Medical Schools Fight Health Care Migration

Medical Schools Fight Health Care Migration
Walmart heiress Alice Walton announced plans to start a Whole Health Institute in Bentonville. The accompanying medical school hasn't reached the design phase, but officials hope it will help upgrade medical services in Arkansas after it opens in 2024. (Marlon Blackwell Architects)

The announcement last month that Walmart heiress Alice Walton would create the Whole Health School of Medicine in Bentonville to pair with her nonprofit Whole Health Institute was welcome news in a state that has a desperate need for better health care.

But even the creation of a new medical school to join the three existing ones within the state’s borders will not guarantee a fix, and certainly not an easy one, of Arkansas’ strained health care industry. Northwest Arkansas, which has seen robust economic and population growth, has been working diligently over the years to upgrade its health care offerings to improve the allure of Benton and Washington counties.

The health care industry in the two counties generates $2.7 billion in activity annually, but that figure could be much higher, according to a study done by the Northwest Arkansas Council in 2019. The council is a nonprofit organization made up of leaders from the business, academic and government sectors.

The region loses approximately $950 million annually in what is called outmigration, residents seeking medical care elsewhere. The report said northwest Arkansas needed to create 200 residency programs and add 6,000 jobs in the health care sector.

The loss of economic activity spurred the council to create its Health Care Transformation Division, an initiative to work with health care providers to make the region a health care destination. Ryan Cork was hired as executive director in February.

Cork believes the outmigration trend can be reversed, or at least stanched significantly, within three years.

“The Health Care Transformation Division is to help some of the reverse outmigration of patients and health care dollars,” Cork said. “The truth is there will always be someone who leaves through a connection or a family. You’re not going to completely stop the migration.”

The Whole Health School of Medicine can be another feather in the region’s cap. School officials haven’t announced where the facilities will be located, but they hope to begin construction in 2022 and enroll its first class two years later.

Slots Machine

The state is 48th nationally in physicians per capita, with the Fort Smith region being the worst in the state, said Kyle Parker, the CEO of the Arkansas College of Osteopathic Medicine in Fort Smith. ARCOM opened its doors in 2017 to address that lack.

Northwest Arkansas is more affluent than Fort Smith and has seen enormous growth in recent years with the establishment of Arkansas Children’s Northwest in Springdale and multimillion-dollar expansions by existing hospitals such as Mercy Northwest Arkansas and Washington Regional Medical Center.

Establishing a medical school isn’t easy or inexpensive, but the hardest work with such a school is arranging rotational slots and postgraduate residencies. Third- and fourth-year students spend weeks rotating through clinics and hospitals learning various specialities; then after graduation, they take residencies that last anywhere from three to seven years at a hospital before becoming full-fledged doctors.

ARCOM's first class will graduate in May, and Parker said nearly 75% of its 145 members have found residencies within its service area, which comprises Arkansas, eastern Oklahoma and parts of southern Missouri and northern Louisiana. That residency placement is crucial because national studies have shown that approximately 70% of doctors stay in the area where they served their residencies.

Arkansas’ dilemma — “It’s a Catch-22,” Parker said — is that rotation and residency slots are restricted in the state because of the low physician numbers. Fewer physicians mean fewer are available to serve as teachers to medical school students and residents.

“Where the squeeze comes in is, because we are so short on doctors to begin with, it is harder and harder to find places where your students can do rotations,” Parker said. “You need the residency slots in the state. We’re just not big enough to do that. It is going to be difficult to keep growing the kids after graduation. If you’re making them leave the last two years of medical school because you can’t find a place to rotate, that doesn’t bode well.

“Can we handle four medical schools because of the sheer need of doctors? Absolutely. The logistics are the issue.”

Every Bit Helps

The federal government attempted to help in December when it passed legislation to increase the Medicare graduate medical education program by 1,000 residencies nationally, the first increase in 25 years. U.S. Senator John Boozman, R-Ark., a former physician, has cosponsored current legislation that would add another 2,000 slots.

It’s true that only a small number of those would be in Arkansas, but the federal GME program would alleviate the cost factor for many hospitals’ residency programs.

“That is not a small task,” Cork said. “We need more slots to not only train our medical schools now but those that will come online, but also stay competitive and draw talent from other states. Arkansas has been a donor state for a while now.”

Whole Health officials are aware of this situation. Dr. Tracy Gaudet, the executive director of the Whole Health Institute, has previously said the medical school has been working “hand in glove” with local health care systems to ensure residency slots will be available.

Alice Walton and Gaudet, who was unavailable for comment for this article, met with Parker to discuss the process of starting a medical school. The Whole Health School of Medicine is expected to have between 40 and 50 students per class when it opens.

“It is an amazing opportunity for our patients, our community, our providers,” Cork said of the proposed school. “It creates more young doctors [and] that is something we are all going to need as our generation gets older.

“The state with our in-state students can support it — those that look to get into a four-year medical school. It also attracts talent from other [states], the high-caliber [students] coming out of undergrad or postgrad who want to go to medical school. We can attract talent into northwest Arkansas.”

Parker said ARCOM received 6,000 applications for its most recent 150-member class so finding the students is not a problem for any medical school. The hard work comes after that.

“The demand is through the roof,” Parker said. “There’s only so much capacity. The only way the capacity gets added on to is another physician is recruited into a hospital system who is willing to take students from medical schools.”