Shared from the 5/6/2019 Arkansas Democrat-Gazette eEdition

Doctor shortage raises wait times for rural areas

Constant effort, planning, some fortunate circumstances and characteristics of the local population have all helped Northwest Arkansas’ largest cities keep pace with expanding need for primary care physicians — so far, health care providers say.

Still, the region is not immune from a nationwide shortage of physicians for an aging baby boomer population.

“It is a growing crisis on the horizon,” said Dr. Linda L.M. Worley, associate dean of the College of Medicine at the University of Arkansas for Medical Sciences’ campus in Fayetteville. That crisis has reached outlying rural communities in the region and state, Worley and other health administrators say.

According to a 2016 survey cited by UAMS Northwest, 20.2 percent of Benton County residents have no regular doctor. The figure for Washington County was 17.6 percent, for a total of about 68,000 people who do not see a doctor or other health care provider regularly.

The Veterans Health Care System of the Ozarks approved a higher compensation package for primary care physicians in April, associate director Birch G. Wright announced at a meeting last month. Yet the veterans system, on average, has waiting times for an appointment with such doctors that are as short or shorter than local clinics and hospitals, he said.

Primary care physicians take care of most health problems and recommend patients to specialists when needed. A new patient can get an appointment with a primary care doctor for a general checkup within two weeks at the veterans system’s main campus in Fayetteville, according to figures given by Wright. But getting the same appointment earlier this year at the clinic in Ozark in Franklin County could have taken twice as long, according to the Veterans Affairs figures. Those figures are improving, though, Wright said. As of the latest tally by the department, a wait time for a new appointment in Ozark is down to no more than 21 days.

The difference between getting an appointment in Ozark or one in Fayetteville illustrates the difference between health care in a metropolitan area and a rural one, Wright said.

The veterans system has the option of referring its patients to outside clinics and does so if a patient requests it. The system has found, in general, that it can rarely get an appointment with outside clinics any faster, according to Wright.


The key bottleneck in the supply of doctors is the number of residency slots available, according to Wright, Worley and others. There are more medical school graduates than slots available nationwide, each said.

In that respect, Northwest Arkansas is lucky to be able to start a new residency program at Mercy Health in cooperation with the veterans system and UAMS Northwest, Worley said. Wright agreed the program at Mercy is already a major help.

A medical school graduate must spend at least three years, depending on the specialty, in a supervised residency before becoming a licensed doctor. The federal government pays 90 percent of the costs of most medical residencies, Worley said. But in a cost-saving measure, Congress capped the number of residents it would pay for. The gap between the number of medical school graduates and the residencies they can go into — and the number of doctors needed — has grown ever since the cap was imposed in 1997, she said.

One exception to the cap, though, was for hospitals that never had a residency program before, Worley said. Mercy Northwest’s hospital in Rogers was able to start its new program in 2016 and announced its expansion on March 12. The expansion will begin on July 1 and allow a total of 11 positions a year for a total of 33 doctors in training at a time by 2021.

Mercy Northwest also announced expansion plans when it announced the residency program in 2016. Those plans include a $40 million clinic in Springdale. All that was part of a $247 million expansion plan announced that year.

“It’s not a dead run, but we’re always jogging,” said Dr. Steve Goss, president of Mercy Clinic Northwest Arkansas, about recruiting doctors to the region.

“Northwest Arkansas is growing, but the things that make the region attractive to everybody else makes it attractive to doctors, too,” Goss said. “That has made recruitment easier, which is important because recruitment is a nationally competitive environment.”

Wright is correct about how recruiting doctors into rural Arkansas is a much greater challenge, Goss said. Mercy operates a hospital in Berryville.

“So far we’ve had good success in recruiting there, but that is largely due to it being only an hour away from everything you can want here in this part of the region,” he said. “Recruiting in rural areas: That is a different ball of wax.”

The contrast is even greater between Northwest Arkansas and much of the rest of the state, such as east Arkansas, said Dr. Chris Westfall, dean of the College of Medicine at UAMS in Little Rock.

“Arkansas has 61 family practice physicians per 100,000 people,” Westfall said. “The national average is 73 per 100,000, and the top 10 percent of the country has 88 per 100,000.”

Westfall also said medical residencies were the biggest bottleneck in the supply of doctors.

“When you look at the pipeline, the medical school portion is pretty wide,” Westfall said. “The residencies are the narrow part.

“The thing about the Northwest region is that Washington Regional [Medical Center in Fayetteville], the veterans hospital and everyone else there have been working pretty feverishly to keep up.”

The growth means a generally younger, healthier population than in much of the rest of the state and nation, said Denten Park, Market CEO for Northwest Health. Northwest Health operates hospitals in Spring-dale, Bentonville, Siloam Springs and Johnson.

“Another aspect of that is that the younger generation is not aggressively pursuing health care,” Park said. That will have long-term consequences someday, he said. “We want them to get preventative care, but right now they are young and think they are invincible.”

Jason K. Wilson is CEO of Medical Associates of Northwest Arkansas, an independent physician group based in Fayetteville. His group has been able so far to recruit physicians, but the biggest challenge has been in specialists, he said.

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