Arkansas has 160 more doctors in residency than it did just a few years ago thanks to the creation of two osteopathic medical schools in the past decade.
While those numbers are welcome in the state, much work remains to reverse Arkansas’ poor health care results. The state ranked 47th in overall health care in U.S. News & World Report’s annual list released in May.
But lack of awareness isn’t keeping the state from improving its health care results. It’s the lack of infrastructure — chiefly the lack of residency programs in the state.
Money plays a large role. An official with the Arkansas College of Osteopathic Medicine in Fort Smith said it takes as much as $1.5 million to start a medical residency program, a financial stumbling block for health care facilities in Arkansas counties that need the most help — if those counties even have the required facilities to support them.
As a result, most of Arkansas’ 160 new D.O. residents are concentrated in the urban economic and population centers of Little Rock, northwest Arkansas, Jonesboro and Searcy. The residents are graduates from the state’s two osteopathic schools of medicine: ARCOM, which opened in 2017, and the New York Institute of Technology’s College of Osteopathic Medicine at Arkansas State in Jonesboro, which opened the year before.
But the progress is unmistakable. There were about 210 residency positions in 2016, according to the National Resident Matching Program; in 2023, there are more than 350. Arkansas has also seen an increase in the number of osteopathic doctors, which rose by 143 from 2020 to 2023, according to data from the Arkansas State Medical Board (see chart).
“It’s a long game,” said Dr. Shane Speights, dean of NYITCOM-Arkansas. “It’s a generational approach to correcting health care outcomes in the state. You have to start some time and you have to put forth the effort to make it happen or it will never happen.
“It really takes a long game and putting up the resources to make it happen. It takes sweat equity to really make a generational change.”
It’s no surprise that there are health care holes in a state like Arkansas, which, despite some prominent population areas, remains about 41% rural.
Combating the rural deficiency was a motivating factor behind the creation of each of the state’s osteopathic schools of medicine. The idea was to teach and graduate D.O.s, who would then practice medicine in the state where they were educated.
Osteopathic medical schools tend to attract more students who are interested in family medicine, internal medicine and pediatrics. ARCOM said more than 70% of its residents enter primary care fields.
D.O. schools such as ARCOM also pair third- and fourth-year students with physicians on their community rotations, giving them exposure to medicine in small communities.
“They’re out there, they’re meeting people, they’re settling down and developing their lives in those areas,” ARCOM Dean Dr. Shannon Jimenez said. “Part of our rubric is we choose students who are more likely to be primary care and more likely to practice in rural and underserved communities.”
But graduating physicians still need places to do their residencies. Federal legislation, co-sponsored by Sen. John Boozman, R-Ark., would make more money available for residencies nationwide. Introduced in April, the Resident Physician Shortage Reduction Act would lift the cap on the number of Medicare-funded graduate medical education positions and raise the number of those positions by 14,000 over seven years.
A news release about the bill says Arkansas ranks among the lowest states in active patient care physicians per 100,000 persons, and that between one-third and one-half of medical school graduates leave Arkansas for residency training.
Dr. Sherry Turner, an associate dean at ARCOM, has more than a full-time job working with communities to try to establish or expand residency programs. It’s not just money, she said; it’s hard to place a residency program in a county that doesn’t even have a hospital or a training health center.
“These areas don’t have hospitals,” said Turner, who oversees graduate medical education. “As we have known in our state for the last few years, the critical-access hospitals are closing as well. There is not a quick answer to that question.”
Speights said fixing Arkansas’ rural health care problems is a “heavier lift.”
“Most of the residencies exist in more urban areas because you have to have the support system, the curriculum to support them,” Speights said. “It takes more work but you can get residencies into more communities that really need them. We don’t necessarily need more doctors in Pulaski County; we don’t need a lot more doctors in Craighead County. But we need doctors in Phillips, Desha, Ashley, Mississippi [counties]. The list goes on and on.”
Speights was chief medical officer at St. Bernards Healthcare in Jonesboro before becoming dean at NYIT-Arkansas, so he knows the difficulty of recruiting doctors.
He also knows that while in 2015 there were 57 family medicine and 16 internal medicine residencies in Arkansas, now there are 99 and 93. Speights said the medical education industry will have to think of new solutions to the problem of bringing health care to areas that can’t readily afford it.
“It is going to take outside investments to partner with communities to make that difference,” Speights said. “How can we be innovative and forward thinking to fill the need?
“A medical school wasn’t going to fix it. Increasing the residencies isn’t going to fix it just by itself. It is a continuum how you fix health care in the state. There is not a silver bullet that is going to address the entire issue. You can chip away at these individual issues and start making a big difference.”
Turner said she is working with Mercy Hospital in Fort Smith on possible solutions.
“One of the things we can do is some of our larger hospitals could affiliate in a consortium model and work with these small programs so that residents can get out there,” Turner said. “I’m working with Mercy to look at the possibility of putting residents in some of the critical-access hospitals as we expand their family medicine and internal medicine programs.”
Jimenez said it can be a hard sell financially too to get students into rural residencies. A medical student has to make it through four years of college, four years of medical school and then three to seven years of residency, depending on their speciality.
“It is a process, but the problem is so multifaceted that it will take longer than that,” Jimenez said. “People who live in rural communities tend to be older, tend to be sicker and have more medical issues and tend to be poorer. When physicians go out into those areas where there are high levels of Medicare and Medicaid, which doesn’t pay as well as private insurers, you are getting paid less to take care of patients who have complicated medical conditions.”