Fewer than half of area medical school graduates are matching with residencies in Arkansas, but the state still does well in retaining its graduates as physicians, University of Arkansas for Medical Sciences and Association of American Medical Colleges data show.
In this year's match with residency placements -- an annual process that concludes in March -- 72 of 160 UAMS College of Medicine seniors who matched, or 45 percent of the group, were headed to programs in Arkansas, according to the school's statistics.
That percentage has bounced between 35 percent and 46 percent since 2010, during which time an average of 41.7 percent of those students matched with Arkansas residency programs.
Overall, UAMS data provided to the Arkansas Democrat-Gazette reflect a slight downturn from late in the previous decade, when between 51 percent and 57 percent of graduates matched with in-state residencies.
Of students coming out of what until recently was the state's sole medical program, Dr. Richard Wheeler, UAMS' executive associate dean for academic affairs, said he wants to see "as many people as we can get" in area residencies. The health sciences university has worked hard to expand the availability of nearby options, including 24 new slots that opened at Baptist Health in North Little Rock last year.
But what he often sees is students who depart for residency and then return home to practice.
"Would I like for all of them to stay here? Actually not," he said, pointing to the experience that early-career doctors gain as they see the way medicine is practiced in other places.
"It's not such a bad thing, sometimes, to go away for a little while -- as long as you come back and take care of the folks here in Arkansas," he said.
He didn't find a recent dip to be meaningful, saying the numbers have been "pretty consistent over the years."
Medical students choose residencies -- where they learn a specialty and which are usually the final phase of training -- by interviewing at institutions, ranking choices and being matched via an algorithm. About half of applicants get their first choice.
For health care observers, residency and matching statistics are closely watched because doctors often stay close to the areas where they conclude their education. Nationally, 47.5 percent of doctors were active in the state where they completed that phase of their training, the Association of American Medical Colleges said.
That means robust residency programs act as a medical workforce pipeline.
It's not clear how Arkansas' percentage of medical students matching with local residencies compares with other states. The National Resident Matching Program, a nonprofit group that governs matching, doesn't yet publish a report analyzing data in that way, a spokesman said.
In linking to in-state residencies in this year's match, Arkansas' medical graduating class fell in the middle of some public programs surveyed in neighboring states.
Forty-nine percent of this year's class from Louisiana State University School of Medicine in New Orleans and 54 percent from McGovern Medical School at the University of Texas in Houston are going to residencies in those states, while 40 percent of University of Mississippi School of Medicine and 38 percent of University of Missouri School of Medicine students will begin their training at in-state programs.
Among UAMS medical graduates, Wheeler said, career goals and shifts of interest in specialty from year to year can lead students to pursue programs elsewhere.
Personal reasons, too, play into decision-making for students who grew up in Arkansas, he said.
"You have people that desperately want to stay, and then you have other people that say, 'I've been here all my life.'"
While a minority of medical students wrap up their training at local residencies, Wheeler stresses -- and data support -- that they eventually return in large numbers.
In 2016, the most recent year for which data were available, the Association of American Medical Colleges said that of 4,931 active physicians who attended medical school in Arkansas, 58.5 percent of those doctors were practicing in the state.
It's the nation's third-highest rate of retention. In fact, Arkansas has a higher retention rate among doctors who attended medical school in the state than it has among those who were trainees in its residency programs.
Doctors may return because they're native Arkansans who aspire to practice in their hometowns, said Arkansas Medical Society Executive Vice President David Wroten, or perhaps because they're attracted to state lifestyle features such as its low cost of living.
"Arkansas is a nice place to live," he said. "If you look at areas like Northwest Arkansas and the Little Rock area, they've had a tremendous influx of physicians in recent years. And a lot of those are physicians that went to school right here."
Wheeler said it would be hard to say exactly why so many come back, but he also mentioned family ties and added there is a lot of opportunity in Arkansas for doctors.
He's "really pleased" with how retention numbers shake out over time, he said.
For medical students who wish to pursue residency in the state, the landscape will change over the next two years as two new doctor of osteopathic medicine programs, located in Fort Smith and Jonesboro, graduate their first classes of students.
It's expected to more than double the number of graduates from state medical schools.
Many of those students may match with local residencies, said Dr. Shane Speights, dean of the New York Institute of Technology College of Medicine at Arkansas State University.
School officials say it's a novel situation, and they've had conversations about the prospect of graduates competing for local residency positions, of which there are now about 281. (A handful of the state's spots went unfilled in the main 2018 match, according to the National Resident Matching Program.)
Officials say maximizing the number of residency slots -- as well as funnelling students to those programs -- remains paramount in a state with few physicians per capita.
"The recipe to fix that is twofold. No. 1, you have to have more students graduating from a medical school within the state of Arkansas. And No. 2, you have to have those graduates attending your residency programs within the state," Speights said.
"If you just have one or the other, it's not going to be successful."
Of about 2,300 working doctors who completed both medical school and residency in Arkansas, 80.9 percent were practicing in the state in 2016, Association of American Medical Colleges data tables note.
HOW RESIDENTS CHOOSE
Recent or rising Arkansas medical graduates say the process of choosing their residencies was complex, which sometimes led to their selection of out-of-state programs.
"It wasn't a decision on a whim. It was something I thought very, very long and hard about," said Dr. Grant Cagle, a 2018 UAMS graduate and internal medicine resident at Brown University in Providence, R.I.
"I think to be a really good, well-rounded physician, I knew that I needed to train other places."
The resources available at Brown, its academic environment and the diverse patient population all have been beneficial to his career path, he said, and he's already doing research on pulmonary hypertension and has published a paper.
"If I'd stayed in Arkansas, I don't think I would have had those opportunities," he said.
Dr. Harrison Lowder, a 2019 UAMS graduate, said he interviewed at the school's residency program in pediatrics. But ultimately he matched with a program he ranked more highly, at Children's Hospital Orange County in Orange, Calif.
Lowder, who grew up in Fort Smith, said he loves the state but needed to choose a program that could accommodate his fiancee's career track in comparative biology.
"I'm making all of my life decisions with another person," he said. "I would love to come back, but it all depends on the changing job market for both of us."
Cagle, who was raised in southern Missouri, agreed that he could "definitely" see himself returning to Arkansas, but only if personal and professional circumstances align.
"I would love to have a husband, two corgis, and be a critical care pulmonary doctor at UAMS with a house in the Heights," he said. "That would just be a dream."
The path led closer to home for Dr. Tracy Kaufman, an East End native and 2018 UAMS graduate who is a psychiatry resident at Unity Health in Searcy.
Having previously worked as a sign language interpreter, she went to medical school with the express purpose of expanding mental health care for people who are deaf, which she says historically hasn't been adequate in the area.
"My whole purpose was to help the deaf population in Arkansas," she said. "I definitely interviewed at other places ... but I was very excited that I matched here in [the state] because that was my goal."
She said she felt encouraged by a recent report that found Arkansas to be among the 10 top-earning states for doctors.
The experience of a doctor who didn't graduate from an area medical school bears out the idea that residency can lead to future work as a health care provider in that area.
Dr. John Brandon Allison, an Alabaster, Ala., native and graduate of William Carey University College of Osteopathic Medicine, currently is chief resident at St. Bernards Healthcare in Jonesboro and signed a two-year contract to work there as a nocturnist after residency.
Allison said he's enjoying living in Jonesboro and being near medical schools he can teach in, though he may return to Alabama eventually.
"It depends on what opportunities I'm offered [and] how I like the next two years," he said.
NEW SCHOOLS
With an influx of graduates from new programs beginning in 2020, "I don't know what's going to happen," Wheeler said. "How many of them are going to want to stay here for residency is not clear to me."
As doctor of osteopathic medicine programs, Arkansas College of Osteopathic Medicine in Fort Smith and the New York Institute of Technology College of Medicine at Arkansas State University in Jonesboro have a slightly different emphasis from doctor of medicine, or MD, programs. But because of accreditation changes, doctor of medicine and doctor of osteopathic medicine graduates will soon match into residency programs interchangeably.
Deans at the osteopathic medicine programs also describe their student bodies as slightly more geographically diverse than UAMS, with about 60 percent of Fort Smith and 80 percent of Jonesboro students hailing from Arkansas and its surrounding region.
In Jonesboro, Speights said, the medical school's administration is hopeful that many in its 2020 class will pursue residencies in the state.
As one way to encourage that, the program requires a one-month rural rotation and has third- and fourth-year rotations in Arkadelphia, Mena and Pocahontas.
"We're trying to affect where they go by giving them that experience in their third and fourth year of medical school, in the hopes that they will go to those areas and stay," he said.
One overall goal of the program, Speights said, is getting graduates into practice in the state's small towns and rural areas, preferably as generalists.
Dr. Tony Little, associate dean for graduate medical education at the Arkansas College of Osteopathic Medicine, said he's optimistic that among students in that program's first graduating class, in 2021, "the far majority will find spots in Arkansas" but that some also will filter into the region, including in Oklahoma, southern Missouri, northern Louisiana and east Texas.
He said talks are underway regarding partnerships between the Arkansas medical schools to try to get some new residencies going within the state.
That process can take up to three years for full accreditation -- "It's not a sprint to do this," he said -- and generally requires one institution to take the lead.
Little said CHI St. Vincent Hot Springs or a rural health residency track involving a partnership of hospitals in the Delta region have been discussed as possible sites, but he added that the schools are still trying to find the right model.
While it may take a few years, he said, he thinks having more medical school graduates in Arkansas, especially if they do opt for residencies in the state, will have a noticeable effect on health outcomes.
Over time, it could affect metrics on chronic conditions such as diabetes or kidney failure, he said.
"It can't do anything but move the needle ahead. ... Access to care is what we want to see change," he said.
A Section on 04/22/2019