Arkansas, like other rural states, is experiencing a shortage of physicians. Many medical school graduates in Arkansas end up leaving the state where they can find more residency opportunities.
But now Arkansas has two osteopathic medical schools — the Arkansas College of Osteopathic Medicine in Fort Smith and the New York Institute of Technology College of Osteopathic Medicine in Jonesboro — to go along with the University of Arkansas for Medical Sciences (UAMS) in Little Rock. And many in the industry are optimistic the state’s health care partners can provide enough opportunity to entice young doctors to stay in Arkansas and even serve in those rural areas that need them.
David Wroten, executive vice president for the Arkansas Medical Association, said the number of students graduating from an Arkansas medical school has increased nearly three-fold, and that’s good news. But if these new graduates can’t find residencies in Arkansas, they will have no option but to go to other states.
“They are more likely to stay in those states where they do their residency,” Wroten said. “So, if we want them to stay and practice in Arkansas, we need residency positions for them. Fortunately, all of the major health care systems in our state are or already have started providing residency opportunities.”
Conway Regional launched its family medicine residency program in 2020, and other institutions have been working to address the issue as well.
James Clardy, M.D., director of the Center for Graduate Medical Education (GME) at UAMS, said training more physicians is particularly important because retirement has increased during the pandemic. The average age of Arkansas physicians is in the 60s and rising for some specialties such as urology.
Clardy said it is important to provide residency positions for medical students in Arkansas because students look around the country for slots. Students who stay in Arkansas to do their residencies are more likely to stay in the state after completing their training, he emphasized.
UAMS has worked to enlarge the GME pool throughout the state.
“The rules about having residencies changed at accreditation levels, and a lot of hospitals or medical systems like Unity Health in Searcy decided they were going to sponsor residencies and they did,” Clardy said. “At Unity Health, we collaborated with them, but it is not a UAMS-sponsored operation. UAMS is directly working towards sponsoring a family residency position in Eureka Springs and Berryville, and one in Crossett. El Dorado is also establishing a program. And others are being discussed. We would like to branch out and establish residencies in more rural areas. One way is the direct expansion of residencies. A second way is UAMS partnering with other organizations to establish these residencies. Together, there are almost 100 first-year resident spots in family medicine alone.”
There are certain national accreditation requirements for GME. For example, a family medicine resident needs to have a certain number of pediatric emergency visits. UAMS is sometimes the only hospital in the state with the volume and expertise to help.
“We take in residents from all over the state, and many are not in our program,” Clardy said. “We are helping people as much as we can to get the required clinical experience. Arkansas Children’s Hospital (ACH) and UAMS faculty there allow residents from different programs around the state to fulfill needed clinical rotations at ACH. It is a nice setup that works for everyone in the state.”
UAMS also has teamed up with Baptist Health to expand GME spots.
“We partnered with them for a family medicine residency\internal medicine residency, a psychiatry residency and a transitional year,” Clardy said. “The first year of transitional training lets residents start and then later decide on which specialty to go into. Some could go into radiology, family medicine or OB\GYN.”
Mindful of the national shortage of physicians and the expanding health care needs in Arkansas, Baptist Health has numerous residency and rotation programs across the state.
“Baptist Health and UAMS partnered in 2019 to create the Baptist Health-University of Arkansas for Medical Sciences Medical Education Program in North Little Rock,” said Troy Wells, president and CEO of Baptist Health. “Four residency programs have been started through the efforts including internal medicine, family medicine, transitional year and psychiatry. We are excited that in June we will be graduating our first class of residents in family medicine, internal medicine and transitional year. At our full complement, we will be graduating 40 physicians into the medical community each year. We continue to evaluate the community’s need to determine if increasing the number of residents in existing programs or adding additional programs is feasible.”
Also, in conjunction with UAMS, Baptist Health offers approximately 100 rotations a year for UAMS residents at Baptist Health Medical Center-Little Rock and Baptist Health Extended Care Hospital. These rotations are for areas such as surgery, emergency medicine and multiple sub-specialties such as critical care.
“Baptist Health in partnership with UAMS began a physical medicine and rehabilitation residency program in the early ‘80’s and is still the state’s only such program,” Wells said. “Through this program, 21 residents participate annually at Baptist Health Rehabilitation Institute. For more than 40 years, Baptist Health-Fort Smith has worked closely with UAMS-West to provide first-hand experience for residents in family medicine and multiple specialties. During the three-year program, 28 residents train at Baptist Health-Fort Smith each year.”
In the past 10 years, Baptist Health-Fort Smith has expanded its reach to partner with the Arkansas College of Osteopathic Medicine and Lincoln Memorial University in Harrogate, Tenn., to provide a space for additional medical students each year.
Arkansas College of Osteopathic Medicine
The Arkansas College of Osteopathic Medicine (ARCOM) attained its sponsoring institution accreditation in early 2019.
“Since that time, we have partnered with several regional hospitals and medical centers to initiate and/or support GME,” said ARCOM Dean Rance McClain, D.O. “We currently serve as the sponsoring institution for newly created programs in family medicine and internal medicine at Mercy Hospital Fort Smith, as well as internal medicine at Poplar Bluff Regional Medical Center in Missouri. We are the education affiliate for programs in family medicine, internal medicine, emergency medicine, psychiatry and a transitional year program at Unity Health in Searcy. These programs play a vital role in keeping Arkansas medical students in this state and region for their GME training by expanding the number of programs and GME positions within the state.”
Looking to the future, NYIT is working with other hospitals and health systems regarding opportunities to begin GME programs at their institutions as well. “We are working to someday have enough affiliated residency programs and training positions that every ARCOM graduate would have the opportunity to stay and train in GME programs in our service area,” McClain said.
Studies have consistently shown that more than half of physicians practice in the state where they completed their GME training. McClain said these percentages improve when the physician attended medical school in that state, as well.
“At ARCOM, we have focused on providing students a pathway to attend medical school in this region and have developed educational partnerships with numerous hospitals throughout Arkansas and the region where our students complete the third and fourth year of their medical education,” McClain said. “This period of their education is termed clinical rotations. We are working to create partnerships with regional hospitals that also allow them the opportunity to apply for and complete residency training programs in the same communities and same facilities they are in during those final two years of medical school. We are excited to analyze the impact of these efforts in July of 2024, when the first graduates of ARCOM will be graduating from their residencies and beginning their clinical practice as a fully licensed physician.
“It’s no secret that Arkansas has consistently ranked low in key areas of health care, including access to care, cost of care, health outcomes and many other metrics used to rank states. In particular, rural areas have seen great difficulty recruiting and retaining physicians in practice. This leads to the challenges listed above and the lower rankings that Arkansas has consistently received.”
McClain noted that the ARCOM mission statement includes a focus on serving the underserved. As someone who grew up in a small rural farming community in southeast Kansas that was similar to countless Arkansas communities, he knows how important physicians are to rural communities.
“I have strived to show the physicians of tomorrow how vital and fulfilling their career can be when they pursue becoming a primary care physician in a rural and underserved community,” McClain said. “We will continue to focus the efforts of this institution based on that mission, and I look forward to the day when we admit medical students who were born and raised in these Arkansas communities that tell us they are coming to our school because they want to be just like their hometown physician, an ARCOM graduate.”
NYIT College of Osteopathic Medicine at A-State
Shane Speights, D.O., dean of the NYIT College of Osteopathic Medicine at Arkansas State University, said that residency training is the part of medical education that teaches the physician how to practice a certain specialty. Having training programs in Arkansas is key, not only to the health of our state, but the retention of physicians, he stressed.
“Our own data shows that 57 percent of physicians that complete their residency training in Arkansas remain here to practice,” Speights said. “That’s a good thing, considering Arkansas ranks at the bottom of the country for physicians per capita. Residency training programs are a minimum of three years in length. When a physician is in residency, they become ingrained in the community. They join a church, make friends, participate in community events and their kids attend local schools. They develop ties to the community, which makes them much more likely to stay once they complete their training. Look no further than the towns that currently have residency training programs — Jonesboro, Conway, Searcy, Batesville, Hot Springs, etc. — and you will find a pipeline of new physicians into those communities. It’s incredibly important that we get more physician residency training programs started in Arkansas, so they’ll contribute to that statistic and stay here to practice.”
Before NYITCOM opened its doors in 2016, Speights said officials knew they needed to work to create more opportunities for their graduates to attend residency programs in Arkansas. Prior to 2015, no one outside of UAMS was operating residency programs in the state.
“That year, NYITCOM received a $250,000 grant from Arkansas Blue Cross and Blue Shield. We used that money to host three statewide ‘Graduate Medical Education Readiness’ events to educate stakeholders on the need for increasing residency training and the resources available to do so. At the events, we assembled national experts in residency creation, finance and training to speak and answer questions from hospitals and health care organizations across the state on how to build and grow GME in Arkansas. And it worked.
“In the past seven years, the state has added five new family medicine 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.”
Speights said in the first three classes, NYIT had 46 students placed into programs that didn’t exist prior to our Arkansas campus opening.