Population increases in Benton and Washington counties in recent years have made it difficult for the region to keep up with a demand for primary care physicians, health care officials said.
There is one primary care doctor for every 1,787 people in Benton County compared to the state average of one doctor for every 1,562 people, according to a report released in March from the Robert Wood Johnson Foundation.
Arkansas’ ranking
America’s Health Rankings ranked Arkansas 39th of 50 states in 2014 for the population of primary care physicians per every 100,000 people. It states that there are 102.6 primary care physicians for every 100,000 people in the state. The report is released by the United Health Foundation.
Source: Staff report
Washington County fares better with 1,251 people per doctor. It still trails other highly populated counties in the state, including Sebastian County, which has one doctor for every 878 people and Pulaski County, which has one doctor for every 924 people.
Counties ranked in the 90th percentile for health outcomes average about 1,045 people per doctor, according to the report.
Multiple organizations across the state are working to meet the primary care physician demand in Northwest Arkansas, health officials said.
"We are right now in a planning process to develop a vision for the next five to 10 years," said Dan Rahn, chancellor of the University of Arkansas for Medical Sciences in Little Rock.
Residency programs are important to increasing the doctor population in the state, said Mark Mengel, vice chancellor of UAMS regional programs. Most doctors practice within 100 miles of where they do their residencies, he said.
UAMS has 30 primary care residents in Washington and Benton counties, Mengel said. All of the residents spend some time at Washington Regional Medical Center in Fayetteville, Northwest Medical Center in Springdale and Willow Creek Women's Hospital in Johnson.
UAMS has operated the residency program since 1975, Mengel said. The three-year program enrolls 10 new residents per year, meaning there are a total of 30 residents in the program at once.
One of UAMS' goals is to establish an internal medicine residency program in Northwest Arkansas, Rahn said. It's hoped the medical school can enroll six residents in the three-year program in 2016. The program is still being developed so it is uncertain where the residents will practice. There has been some discussion about them working at Mercy Hospital in Rogers, which does not have a residency program.
"It is an opportunity for us in Arkansas," Mengel said. "Unless we have the residency spots our students are going to go outside Arkansas for residencies."
Rosemay Pierre completed the family practice residency program last year. Originally from New Jersey, she decided to stay in Arkansas.
"I had already made friends here," Pierre said. "I decided to stay and practice in the area."
Pierre accepted a job with Washington Regional Family Clinic in Fayetteville.
"There were a lot of people in my graduating class who were not from Arkansas," Pierre said. "They were from New York, Puerto Rico, Mississippi. For the most part we decided to stay in this area."
UAMS' cost of providing a residency to a student is $320,000 per year, Mengel said. About $160,000 of the cost is reimbursed through federal Medicare funding to the hospital providing the residency. Hospitals return the funding to UAMS, he said.
Some Barriers In Place
Northwest Arkansas has some difficulty providing residencies because of a Medicare limit, Mengel said. The Balanced Budget Act of 1997 put a cap on the number of residencies Medicare would cover for hospitals, he said. The cap limited Medicare's spending on the program, helping to reduce the national agency's spending.
Mengel said that meant hospitals with existing residency programs couldn't expand, and new residency programs were only allowed to expand for three years, he said. The cap makes it difficult to keep up with doctor demand in regions that are seeing population increases, he said.
Benton and Washington counties had a combined population of 160,908 during the 1990 United States Census. The bureau estimates the counties grew to a population of 463,113 in 2014.
The area hospitals that have residency programs have reached their caps. For example, Washington Regional Medical Center is limited to 22 residents, Mengel said.
The only other residency program is a psychiatric residency run by UAMS provides two residencies per year, Mengel said. The students can opt to spend their first or fourth year in the program at Northwest Medical Center in Springdale.
"We believe the area could support other residency programs and discussions have occurred about that but the barrier has been the cap on the residency slots at our partner hospitals, which is a significant financial barrier," Mengel said.
Until that barrier is removed it is hard for UAMS to set a goal regarding how many residency slots Northwest Arkansas should have, Mengel said.
Mengel said there is a national movement to lift the freezes placed on residency spots by the Balanced Budget Act.
The Association of American Medical Colleges is one organization that has spoken against the freezes. It states the freezes can cause shortages in certain medical specialties especially in regions in the United States that have seen a rapid population growth.
"It is essential that additional flexibility, in terms of residents trained, be provided to teaching hospitals and medical schools so that they can respond to dynamics inherent in changing populations in medicine," the association's website states.
Mengel said limited federal funding means UAMS must find money elsewhere. One option is to establish programs at hospitals that don't have a cap, such as Mercy, because it has never had a residency program. UAMS could also ask for more money from the state.
Steve Goss, president of Mercy Northwest Arkansas Clinics, said Mercy has been working with UAMS for the past two to three years to establish the internal medicine residency program.
"Given the right circumstances, I think it would be great," Goss said. "We look forward to making it happen if we can."
Meeting Demand
Mercy also has been trying to meet the need of primary care physicians in the area through recruitment, Goss said. Mercy added 31 new advanced practitioners and doctors to the area in 2014, he said. A majority work in the primary care setting, he said. Another 14 have been added this year and it's planned to bring in another 16, he said.
"With the growth here in this area we will still likely be behind as soon as any of those folks have been here for a year," Goss said. "Our doctors are busy across the board and people are always trying to get in" to see doctors.
Goss said the best way to recruit doctors is to provide a level of care that doctors want to be a part of.
"We have to market and be nationally competitive," Goss said. "Updated facilities and equipment are a part of it, but we also are looking for those that want to be a part of and contribute to our culture."
Many times this means a trip to the region to understand what Northwest Arkansas can offer, Goss said.
Health-care providers in the region must look for alternative ways to meet the demand, Goss said. This means creative strategies such as extending hours at clinics, he said. For example, several Mercy clinics have started offering early morning walk-in hours.
Goss said some doctors are working longer hours to accommodate more patients. Other doctor's offices are being creative with scheduling to better meet the needs of the community, he said.
Northwest Health System CEO Sharif Omar said the hospital system has also been working on recruiting doctors to the region. In the past two years, the health-care provider has recruited about 20 primary care physicians and nurse practitioners.
"The health care systems recognize that we are behind," Omar said. "I think everyone is dedicated to making sure there is enough providers in the market."
Northwest clinics have also expanded hours, Omar said. Northwest Medical Plaza at Pinnacle in Rogers expanded to 8 a.m. to 8 p.m. seven days a week.
The facility was opened as a traditional clinic, said Pat Driscoll, Northwest Health Systems spokesman. It was expanded this year to provide urgent care services for walk-in patients, she said.
Primary care physicians aren't the only concern for the region, Goss said. Health-care providers have to add more hospital beds, specialists and equipment to serve the additional patients brought in with every new primary care provider, he said.
"We have seen some information that would say based on the growth in the area over the next 10 years there will be the need to have another hospital the same size as Mercy," Goss said. "That is very unique in the country. Hospital beds are not quick to be built and not easily built. It is a good challenge to have, but a challenge nonetheless."
Teresa Moss can be contacted by email at tmoss@nwadg.com or on Twitter @NWATeresaM
A Section on 04/20/2015