The American Association of Medical Colleges (AAMC), ranks Arkansas 47th in active patient care physicians per 100,000. America’s Health Rankings.org and U.S. News and World Report grades Arkansas 48th and 49th in healthcare outcomes, respectively.
Obesity, smoking, physical inactivity, childhood immunizations, preventable hospitalizations, dental care and a decreasing number of primary care physicians are major factors. The correlation between physician workforce and healthcare outcomes is not surprising. The changing tides of medical education in our state will affect physician recruitment and retention.
Since 1879, the University of Arkansas for Medical Sciences (UAMS) College of Medicine has been the sole producer of physicians within the state. In 2018, 155 UAMS graduates were accepted into residency or graduate medical education (GME), programs. Approximately 58% will stay in Arkansas for residency while others may leave for programs out of state. UAMS and other medical school graduates who complete residency in Arkansas remain to practice here at a rate of 55%.
Historically, this number increases to over 80% if a physician completes medical school and residency training in Arkansas. With Arkansas’ first osteopathic medical school located in Jonesboro, the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University (NYITCOM at A-State), and a second in Fort Smith, the Arkansas College of Osteopathic Medicine (ARCOM), the number of medical school graduates in the state will increase dramatically. NYITCOM is accredited for 115 students per year and ARCOM is accredited for 150, an increase of 265 students per year (61%) compared with the current UAMS class size of 174. Together, the three schools will produce roughly 439 graduates per year.
Currently, 40%-50% of medical school graduates leave Arkansas for residency training. Presently, there are 223 positions available for graduating medical students to fill in Arkansas. As a state, we must expand opportunities to retain medical school graduates from seeking other options. Residency programs, which are largely based out of hospitals, are not one size fits all. However, every hospital can participate in residency training at some level. Unity Health, St. Bernards Medical Center, NEA Baptist Memorial and White River Medical Center each started graduate medical education in ways that fit their needs and the needs of their communities. Others are exploring the benefits of GME, and hopefully more will come.
Increasing the number of physicians in the state is only one ingredient in the recipe for a healthier Arkansas. Getting physicians to practice in needed areas is another. Studies show physicians are more likely to practice in areas they are familiar with or have been exposed to during medical training. Medical students and resident physicians who had rotations in rural or underserved areas were more likely to return to similar areas to practice compared with those who did not. Medical students are exposed to a vast array of illnesses and a variety of patients when they are trained in different communities across the state.
Nationally, only 16% of Medicare hospitalizations occur in an academic medical center leaving the other 84% of hospital care delivered in community based hospitals, by community based physicians. Requiring students and residents to regularly rotate in rural and underserved areas produces positive results for the learner and the community. In other areas of the nation, specifically the Pacific Northwest, unique student and resident training strategies have been implemented, which encourage new physicians to practice in underserved areas with up to an 80% success rate.
Our physician workforce shortage will be a historical conversation if we can cultivate the next generation of physicians within our state and create a sustainable pipeline for a healthier Arkansas. Excellent physicians practice high-quality medicine in communities large and small across the state. Young medical learners should take advantage of that knowledge and witness the care provided. Hospital administrators and CEOs should engage all institutions of medical education to address the healthcare needs of communities.
And lastly, we should continue to expand residency training programs as evidence continues to confirm physicians commonly practice in familiar geographic areas within 100 miles of where they complete their graduate medical education.
Editor’s note: Dr. Shane Speights is dean of the NYIT College of Osteopathic Medicine at Arkansas State University. The opinions expressed are those of the author.