Guest Editorial by Ray Hanley, President and CEO, AFMC and Stacy C. Zimmerman, MD, FACP, FAAP, Chair, AFMC Board of Directors

Arkansas has a physician shortage, especially in rural areas. Several trends are driving this shortage. An increased number of Arkansans have access to health care through the Medicaid-expansion program, Arkansas Works. Our population is aging, and the older we get the more medical services we use. Another reason is because more than a third of all active physicians will be age 65 or older during the next 10 years, and many will retire. 

Thanks to a growing medical school at the University of Arkansas for Medical Sciences and two osteopathic schools – Fort Smith’s Arkansas College of Osteopathic Medicine and Jonesboro’s New York Institute of Technology’s College of Osteopathic Medicine – we’ll have an additional 300 medical school graduates in three to four years. Arkansas can expect more than 475 new physicians every year. 

That sounds great, but here’s the problem. While medical schools have expanded class sizes, the number of practicing physicians cannot expand without more residency slots. There’s a surplus of residency slots nationwide, but Arkansas has only about 250 residency slots for more than 475 graduates. When Arkansas-trained physicians move to other states for their residencies, very few of them return to Arkansas to practice medicine. 

To keep Arkansas-educated doctors practicing here, several hospitals are increasing residency slots or creating new residency programs. Unity Health in Searcy has developed residency programs in emergency, family, internal medicine, and psychiatry that will accept 24 graduates per year. They’ve already hired three graduating residents as hospitalists in Searcy. 

Northeast Arkansas Baptist has programs in pharmacy, radiology, and family and internal medicine. St. Bernards has a program in internal medicine and Mercy Hospital Fort Smith has residencies in family and internal medicine. UAMS offers 61 residency and fellowship programs with fewer than 200 slots. 

Medicare finances the bulk (90%) of residency programs, but federal funds are capped at $10 billion annually. Medical analysts have called for federal support for an additional 3,000 residency slots nationwide over the next five years. 

More than 70 percent of physicians under age 40 have significant student loan debt. Debt plays a major role in career decisions and our nation’s supply of physicians. Financial concerns also effect students’ choice of practice area. Although many students plan to pursue family medicine or primary care, debt pressure causes some to pursue higher-paying specialties. Concerns about debt keeps students from diverse ethnic and socioeconomic backgrounds from attending medical school altogether. 

One option to expand the number and diversity of health care professionals is the National Health Service Corps. It offers tax-free, federal assistance (loan repayment or scholarships) to support health care providers who commit to practicing for several years in medically underserved areas. 

Mitigating student debt and expanding Arkansas residencies will help stop the loss of our medical graduates to other states.