The number of students graduating from Arkansas medical schools has outpaced the number of residency slots in the state for the last three years, disrupting the state’s student-to-doctor pipeline.
But Arkansas leaders in medical education are working to add more residency positions to the state’s hospitals in hopes of alleviating the physician shortage.
This matters to the state’s medical infrastructure because most doctors continue to practice medicine in the state in which they completed their residencies, according to the American Association of Medical Colleges.
Medical school graduates began outpacing residency slots in 2021, largely thanks to two new medical schools in the state. The discrepancy has continued through this year, with 401 graduates and 356 residencies in 2023, according to Arkansas Center for Health Improvement data.
The University of Arkansas for Medical Sciences sponsors roughly 80% of residencies statewide, Chancellor Dr. Cam Patterson said.
UAMS has been working to increase residency positions in rural areas of Arkansas, the places in most need of more medical professionals, but creating those positions takes resources beyond just money for residents’ salaries, Patterson said.
“You have to have a dedicated faculty who are committed to education, you have to figure out how to supplement their salaries for the clinical work that they give up in order to do that training, and you have to have specific educational experiences that will satisfy the requirements for completing a residency,” he said.
Some Arkansas counties do not have hospitals, according to the state Department of Health, and six counties — Cleveland, Madison, Marion, Montgomery, Newton and Perry — had only one full-time primary care physician per 10,000 residents in 2020, according to ACHI data.
Additionally, Arkansas’ physicians are increasingly nearing retirement, with 27% of them age 60 or older, according to ACHI data.
This makes bolstering the state’s medical field with early-career physicians all the more important, said Republican U.S. Sen. John Boozman, an optometrist from Rogers.
“It would be sad if we have all these people we’re investing in, and they have to go out of state to get additional training and they’re not coming back,” said Boozman, who has been working on federal solutions to increase residency slots.
In addition to its main Little Rock campus, UAMS trains residents at eight regional campuses throughout the state, some of which are in rural areas. Those campuses are in Batesville, Fayetteville, Fort Smith, Helena-West Helena, Jonesboro, Magnolia, Pine Bluff and Texarkana. Most of them focus on family medicine, which will be the focus of the ninth campus that will open in El Dorado in 2025, UAMS announced in May.
However, Little Rock is the only place in the state for physicians to train in some medical disciplines, such as general surgery, orthopedic surgery, and obstetrics and gynecology, said Dr. Amanda Deel, the associate dean of academic affairs and graduate medical education at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University.
“Those residents have to do so much training in a variety of situations and over such a long period of time [that] those particular ones are hard to create and sustain,” Deel said.
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Potential solutions
Boozman is co-sponsoring three bipartisan Senate bills aimed at creating more residency slots nationwide and retaining the doctors that train in those positions.
The Physicians for Underserved Areas Act would change the residency distribution process to give areas where a hospital has recently closed a greater chance of receiving new residents. Some rural Arkansas hospitals have said they have been at risk of closure due to financial strain from the COVID-19 pandemic, though some have received federal funding to stay afloat.
The Resident Education Deferred Interest Act would allow medical and dental school graduates to pause student loan payments and interest accrual during their residencies. Boozman said this would incentivize physicians to accept residencies in rural areas, removing the “pressure of immediately having to agree to practice in a larger area that pays more.”
The Resident Physician Shortage Reduction Act would lift the federal limit on the number of Medicare-funded residency slots nationwide, raising the total number of slots by 14,000 over seven years. The legislation would prioritize places like Arkansas, not only because of its rural areas and larger numbers of medical school graduates than residency slots, but also because of its new medical schools: ASU-NYITCOM opened in 2016, two years after the Arkansas College of Osteopathic Medicine opened in Fort Smith.
The ASU medical school received a grant in 2015 to host graduate medical education training sessions, and Arkansas has since seen an increase in residency slots statewide. When ASU saw its first class of NYITCOM graduates in 2020, 58 of them matched with residencies in the state that did not exist in 2016, said Casey Pearce, the college’s marketing director.
Statewide, the number of residency slots in Arkansas increased from 210 to 356 between 2017 and this year, according to ACHI data.
Deel said 100% of the ASU medical school’s 2020 graduates who grew up in Arkansas and accepted in-state residency slots are still practicing medicine in the state.
Conway Regional Health System accepted three ASU-NYITCOM graduates as residents in 2020, and all three are still practicing medicine in Central Arkansas.
Meanwhile, the Alice L. Walton School of Medicine in Bentonville is scheduled to open in 2025, pending accreditation. One of the school’s goals is to increase the number of residency slots and retain as many physicians as possible in Arkansas, President and CEO Walter Harris said in a statement.
In 2021, Northwest Arkansas Council worked with UAMS and other health systems in the state to advocate for $12.5 million in state funds to expand residency programs in Northwest Arkansas, Harris said.
“We recognize that the need for more residency slots is ongoing, and we are dedicated to continued advocacy toward the goal of improving health outcomes, reducing costs, and expanding access,” he said.
