicians.
“Projections indicate that Alabama will face a shortage of more than 600 primary care providers by 2030 unless steps are taken now to recruit and retain family medicine physicians and other health care providers,” said Irfan Asif, M.D., chair of the UAB Department of Family and Community Medicine, who helped establish the partnership with Cahaba Medical Care.
Upon graduation from medical school, new physicians spend several years continuing their medical educations in their chosen field as residents. The partnership between UAB and Cahaba Medical Care will recruit 12 new graduates per year during the three-year residency, and residents will split their time between UAB’s hospitals and Cahaba’s rural or urban doctors’ offices.
“Most residency programs are housed strictly in hospitals,” said Craig Hoesley, M.D., senior associate dean for Medical Education at the UAB School of Medicine. “We recognize that, to properly train and incentivize young physicians to pursue a career in primary care medicine, particularly in underserved regions of our state, we need to train them within that environment, so they see firsthand the rewards and challenges that come with that career path.”
The program will place seven residents at Cahaba Medical Care’s West End Birmingham clinic, an underserved urban community, and five at its rural Centreville clinic. They’ll spend the majority of their time seeing patients in those clinics, mentored by Cahaba’s physicians, with additional training at UAB in family medicine, as well as specialty areas that include internal medicine, pediatrics, obstetrics and emergency medicine.
Training physicians during a residency program is not new for Cahaba Medical Care. The partnership with UAB is the latest update.
Dr. John B. Waits entered private medical practice in Centreville in 2003. We immediately respect the white coat and stethoscope worn by the physician because it is instantly recognizable to us. But Waits is more than a physician in the Centreville community. Often there is no white coat to identify and single him out. You may encounter him in the role of civic leader, guest speaker, op-ed contributor, socratic teacher, outdoorsman, cross country runner, missionary, business manager, lobbyist, chess club player, or problem solver; to name a few of the roles that he seems to fill effortlessly.
Early in his medical career Waits voluntarily made a decision to remain in a below average income rural community with a high incidence rate of uninsured patients to practice family medicine. In his early practice years most of his patients could not come up with their required co-pays even if they were insured. Instead of moving to a patient market that would almost guarantee comfortable profitability for his practice he chose instead to stay in Bibb County and find ways to deliver medical services to large volumes of low income patients with minimal resources at their disposal.
In 2010 his practice applied for and by 2012 became a designated Federally-Qualified Health Center or FQHC program. As of 2017 there were 14 FQHC’s that served 319,327 patients in the State of Alabama and only one of those has been designed as a Teaching Health Center. That one is Cahaba Medical Care in Bibb County, Alabama. CMC now operates as a non-profit organization and is governed by a community-led board of directors, many of whom are patients of the clinic.
Dr. Waits and Cahaba Medical Care are presently leading a community effort to rebuild a flood damaged walking trail, add a canoe launch for access to the Cahaba River and add outdoor exercise activities for the community. He is aggressively and personally involved because he sees recreation as an extension of community medicine and service to his community as an integral function of the clinic’s mission and purpose.
Dr. Waits credits much of the success of this program to his partnership with co-founder Dr. Lacy M. Smith.
Dr. Lacy Smith graduated from the UAB School of Medicine in 2008 and completed her residency at the Tuscaloosa Family Medicine Residency College of Community Health Sciences in 2011. Her involvement in a rural medicine research project as a resident would go on to shape her career. Upon completing her training, she would spend her first eight years with the Rural Health Clinic in Bibb County, joining Cahaba Medical Care in Centreville in 2011.
She was instrumental in converting Cahaba Medical Care into what we know it as today; working to achieve non-profit status and winning a $650,000 competitive grant to transform it into a Federally-Qualified Health Center (FQHC) Community Health Center. She now serves as the Deputy CEO, Chief of Operations, primary grant writer, and Chief Medical Officer for this 11-site organization with over 275 employees and 54 health care providers.
Additionally, she serves as the co-founder and Associate Program Director of the Cahaba Family Medicine Residency (now, Cahaba-UAB Family Medicine Residency). This program graduated its 3rd resident class in 2018 with 50% of those students planning to remain in Alabama; the program is rapidly successful and will host 36 residents by 2021.
During her tenure as COO and CMO with Cahaba Medical Care, she has written over ten successful, multi-year federal grants supporting either uninsured and low-income patients or primary care training. Additionally, she has led the clinic and her team in its successful application in 2014 (and renewal in 2017) to becoming an NCQA Level 3 (highest) Patient Centered Medical Home as well as an accredited JCAHO Ambulatory Care Center and Patient Centered Medical Home. Additionally, during her tenure, Cahaba Medical Care has been nationally recognized by HRSA as a “Clinical Quality Improver” from 2013-2016, and as a “Health Center Leader” three years in a row (2016-2018), recognizing a clinical team that achieved the best overall clinical performance among all health centers nationwide.
Her work has increased the health care capacities of multiple rural communities including Maplesville, Woodstock, Bessemer, and Centreville. She has recently focused her attention to the underserved health care populations within Jefferson County, bringing medical care to the communities of West End and Ensley. While pursuing the expansion of medical care in these areas, she also maintains an active clinical practice and is highly sought after by her patients.
The Teaching Health Center program is an innovative way of funding residency education that allows training of primary care residents to occur in community based ambulatory care clinics instead of in large hospitals. This means 12 resident physicians who are learning how to take care of all patients are training in Bibb County, in the Cahaba Medical Care facility and in the Bibb Medical Center.
Dr. Smith was awarded the 2019 Distinguished Young Alumni Award by the UAB Medical Alumni Association on February 23, 2019. In his letter of nomination Dr. Waits said about Dr. Smith “over her first 8 years, Dr. Lacy Smith joined a small-town practice, and transformed it into a major healthcare facility, providing high-quality healthcare for tens of thousands of low-income patients, creating jobs, training the next generation of primary care physicians, and providing for the future workforce of the state of Alabama.”
Cahaba Medical Care is located on the campus of Bibb Medical Center and for the outside observer it is often difficult to tell the difference between CMC and BMC. Dr. Waits’ and Dr. Smith’s innovations and creativity in the practice of medicine and how the practice deals with the financial issues and challenges of the profession are refreshingly creative.
Cahaba Medical Care and Bibb Medical Center are succeeding where others have failed in rural health care and in the process have focused a bright light of attention on the medical industry that thrives in Bibb County.
It has become obvious to an outside observer that when combining the economic impact of Cahaba Medical Care and Bibb Medical Center the two entities make up the largest employer and perhaps the largest economic engine in Bibb County today.
For 2018 the two entities reported they have a combined 525 employees and an annual payroll over $17 Million.
