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Supply Lags Demand for Osteopathic Residencies

6 min read

Two new osteopathic medical schools preparing to open in Arkansas aim to address the state’s shortage of primary care physicians, but the pipeline of required residencies may be too narrow to handle a flood of new medical school graduates beginning in 2021.

Dr. Dan Rahn, chancellor of the University of Arkansas for Medical Sciences, said the approximately 215 residency spots that come open each year in Arkansas won’t be enough for the 187 M.D. graduates UAMS produces each year plus the 265 annual D.O. graduates expected from the two osteopathic schools.

“So to have residency program capacity for this number of graduates really requires a very significant expansion,” Rahn recently told Arkansas Business. “That is an increasing problem nationally.”

The New York Institute of Technology will lease space on the campus of Arkansas State University in Jonesboro and is on track to start teaching its first class of 115 osteopathic students in the fall of 2016.

Construction of Fort Smith’s Arkansas College of Osteopathic Medicine is expected to be completed next July, according to Kyle Parker, CEO of Arkansas Colleges of Health Education, which is doing business as ACOM. Instruction of 150 students could begin there in the fall of 2016 or 2017, depending on approval from the Commission on Osteopathic College Accreditation of Chicago.

Administrators of the osteopathic school, however, say they are working to create more residency spots in the state.

“We already have 66 new residency spots approved,” said Dr. Barbara Ross-Lee, NYIT’s vice president for health sciences and medical affairs. When the Jonesboro location opens, she also will have the title of site dean.

“We expect we’re going to have two, three times that many,” Ross-Lee said.

Parker also wasn’t concerned about the lack of residency spots and pointed to Mercy Fort Smith’s recent announcement that it is working to add a total of 75 residency slots for two different programs, family medicine and internal medicine.

Parker said he’s working on adding residencies at other hospitals.

For the American Osteopathic Association, the shortage of residencies is a real problem and isn’t limited to Arkansas.

“We are absolutely concerned by the current number of residency positions,” Boyd Buser, president-elect of the AOA, said last week in a statement to Arkansas Business. “With growing class sizes and new medical schools, we are addressing the nationwide physician shortage — especially in primary care. However, the U.S. physician supply cannot increase without increasing the number of residency positions. We need and support policies that address both training capacity and funding.”

Match Day

Match Day, the day in March when medical students learn where they will be paid to train as residents for the next three to seven years, wasn’t a landmark day for the 13 UAMS students who didn’t find a match. Five students have since found residency programs, but eight were still without residencies last week, according to UAMS.

“You can’t sit for the boards until you’ve completed residency training,” Chancellor Rahn said. “Every state requires some level of graduate education and residency education in order to be eligible for a license.”

Without a residency, medical school grads are in a holding pattern. Meanwhile, they have to juggle their medical school loans, which are typically more than six figures.

“It’s a real problem,” Rahn said. And not just for UAMS students.

In 2015, 41,334 medical graduates applied for 30,212 available first-year and second-year residency positions, according to a March 2015 news release from the National Resident Matching Program of Washington.

Nationally, 93.9 percent of M.D. graduates and 79 percent of D.O. graduates applying for first-year positions were matched, the news release said.

The American Association of Colleges of Osteopathic Medicine, however, disagreed with the NRMP’s numbers. It said that 99.4 percent of all osteopathic graduates matched this year. The NRMP didn’t including all possible positions, the AACOM said.

Before the Commission on Osteopathic College Accreditation approves an osteopathic medical school, the school must demonstrate a growth in residency positions, said Dr. Stephen C. Shannon, the president and CEO of the American Association of Colleges of Osteopathic Medicine.

“So no school is being approved … without that analysis being done regarding residency positions for graduates,” Shannon told Arkansas Business last week.

Still, the Missouri Association of Osteopathic Physicians & Surgeons was so concerned about the limited number of residency spots that it declined in May 2014 to give NYIT a letter of support for the Jonesboro location.

“Our organization has significant concerns regarding the lack of training sites nationwide, not only for students, but also for postgraduate training,” said Brian Bowles, executive director of the Missouri association. He made the statement in an email to George Mychaskiw II, a consultant to the Jonesboro campus of the NYIT College of Osteopathic Medicine. Jonesboro is less than 60 miles from the Missouri border.

In the email, which ASU released in response to a Freedom of Information Act request, Bowles also said that Missouri’s two colleges of osteopathic medicine were sending a “significant numbers of students out-of-state” for their residencies.

“While we appreciate your efforts to establish new osteopathic programs, our Board does not think it [is] in the best interest of the profession to continue to establish new schools with the obvious lack of osteopathic postgraduate training sites, as well as the inability to currently keep all of our osteopathic medical students in-state for their rotations.”

(See: Emails: Osteopathic Association Opposed Jonesboro Location)

NYIT Plans

As the 86,188-SF Wilson Hall on the campus of ASU in Jonesboro undergoes $12.6 million in renovations, NYIT’s Ross-Lee is working on adding more residency spots.

“All of us have to be creative in this constrained environment,” she said.

She said that she has reached out to small- and medium-sized hospitals that haven’t been involved in graduate medical education programs to see if they would be interested.

With the smaller hospitals, “we provide them with the faculty development support,” Ross-Lee said. “And we do it in a consortium fashion. So we’re able to bring hospitals together that don’t have all of the resources, but we can provide it for a group.”

(See: Economic Benefits Touted for Osteopathic Locations)

And the plan seems to be working. She said she is working with at least 15 hospitals in the region, including some in Tennessee and Mississippi that are interested in starting residency programs.

“Many of these hospitals have never been involved in residency training programs, and based upon that, they can qualify for Medicare funding” to offset the cost of the resident, she said.

The estimated total cost of a UAMS family medicine resident is about $300,000 per resident, of which half is paid for by billing patients, while half comes from other sources, including the Centers for Medicare & Medicaid Services.

Shannon, of the American Association of Colleges of Osteopathic Medicine, said the Balanced Budget Act of 1997 capped the federal funding for a number of residency positions at hospitals.

“However, the cap does not apply to hospitals that did not have residency training prior to that time,” Shannon said. “So a lot of growth, especially among the osteopathic programs, has occurred in hospitals beginning to do medical education.”

Parker said that in addition to working with Mercy’s Fort Smith on its residency spots, he’s working with other hospitals, but he declined to say which ones. He added, however, that those hospitals aren’t facing the caps placed on them by the Balanced Budget Act.

“We feel very comfortable that all of these graduates will be able to find a home here in the state of Arkansas,” Parker said.

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