With new medical residency programs, the state’s largest health care systems are addressing what doctors say is an increasingly urgent shortage of primary-care doctors in Arkansas.
The Baptist Health-University of Arkansas for Medical Sciences Medical Education Program, a collaboration between the health systems, announced Monday that it will begin recruiting medical residents for newly accredited, jointly funded training programs at Baptist Health Medical Center’s North Little Rock campus.
The residency programs in internal medicine and family medicine, which are specialties that future primary-care doctors can train in, each will accept up to 12 students for programs that begin next July.
When the program’s students wrap up the three-year training that traditionally follows medical school, that could mean as many as 24 new primary-care doctors per year in a state where the shortage of such providers is “acute,” UAMS chancellor Dr. Cam Patterson says.
Arkansas has struggled with a physician shortage in general, ranking 46th on a physicians-per-capita list produced by the Association of American Medical Colleges, but the shortfall of primary-care doctors has been of special concern among health care professionals.
They are “the physicians who provide the majority of our day-to-day health care needs,” writes Baptist Health president and CEO Troy Wells in an email. Doctors say they are one of the most important parts of improving patient outcomes.
“If we want to be serious about wellness, about cost control, about providing health care more cheaply and efficiently, that’s going to be done through primary care providers and not through specialty providers,” Patterson says.
Some research suggests that Arkansas will need 410 more primary-care physicians by 2030 to keep up with patient demand, says Dr. Karen Mitchell, medical education division director at the American Academy of Family Physicians. According to an Association of American Medical Colleges study, the U.S. overall will have a shortage of between 14,800 and 49,300 primary-care physicians by that time.
In practice, what limited primary care access looks like is patients turning up in Arkansas emergency rooms for regular care, or to manage chronic conditions such as diabetes, which those facilities aren’t typically set up to handle, says Dr. Sara Nehring, who is program director of internal medicine residency programs at St. Bernards Healthcare in Jonesboro.
Patients also tend to be sicker by the time they go to a doctor, “coming in with advanced disease, or [after] screenings for cancer aren’t done in a timely fashion,” she says, resulting in doctors managing more complicated cases.
There’s been a “little uptick” in the number of medical students electing to pursue family medicine. The percentage of Arkansas medical students who choose that specialty is slightly higher than the national average, Mitchell says. But a number of barriers continue to deter new medical graduates from dedicating their careers to primary care.
There are quality-of-life issues at play, Nehring says. Doctors can be reluctant to live in the rural communities where primary-care doctors are most needed and in which the doctors are never really “off-duty” — as opposed to shift work in urban hospital.
For many medical school graduates, student debt can be a factor. The cost of medical school alone can top $200,000. That debt can compel aspiring doctors to seek out better-paid specialties, such as cardiology or gastroenterology.
And even for those who are interested in primary-care specialties, there aren’t always residencies, or post-graduate training, available in the areas that need providers. That’s another issue that’s vexed Arkansas health care professionals.
Right now, Patterson says the state is about 150 residency slots short of what it needs, meaning some graduates from the state’s medical schools have to go to other states to complete their training.
Though residency programs are time-consuming to start and expensive to maintain, Arkansas has to have more of them, agrees Dr. Stacy Zimmerman, program director and fellow in internal medicine and pediatrics at Unity Health in Searcy.
Residents learn practice preferences, develop mentors and frequently start families during their residencies, so they’re likely to settle and practice in the place where they finish their post-graduate training, she says.
Once students leave the area for training, they typically don’t return. One study found that 68 percent of doctors who complete all of their training in a state (including residency) are likely to stay there.
That means that new medical schools alone, such as the NYIT College of Osteopathic Medicine at Arkansas State University that opened in 2016, aren’t enough to increase the supply of working physicians in the state.
“If we don’t fix the second leg of the issue … we won’t retain these physicians,” Zimmerman says. “All this resource we spent in educating them to become doctors will be worthless.”
Creating more primary-care residency slots then, is a two-pronged attack in addressing the doctor shortage. It’s being done not only with the North Little Rock programs but at other hospitals.
Two years ago, St. Bernards administrators decided that the hospital would self-fund an internal medicine residency program for up to eight residents each year, with the hopes that those doctors would practice in Jonesboro or the surrounding area when they completed their training, Nehring says. In Searcy, Zimmerman’s program takes up to 10 residents a year.
Patterson says the UAMS system plans to add four to five programs over the next few years in areas of Arkansas that are designated as medically underserved, which is based in part on the ratio of primary-care doctors to the general population.
The most recent primary-care residencies are based in well-served central Arkansas, but he thinks that the “saturation” of providers in the region, as well as community rotations and possible incentives — such as debt relief programs — could encourage the new doctors to practice in other areas of the state.
As doctors from primary-care-focused residencies begin to practice, that could help mitigate a strain on overstretched health-care providers in the community. That’s something that Todd Burks, administrator at Spring Hill Family Medicine in North Little Rock, says he’s picked up on.
He says his clinic receives 10 to 15 phone calls a day from people who need primary-care doctors, but can’t find one that’s accepting new patients.
“A lot of people are understandably frustrated,” he says. “[But] there’s a limit to what you can adequately take on.”