Progress made to address physician shortage, more work remains

According to the Association of American Medical Colleges (AAMC), Arkansas ranks 47th among U.S. states for active physicians per 100,000. Of the physicians that are actively practicing here, over a third are over the age of 60. We have a physician shortage, and it could worsen as those doctors retire in the coming years.

New York Institute of Technology College of Osteopathic Medicine at Arkansas State University graduated its second class in May. That’s 117 more physicians that can now go on to specialty training – also called residency training. Ideally, they choose to practice in our state.

I vividly remember the conversations and debates that were sparked when we started discussing of the creation of NYITCOM at A-State. One of the “obstacles” thrown at us was the limited opportunities for medical school graduates in Arkansas in terms of residency training. In fact, we were told “you can’t create new residency programs in this state.”

As we have found at NYITCOM, the issue is not getting our medical school graduates into residency; it’s getting them into residencies in Arkansas. The majority of medical school graduates are competitive and programs around the country want them. Even if they want to stay in our state, there might not be that opportunity.

Our state’s physician strain is particularly felt in primary care specialties. In 2014, there were seven Family Medicine residencies with 57 annual spots and one Internal Medicine residency with 16 spots in Arkansas. That meant there were a total of 73 spots available in our state that a medical school graduate could enter into one of those specialties.

At that time, only about half of the medical school graduates in Arkansas entered those programs. The remainder of the positions were filled with graduates from other states and other countries.

That’s why NYITCOM started the conversation about expanding residency programs early, even before we recruited our first medical student. Our founding dean, Dr. Barbara Ross-Lee, knew that although another medical school could make a positive impact on the state, the only way to truly increase the number of physicians practicing in the state was by increasing the residency training opportunities.

NYITCOM at A-State hosted three statewide “Graduate Medical Education Readiness” events to educate stakeholders on the need for increasing residency training and the resources available to do so. We assembled national experts in residency creation, finance, and training to speak and answer questions from hospitals and healthcare organizations across the state on how to build and grow GME in Arkansas. And it worked.

In the last half decade, the state has added five new Family and nine new Internal Medicine programs, accounting for 113 new positions annually. There are now 12 Family and 10 Internal Medicine programs in Arkansas with a total of 186 positions each year. New Psychiatry and Emergency Medicine programs have also recently opened.

Prior to 2017, there had not been an expansion of Family Medicine residency positions created in Arkansas since 1992, and prior to 2015, there hadn’t been an Internal Medicine program started since 1949.

It wasn’t easy. It takes leaders with vision and dedication to make it happen. Though the federal government typically covers the ongoing costs of residency programs, the start-up costs can run as high as $1.5 million.

Fast forward to May of 2021, with 23 NYITCOM at A-State graduates remaining in Arkansas for residency training. Many will train in programs that didn’t exist just a few years ago. It certainly represents progress, but it’s not enough. We still have more to do to support our hospitals and institutions in the state that are willing to create the next physician workforce.

We need to focus on the rural and underserved areas of our state and leverage resources to create training programs in those needed areas. Why? Because over half of our state population lives in a county with a population less than 80,000. Also, our own data shows that 57% of physicians that complete their residency training in Arkansas remain here to practice. Training and retaining physicians in those areas translates to healthier communities and a healthier, more productive workforce.

Whether you agree with what goes on in Washington or not, we should act now to capitalize on the federal funds flowing into our state. We need to invest in the health of our current and future generations. Wise decisions now could help move us from one of the unhealthiest states to one of the healthiest and productive in the country, but it’s up to us.

Editor’s note: Dr. Shane Speights is dean for the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) at Arkansas State University. The opinions expressed are those of the author.