So I currently reside in Texas and am planning on attending the University of Alabama (full tuition) for pre med and then hopefully going to the University of Alabama at Birmingham for medical school. How easy would it be to establish residency over my 4 years at Alabama as the acceptance rate to the medical school and tuition is significantly better for residents? Thank you

It is difficult. Since you are starting your education journey in AL as an out of stater, even if you change your drivers license, voting, stay in AL for summer jobs etc, you will be presumed to still be an out of stater. Go on the U of A website because they have a good explanation of how this works.

Requirements to establish an Alabama state residency–

Most medical schools use the state where a student’s high school of record is located as the presumptive home state for traditional students who are applying to medical school during college or directly after college graduation.

Students taking gap years post graduation and who are self-supporting can establish their own independent domicile & residency in a new state and apply as resident of that state.

BTW, it’s unwise to be singularly focused on attending a particular medical school. Admission to med school is extremely competitive. To have the best chance for an admission, students need to apply broadly. The median number of applications that successful applicants send out is 16.