NORTHWEST ARKANSAS (KNWA/KFTA) – Texas is one of a number of states facing a doctor shortage — with 8.8% of the U.S. population, it has 7.3% of the nation’s active physicians, according to the Texas Medical board. Another state, Arkansas, is exploring a solution to its own doctor shortage.

As Northwest Arkansas and the River Valley continue growing, so is the area’s need for healthcare workers. But without action, the disparity between the number of physicians and the number of patients that need care is expected to continue climbing.

An Arkansas Hospital Association report estimates that in four years, cities like Fayetteville, Springdale and Rogers will only have a fraction of the physicians they need. Specialties like radiology and optometry are facing some of the largest gaps, with the workforce expected to reach only two-thirds of the area’s demand.

“We’re at a deficit now of health care providers locally,” said Northwest Arkansas Council’s Ryan Cork, who focuses on health care for the council.

“And that deficit will only get deeper and deeper if we don’t act.”

A growing region, and a growing problem

While health care worker shortages are widely reported nationally, Cork says Northwest Arkansas’ growth makes addressing this need uniquely challenging. The Northwest Arkansas Regional Planning Commission estimates that the area’s population is expected to nearly double over the next two decades.

“Our need for the health care to grow at the same pace, and in some cases outgrow our resident’s pace, is there today,” Cork noted.

Cork says the region already loses its patients, and potential long-term residents, to other states with the capacity to provide more specialty care. It’s a shortage recognized by Stephanie Gardner, the Chief Strategy Officer and Provost for the University of Arkansas for Medical Sciences.

“About 11% of cardiac procedures are being done outside the region,” Gardner said. “That’s a lot of care.”

Gardner also worried about what impacts the age of the state’s current physicians will have on this shortage. In 2020, an Arkansas Department of Health report said the average age of all primary care physicians in the state was 58.

“So we may see before it gets better,” Gardner warned. “We may have a period of time when it’s even tougher to fill the need.”

And during this period of need, patients traveling for care are costing the state. For Northwest Arkansas alone, an NWA Council report estimates the region loses almost $1 billion to patient migration. Addressing the area’s physician shortage, Cork suggested, would not only help the area’s patients but the local economy.

“So even if you carved out some of that travel cost and went from $1 billion to $500 million. That’s still an additional injection of $500 million annually into our local economy of individuals that already live here,” Cork said.

A path forward

While there may not be a silver bullet that fixes all regional and statewide doctor shortages, everyone KNWA/FOX24 spoke to agreed on one major path forward: keeping more of the state’s medical students in Arkansas by expanding residency programs.

“If the training doesn’t exist,” Gardner said, “they leave the state.”

Cork says this is already happening. He pointed to 2021 when Arkansas graduated 200 more medical students than it could move into residencies.

“And so right off the bat, regardless of if you wished to stay, there wasn’t a spot for you to stay. And so, we were then shipping 200 young physicians that graduated medical school out of state,” Cork said.

Gardner said whether medical residents come from out of state or from the state itself, they usually prefer to stay, and this belief is supported by data.

According to the Association of American Medical Colleges, medical residents end up practicing in the state of their residency over 50% of the time. That’s something the current Vice Dean of Graduate Medical Education at U.A.M.S., Dr. Molly Gathright, experienced personally.

“I felt the need to give back to a state that really had invested in me,” Gathright said.

The Dean of the Arkansas College of Osteopathic Medicine in Fort Smith, Dr. Rance McClain, said keeping medical students like this in the state through residencies is a more consistent strategy than recruiting doctors from other states.

“That’s so much harder to do versus a student that has been educated here and already knows all the values that come with living in Arkansas,” McClain said. “How much of a work-life balance you can have, all of the resources that are available, and all of the benefits that people who are from here know about.”

Roadblocks to residencies

While residencies may display promise for healthcare providers trying to keep up with rapid population growth, Gardner and Gathright say they’ve learned first-hand that the cost of establishing these residencies is a significant barrier.

“We can’t just wave our hands or our magic wand and say, ‘Poof, we need a new residency program,'” Gathright said.

The amount of money it costs a hospital to train a residency varies on things like location, salary, and specialty. For example, the Alliance for Academic Internal Medicine estimates that internist residencies cost hospitals around $183,000 per year, per resident. The Society of Teachers of Family Medicine published a study that said family medicine residencies cost hospitals a median of $179,000 at the same rate.

Gardner says it’s through the federal government’s support that UAMS can afford resident training. The Centers for Medicaid and Medicare Services, or CMS, reimburses hospitals for the residencies they take on, but only up to a certain cap. And after five years of a hospital’s initial growth, that cap is locked in, regardless of how much the hospital continues to scale.

“So hospitals such as UMass, or in Northwest Arkansas, Washington Regional Medical Center have had caps established many years ago in the nineties,” Gathright said, “and that kept those hospitals typically from adding more residents to their growth.”

Uncapping our state’s residencies

With these residency caps set decades ago for many of the state’s bigger hospitals, healthcare leaders are getting creative.

Gardner says UAMS has been assuming the cost for residencies that exceed their cap.

Washington Regional Medical Center was reclassified as a rural hospital to get its cap re-evaluated. While this can’t be repeated, the result was 92 more residencies. Cork says this is opening several new doors for training.

“Now, we’re starting internal medicine residency programs. We’re going to start neurology. We’re going to start emergency medicine. We’re going to look at having general surgery.”

As hospitals look for funding sources beyond the federal CMS, Arkansas State Representative Dr. Lee Johnson said he created a program in 2019 to help distribute residency funding throughout the state. He said he hopes the infrastructure helps incentivize future investment in state residency programs.

“The challenge has been trying to find funding to launch that program,” Johnson said.

“I’m hopeful that this legislative session we’ll be able to find some funding to try and start that ball rolling,” he continued.

Johnson, the chair of the state house Public Health, Welfare, and Labor Committee, argued that whether the money comes from state or federal funds, investments into Arkansas’ residency programs pay off in the long run.

“There are initial startup costs for a research program. It costs about $2 million in initial startup costs to get a residency program with eight residency slots up and running. But over time, as those residents grow their practice, right, and as they become mature, that residency program can pay for itself.”

Johnson is also calling on the federal government to raise its cap on how many residencies the CMS supports. U.S. Sen. John Boozman, R-Ark., says he agrees that creating more residencies should be priority.

“We’re partnering with other senators and other areas to flatly increase the amount of graduate medical education slots throughout the country,” Boozman said.

The senator also teamed up with U.S. Sen. Jacky Rosen, D-NV, in 2022 to introduce a bipartisan bill that changes how the CMS redistributes the residency slots given to closing hospitals. While the bill, the Physicians for Underserved Areas Act, has yet to pass, he said he’s optimistic this will be one of several federal initiatives that will keep medical residents in the natural state.

“All of these things work together. And the good news is that I think that we are in that process working very, very hard. And as a result, it’s going to pay off in the future.”

A future solution for a current problem

As Arkansans wait for new residencies to make an impact on the state’s physician shortage, Boozman acknowledges the aging workforce poses a more immediate threat.

“So not only do we have a problem now, but that problem is only going to be exacerbated,” Boozman warned.

New residency programs take years to establish. Washington Regional has until 2030 to fully integrate the 92 residency slots it was granted, and future residency programs could be even further out. Once these programs are underway, it still takes several more years before medical residents become practicing physicians.

Cork acknowledges that it may take some time for residents to feel the changes this focus on residencies may bring.

I believe it’s one thing to say, ‘Hey, I hear you,’ and then not do anything. But here we are saying, ‘Hey, I hear you,’ We also are doing something in that we have a plan.”

For Arkansans, waiting for access to the care they need, the results of that plan can’t come soon enough.

This in-depth series was made possible in part by a grant from the Solutions Journalism Network.