LITTLE ROCK — Wanting to guard against the chance of bad doctors operating on Arkansans, Gov. Mike Beebe suggested possibly allowing the state's medical school to waive geographical quotas when judging applicants.
"Certainly you have to recognize and acknowledge that diversity should exist so long as it doesn't adversely impact the quality of the product that we're going to put out there to work on our bodies or our minds," Beebe said Wednesday in an interview.
Medical schools in other states contacted by the Arkansas Democrat-Gazette said later that they have no geographical quota system in law, or as a matter of policy, such as at the University of Arkansas for Medical Sciences in Little Rock.
"It would be difficult to come up with a [quota] formula if [Iowa] wants to admit its best applicants," said Judith Lehman, admissions coordinator at the University of Iowa College of Medicine.
Arkansas law requires that each of the state's four congressional districts evenly split 70 percent of the first 150 slots in the first-year medicalschool class. That works out to a minimum of 27 freshmen from each congressional district.
Legislators discussed the topic at a meeting last week. Some wondered whether the law is keeping high-qualified students out of UAMS and whether the practice is meeting its purpose of providing rural Arkansas with doctors.
Beebe said "my approach" would be a "safety net" to allow UAMS to be exempt from the congressional district quota if adhering to it would mean admitting below-standard applicants.
"If the facts reflect that [UAMS is] running a risk in admitting people through the quota system who qualification-wise run a risk to the public, then [the law] should be changed," he said.
But the governor said he hasn't thoroughly studied the issue to be convinced that's the case. He said if UAMS is satisfied that the system isn't leading to low-quality medical-school graduates then the law should stay as it is.
Last week, Tom South, director of admissions at UAMS, told a legislative committee that the school was struggling to meet the law because it has gotten so few applicants from the 1st District in eastern Ar-kansas and from the 4th District in southern Arkansas. He said the school must raise the admissions rankings of some rural students to meet the law's setasides.
Debra Fiser, dean of the College of Medicine at UAMS, said Wednesday that her school is "absolutely not" admitting doctors who could be a danger to the public.
"We are very careful not to enroll students that are not able to do the work," Fiser said. "We have been very fortunate to have an applicant pool that could support that."
But, she added, "We are at the mercy of the applicant pool." She said there is no guarantee that in the future the law might force UAMS to accept students who don't belong there.
"We would welcome the flexibility [to be exempt from the quotas] should we have a need for that," Fiser said.
In preparation for the 2009 legislative session, she said UAMS will work on producing data to indicate whether the law is successful in leading students to return to their homes to practice. She said that's something UAMS hasn't been tracking.
Once the data are compiled, UAMS will develop recommendations on how to change the law, she said.
One legislator suggested last week that students with poor grades may make the best doctors and that rankings by admissions committees may be artificial.
Fiser said there is "no gold standard" to judge doctor performance so she can't say how well applicant rankings dictate future doctor quality. But, she said, the school takes into account the "whole person" including gradepoint average, standardized test scores and letters of recommendation, among other things.
Dr. Robert Sabalis, associate vice president of the American Association of Medical Colleges, said it would be "uncommon" for medical schools to have a geographical quota system for in-state students. But the association hasn't surveyed medical schools on that question.
Arkansas is one of 19 states that have only one medical school.
Admissions officials at the medical schools in Mississippi, Iowa, Oklahoma, Washington, Colorado, New Mexico, and Indiana said they have no geographical quotas.
Lehman at the University of Iowa said trying to get doctors to practice in rural areas by making sure that certain areas are represented in medical school may be premature.
"It's where you conduct your residency where you are most likely to practice," she said.
Henry Sondheimeyer, associate dean for admissions at the University of Colorado School of Medicine in Denver, called Arkansas' quota law "interesting" and said he's never heard of anything like it.
Colorado is overwhelmingly rural so the large majority of the medical school's 156 first-year students come from the Denver area, he said. The number of "truly rural kids" varies year to year, he said. Sometimes, 35 or 40 are admitted, and one year there were only about 15, depending on the applicant pool.
At the University of Oklahoma in Oklahoma City, the admissions committee must have members from each of the state's congressional districts but "there are no acceptance requirements" for students from certain areas of the state, said Dotty Shaw Killam, admissions director at the school.
Marlene Ballejos, admissions director at the University of New Mexico in Albuquerque, said, "I don't know if a quota would help because we get so few applicants from rural communities."
But Cindy Turnage of theUniversity of Mississippi School of Medicine in Jackson, said a quota isn't necessary because "right now we get plenty of applicants from all over the state."
Patricia Fero, director of admissions at the University of Washington in Seattle, said the only geographical set-asides her school has is from four states without medical schools - Alaska, Montana, Idaho and Wyoming - that have "bought" positions for students from their states.
She said first-year medical students from those states and from eastern Washington study at satellite campuses in hopes that they will "become attached to those areas and go back" to practice. All students study in Seattle starting with their second year.
Despite the lack of a formal quota, Fero said some students are given preferences informally during the application process if they come from areas where there have been few applicants.
One student from central Arkansas said Wednesday that she felt like she was being discriminated against by the Arkansas law.
"I think it's absolutely not fair," said the woman who asked that her name not be used because she has reapplied at UAMS. "I don't understand how this is legal."
The woman said she was rejected by UAMS, despite having a high grade-point average in college and experience working in the medical profession. She acknowledged that her score on the MCAT, the standardized test formedical school, was "mediocre" but, she said, she believes that she would have been admitted if she lived in south Arkansas.
She said she knows one Little Rock man who had to get his medical degree from a college in the Caribbean because the geographical quotas kept him from getting into UAMS.
Beebe, a lawyer and a former attorney general, said he didn't see any constitutional problems with the congressional district quotas.
"There is a rational basis for it - geographical diversity," he said. "You're not discriminating based on race or sex or age. You can discriminate [based on geography] if there is a rational basis for it."
According to UAMS, the only congressional district that had more than the minimum number of freshman students was the 2nd District in central Arkansas.
Fifty-three freshmen were admitted from the 2nd District, up from 47 in 2006.
But the other three districts had 27 admitted each, which was less than in 2006.
The number of applicants declined from 2006 to 2007 in the 1st District, in east Arkansas, (56 to 50) and in the 4th District (74 to 61).
The number of applicants increased in the 2nd District (103 to 123) and in the 3rd District (51 to 62).
Congressional district quotas in Arkansas law, found at Arkansas Code Annotated 6-64-406, have existed since at least 1967 when the first 75 medical-school slots were set aside to be dividedby the districts.
In 1977, the quotas were enlarged to the first 70 percent of the entire class.
In 2007, a change limited the quotas to the first 70 percent of the first 150 students of the 160 admitted each year.
The Arkansas Medical Society doesn't have a position on the quotas, said David Wroten, the group's executive vice president.
"What I can tell you is that policy is many, many, many years old and should be discussed like any policy that's several years old," Wroten said. "Anecdotally, [doctors ask] all the time, 'Are we getting the best, the mostqualified students into medical school?'"
He said he doubts that the law is leading to many doctors practicing in rural Arkansas.
"We've had the policy for how many years now and we still have a large shortage of health-care providers in rural areas," Wroten said.
Front Section, Pages 1, 5 on 10/25/2007