Two solutions to doctor shortages

Arkansas has a physician shortage, especially in rural areas. Several trends are driving this shortage. One reason is the increased number of Arkansans who have access to health care through the Arkansas Works program that expanded Medicaid coverage.

Demand has also increased because our population is aging – the older we get the more medical services we use. And, more than a third of all active physicians will be age 65 or older during the next 10 years, so we can expect many to retire. Physician retirement will have the greatest impact on our supply of specialists.

Thanks to a growing medical school at the University of Arkansas for Medical Sciences and two osteopathic schools – Fort Smith’s Arkansas College of Osteopathic Medicine and Jonesboro’s New York Institute of Technology’s College of Osteopathic Medicine – we’ll have an additional 300 medical school graduates in three to four years. Arkansas can expect more than 475 new physicians every year.

Sounds great, but here’s the problem. After medical school, graduates generally enroll in a residency program for more intensive training. Although there is a surplus of residency slots nationwide, Arkansas has about 250 residency slots for more than 475 graduates. When Arkansas-trained medical students move to other states for their residency, very few of them return to Arkansas to practice medicine. Young doctors tend to practice where they complete their residency.

To keep Arkansas-educated doctors practicing here, several hospitals are expanding the number of residency slots or creating new residency programs. Unity Health in Searcy has developed residency programs in emergency, family, internal medicine and psychiatry that will accept 24 graduates per year. They’ve already hired three graduating residents as hospitalists at the Searcy facility.

Northeast Arkansas Baptist has programs in pharmacy, radiology, and family and internal medicine. St. Bernards has a program in internal medicine and Mercy Hospital Fort Smith has residencies in family and internal medicine. UAMS in Fayetteville has an internal medicine program. UAMS in Little Rock offers 61 residency and fellowship programs but fewer than 200 slots.

Medical analysts have called for federal support for an additional 3,000 residency slots nationwide over the next five years. While medical schools have expanded class sizes, the number of practicing physicians cannot expand without more residency slots. Medicare finances the bulk (90%) of residency programs, but federal funds are capped at $10 billion annually.

More than 70% of physicians under age 40 have student loan debt, and nearly half are carrying debts between $150,000 and $200,000, according to the American Medical Association. Student debt plays a major role in career decisions and our nation’s supply of physicians.

Significant financial burden also effects students’ choice of practice area. Although many students plan to pursue family medicine, geriatrics or other careers in primary care, pressure arising from debt causes some graduates to pursue higher-paying specialties. Concerns about debt keeps some students from attending medical school altogether, especially students from diverse ethnic and socioeconomic backgrounds.

With recent emphasis on eliminating health care disparities, it’s important to ensure a workforce that reflects the general population. Providers with less debt are more likely to start careers in medical education, research, public health or practice in medically underserved areas.

One option to help expand both the number and diversity of health care professionals is the National Health Service Corps. It offers tax-free, federal assistance (loan repayment or scholarships) to support health care providers who commit to practicing for several years in medically underserved areas.

Mitigating student debt and expanding Arkansas residencies will help stop the loss of our medical graduates to other states.
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Editor’s note: Authors of this essay are Ray Hanley,  president and CEO of AFMC, and Dr. Stacy Zimmerman, internal medicine residency program director in Searcy and chairman of AFMC’s Board of Directors. The opinions expressed are those of the authors.