Putting down roots

All Arkansans should have access to high-quality healthcare close to home. However, as a largely rural state, we have experienced significant shortages of physicians and other providers for many years, and our aging population and other factors will exacerbate the situation in the years ahead.

In Northwest Arkansas, these challenges are compounded by the booming population.

Arkansas has one of the lowest per-capita rates of primary care physicians in the country. Northwest Arkansas has a critical shortage of specialty and subspecialty physicians. In addition to the obvious health consequences for our citizens, this contributes to an estimated $950 million annual economic loss for the region.

Fortunately, the Northwest Arkansas Council is working diligently to address these challenges, grow the healthcare economy and help ensure good health for everyone who calls Northwest Arkansas home. Washington Regional Medical Center, Mercy Hospital Northwest, Northwest Health, Arkansas Children’s Northwest and the University of Arkansas for Medical Sciences have joined forces with the council to focus on healthcare transformation.

Nothing is more urgent in this endeavor than expanding physician residency training — also known as graduate medical education (GME) — in Northwest Arkansas.

Why? Because we know doctors are statistically likely to put down roots and practice close to where they completed their training. At UAMS, we have worked to make Arkansas one of the top three states in the country for retaining our medical graduates.

The process of becoming a physician is like a pipeline. One must complete four years of college, four years of medical school, and then three to six or more years of residency training. Those going into a subspecialty such as hematology/oncology, cardiology or transplant surgery typically complete an additional year or two of training through a fellowship.

Decades ago, the number of medical students “narrowed the pipeline” and limited the ability to generate physicians for Arkansas. At UAMS, we increased class sizes and have welcomed 174 freshmen each year since 2009. With the opening of two osteopathic (D.O.) medical schools in Jonesboro and Fort Smith, the number of entering freshmen across the state has jumped to 439, and the first osteopathic students will graduate over the next two years.

Unfortunately, there are only about 277 first-year residency positions in the state. Open to both allopathic (M.D.) and osteopathic graduates, this is far short of what is needed to keep many of them in Arkansas.

There are currently approximately 55 residency and fellowship positions in Northwest Arkansas, including 11 first-year internal medicine positions and nine first-year family medicine positions. This translates to 12.8 residents and fellows per 100,000 people, a fraction of the national average of 37.8. The council commissioned the 2019 Healthcare Transformation Report, which recommends adding 200 training positions in Northwest Arkansas.

It is imperative to widen the residency “pipeline” in Northwest Arkansas and across the state. However, it is not simply a matter of deciding to create more positions. Residency education nationwide is largely funded by the Centers for Medicare and Medicaid Services (CMS), and the number of training positions at existing hospitals has been essentially capped at 1997 levels. We are grateful for U.S. Sens. John Boozman of Arkansas and Robert Menendez of New Jersey, who have introduced bipartisan legislation — the Resident Physician Shortage Reduction Act — in an effort to address this problem.

Meanwhile, UAMS and our partners in the council’s healthcare transformation initiative are working to develop a blueprint for expanding high-quality residency and fellowship positions in the region. We will seek creative solutions for this complex endeavor, including the funding hurdles.

One thing is certain. This crucial work to ensure world-class healthcare close to home will be buoyed by the forward-thinking leaders, communities, healthcare organizations and citizens of Northwest Arkansas.

Dr. Christopher T. Westfall is executive vice chancellor of the University of Arkansas for Medical Sciences and dean of the UAMS College of Medicine. The opinions expressed are those of the author.