HJAR Sep/Oct 2022

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2022 13 infrastructure, there are efforts underway to change that. Editor There’s a lot of lofty talk in health- care, but what do you think actually needs to be done to move those grades up to an A — not just by region, but nationwide to compete? Smyth There are a number of large structural things that need to occur, one of which is really reenvisioning howwe pay for health- care — thinking about putting systems in place that reward for quality and outcomes and not simply for numbers of procedures or services that are provided. That’s work that is a little bit further along in different parts of the country than necessarily here in Arkansas as a state, but it’s work that is going on inArkansas and is being driven by the groups and systems that pay for health- care. Fundamentally, we need to have a sys- tem in place that rewards for outcomes and that incentivizes keeping people healthy rather than simply for the number of pro- cedures or visits or some other arbitrary measure that isn’t really a measure of an outcome or quality. Editor Do you think there are enough future MDs in the pipeline to cover the anticipated needs in the U.S. and in Arkansas? Smyth Certainly, the experts forecast some- thing of a physician shortage. Some of that is probably having the physicians trained in the right areas and having them practice in the right locations. That’s always some- thing that is hard to manage in a free mar- ket, because, of course, people are able to train in whatever specialty they want and practice in whatever location they want. That results in our having more physi- cians in highly populated areas and less in, for example, rural areas. In recognition of the fact that, certainly, we inArkansas need more physicians, particularly more pri- mary care physicians that are located out in our rural communities, we have had a dramatic expansion of the number of resi- dency training physicians that we are spon- soring as UAMS and have started a couple in particular that really are focused on rural training tracks. This is work that a number of the other healthcare organizations across the state have also engaged in, so there are a num- ber of hospitals that have expanded their primary care residency spots as well. Alto- gether, I think, as these spots are open, are filled, and are graduating physicians, it will go a long way to addressing some of our needs here in Arkansas. Editor What is the residency match rate at UAMS College of Medicine? Smyth Virtually all of our students match or go through what we call the SOAP process either in the primary match or the SOAP match, so we’re talking about single digit medical students who don’t find a spot. Editor Are there enough residency pro- grams in Arkansas for graduates? Smyth With the expansion, we are project- ing that there will be as many, if not more, for internal medicine, family medicine, and primary care residency positions that will be added between what we’re planning and what other hospitals have initiated that it should sufficiently accommodate any medi- cal student in Arkansas, and that would include our students in DO programs that are interested in going into internal medi- cine or family medicine. There are currently 1,155 filled residency/ fellowship positions acrossArkansas out of a total of 1,333 that are approved and avail- able. There are currently 185 residency posi- tions in family medicine or internal medi- cine in the state. UAMS has approved or planned an additional 144 residency posi- tions with partners across the state — of these, 66 are in internal medicine or family medicine and 24 are in pediatrics. When in place, we will have just shy of 1500 train- ing positions in the state. Since 2018, 374 approved or planned residency positions have been added. 273 of these were with UAMS-supported initiatives, including part- nership with Baptist HealthMedical Center- North Little Rock. The remaining 111 posi- tions were added by Arkansas College of Osteopathic Medicine in Fort Smith, CHI St. Vincent Hot Springs, Conway Regional, and Unity Health. Adding the training positions is not enough. We have to retain these physicians in Arkansas. The UAMS regional programs have trained 1,425 family medicine physi- cians between 1971 and 2021. Of these, 868 (61%) are still in Arkansas, and 326 (23%) are practicing in rural locations. For the College of Medicine, we are ranked at the 98th percentile nationally for the number of our students that went into family medi- cine, and at the 92nd percentile for those going into a primary care specialty, and at the 93rd percentile for practicing in rural areas. Approximately half of the students that graduated between 2006 and 2011 are practicing in Arkansas (86th percentile nationally), according to the Association of American Medical Colleges. Editor So, if there is a current and expected physician shortage what is stopping UAMS from, say, doubling the number of med students and ultimately physicians coming through? Smyth I’ll start by saying that we have increased our class size. That was one of the first things that I did as dean, and it is really tied with our four-year campus in North- west Arkansas. Last week, for the first time ever, we had all four years of medical school in Northwest Arkansas at our Fayetteville campus. Historically, we’ve had third- and fourth-year students in Northwest Arkan- sas. Last year, we added first-year students. Those first-year students, this year, became second-year students, and as we welcomed our incoming class, that gave us all four years. We’re anticipating having 20 stu- dents there, so we increased the class size to accommodate that.