New UAMS campus would follow patients.

Medical students are needed in Arkansas stat.

The University of Arkansas for Medical Sciences in Little Rock is hoping to avoid a critical shortage of physicians in the future by increasing the number of medical students.

UAMS Chancellor I. Dodd Wilson said he will lobby legislative committees this fall for money to expand the number of students UAMS can graduate each year from about 150 to 195. The total student expansion project expected to cost about $14 million, and Wilson said UAMS will need about $6 million more from the state once the program is fully running, which could be in 2008.

Wilson wants to establish a northwest Arkansas campus to handle the extra students. For the first two years of medical school, future doctors would be taught in Little Rock. But some students would be sent to northwest Arkansas for their third and fourth years to work with physicians in residency at hospitals there.

"We just don't have the clinical sites to educate them here in Little Rock," Wilson said. "Northwest Arkansas is part of the state, and they're going to need physicians."

And, he added, "There's an opportunity for philanthropic support up there."

Some of the state's biggest philanthropic organizations are located in northwest Arkansas, including the Walton Family Foundation of Bentonville.

"It would be much easier for me to stay at 150 [graduates] at the medical school and not grow, but it's not the right thing to do for the state of Arkansas," Wilson said.

Wilson said he's not sure what size building he would need for the new campus.

To get the program off the ground, though, Wilson said UAMS--the state's only comprehensive academic health sciences campus--needs to expand the residency program in northwest Arkansas. And that could require congressional intervention to lift a Medicare restriction on the number of residency spots a hospital can have.

Currently, Northwest Medical Center at Bentonville and Washington Regional Medical Center in Fayetteville together are only allowed 25 residency positions that Medicare will pay for. Wilson said each hospital would need about 40 residency positions.

The Fayetteville VA Medical Center also is interested in starting residency programs, he said.

Some legislators have already bought into the idea of a northwest Arkansas campus for UAMS.

"I think it's a great investment," said state Rep. Jay Bradford, D-Pine Bluff. "I think the Legislature and the governor will see that clearly. I don't consider (the increase in funding) that major a problem because it's ... money well spent."

State Sen. David Bisbee, R-Rogers, said he knows the need for doctors is becoming critical.

"The question is ... do we want doctors or not?" he said. "If you want doctors, you're going to have to bite the bullet and do it."

UAMS recently announced a $255 million expansion, but that won't add more doctors to the state, Wilson said.

The centerpiece of that project was replacing the aging UAMS hospital with a new, 500,000-SF facility. The work is expected to be completed in 2008.

"I don't see that we'll have much more room in our hospital to educate more medical students because we're not expanding the university," Wilson said.

Shortage

The Association of American Medical Colleges in Washington, D.C., predicts the nation will face a shortage of doctors in the next 10-20 years. It has called for medical schools to increase enrollment by 30 percent over their 2002 levels by 2015.

"A shortage of U.S. doctors would have a profound impact on all Americans by affecting access to quality health care, especially for the underserved who already encounter substantial barriers when seeking care," AAMC President Jordan J. Cohen said in a news release in June. "Given the extensive time it takes to educate and train tomorrow's doctors, efforts to increase enrollment must get underway as soon as possible to ensure that the health care needs of the nation in 2015 and beyond are met."

The expanding U.S. population, which is increasing by about 25 million people each decade, and the aging baby boomers are expected to strain the health care industry.

"By 2025, it's estimated that (Arkansas will) be fifth in the country in terms of the percentage of our population that's over 65," Wilson said. "So we're going to need a lot of health care here."

To make matters worse, about a third of doctors nationwide are older than 55--nearing retirement age.

By 2020 the shortage of doctors nationwide is estimated to be somewhere between 85,000 and 200,000, and U.S. medical schools currently only graduate about 16,000 new physicians each year.

One hurdle in enrolling the extra students is finding money to add classes, said Edward Sallsberg, director for work force studies at AAMC.

"States have been facing financial constraints over the last couple of years, so we recognize that it's not easy for a state at this time to increase its investment in medical schools," Sallsberg said.

Arkansas already doesn't have enough doctors. Arkansas is ranked 48th in the country with about 180 doctors per 100,000 people. The national average is 245.6 per 100,000, according to the AAMC.

The good news is that almost 60 percent of the doctors who graduate from UAMS stay in Arkansas, giving the state the third-highest percentage in the country of new doctors who stay in the state where they went to medical school. Nationwide, a state's retention of medical school graduates is 39 percent.

Student Life

In the 1980s, health care officials thought there would be a glut of physicians, so medical schools' class size didn't grow. The number of applicants also stalled, as careers in business have become more attractive than the long years of medical training.

Now the applicant pool is about the same as it was 15-20 years ago, which won't be enough to find qualified applicants to have 195 UAMS graduates a year, Wilson said.

To boost enrollment, UAMS will have to start courting out-of-state students--something it can't do now because of a residents-only restriction in state law.

"There's not another medical school in the country that doesn't at least look at out-of-state students, [but] by law, we can't," Wilson said.

Rep. Bradford agreed that the enrollment process is going to have to be changed to attract more students. UAMS will still favor enrolling Arkansans, though, Wilson said.

Legislators

State Rep. Horace Hardwick, R-Benton, agreed that Arkansas is going to have to increase enrollment to UAMS and said it makes sense to add a satellite campus.

"We're going to have to do something," he said. "It's just a matter of where we're going to do it."

Bisbee said a UAMS location in northwest Arkansas is going to be necessary.

"The question is, does Arkansas want to supply enough doctors for ourselves or not?" Bisbee said. "And if we do, the next-best patient base outside of central Arkansas is northwest Arkansas."

Bisbee said he didn't think offering coursework in northwest Arkansas would be particularly costly. But he said the new campus can't be perceived as a northwest Arkansas medical school if the idea is being sold to the Legislature and the public.

"We don't perceive the med center in Little Rock as being a central Arkansas medical school," Bisbee said. "Our doctors have gone to medical school down there forever, and nobody thought anything of it. That's where the patients were."

Rural Arkansans have to believe that they will benefit from the campus expansion by eventually seeing more doctors in their area.

"If they're not going to get doctors, why do they want to pay for city folks to have doctors?" Bisbee said.

By Mark Friedman

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