If all goes as planned, in the next four years, the University of Arkansas for Medical Sciences will reach an enrollment of 700 — 100 more than it has today — and 60 of its students will be located at a new satellite of the College of Medicine in Northwest Arkansas.
UAMS plans to send 30 students from each third and fourth year class to work in clinical settings in Fayetteville, Rogers, Springdale and Bentonville. Pharmacy students, students in allied health care (technicians, etc.) and nursing students will also be completing their degrees in Northwest Arkansas.
The expansion into Northwest Arkansas, a plan Chancellor I. Dodd Wilson has been discussing with UAMS staff and a few lawmakers for the past year, will require cooperative agreements with hospitals to establish residency programs. It will take advantage of already-established residency programs at AHEC (Area Health Education Center) clinic and the VA hospital in Fayetteville as well. As of now, Wilson said, no facility is planned for the med students, but the Fayetteville medical community expects UAMS will build or rent a facility as the core for the school’s students and administrative needs. The idea, Wilson said, is to send students to a place where there are ample patients and clinical sites already established — and Arkansas’s rapidly growing Northwest fills the prescription. The expansion will require cooperation with the hospitals and community; Wilson was in Fayetteville Tuesday talking to persons from the medical and lay communities to gauge support. A Northwest campus “would be a real shot in the arm for businesses to have a branch of the medical school here,” AHEC medical director Dr. Robert Gullett said.
It doesn’t hurt, it might be pointed out, that some of the state’s most well-heeled philanthropists — like Pat Walker, who has been a big donor to UAMS in Little Rock — are based there.
What will it cost to expand? The plan is so rough it has not even gone to the Board of Trustees, Wilson said, and he declined to estimate a cost. The University of Kansas Medical School-Wichita, a satellite of the main campus in Kansas City, which the chancellor and others visited recently, has 122 faculty members, 14 residencies and a budget of $25 million. Excluding start-up construction costs, UAMS, with 60 students and fewer specialties, might be less. The current budget for the College of Medicine is $404,969,110.
Whatever the cost, Chancellor Wilson said in an interview last week, “If the legislature is unwilling to help, it won’t work.”
UAMS is fortunate in that the chair of the legislature’s Joint Budget Committee is Sen. Dave Bisbee of Rogers. Bisbee said last week the only downside to UAMS expanding into his neck of the woods is that “it costs money.” But, he asked, “Do we want to educate more doctors to serve the population?” If the answer is yes, the state’s going to have to help out. Add this tab to the list of reasons why a tax cut, though politically popular, might not be so easy or desirable to do, despite the state’s big surplus.
Northwest Arkansas is said to be the sixth-fastest-growing region in the country; its population increased by half in the 1990s. Northwest Health System CEO Gary Looper said growth requires the system’s hospitals in Bentonville, Springdale, and Johnson to add 30 to 40 new and replacement doctors a year.
Not only are there more people to take care of in Northwest Arkansas, there is the fact of Arkansas’s aging population, who need more medical attention. The baby boom is turning into the patient boom. Arkansas’s population aged 65 and older is expected to increase by 68 percent between now and 2020, the U.S. Department of Health and Human Services estimates.
The American Association of Medical Colleges recommends an increase in medical school enrollment of 30 percent by 2012 to meet future demands. About 25,000 new doctors are being turned out a year at present; UAMS graduated 132 last spring. An impossible 1.2 million new nurses will be needed by 2014, the U.S. Bureau of Labor Statistics reports. There’s a shortage in the pharmaceutical profession, requiring some rural hospitals to close their pharmacies.
The College of Pharmacy at UAMS is increasing its enrollment to meet demand; all of its 90 graduates this spring were hired, more than half in Central Arkansas alone. Yearly salaries now average $93,550.
“A UAMS Report: Meeting Arkansas’s Health Care Work Force Needs” includes Health and Human Services data that ranked Arkansas 48th in physicians per capita, with 154 doctors for every 100,000 people. Nationally, the average is 198.
A survey conducted by UAMS of health care facilities in state predicted 700 doctor vacancies statewide by next year, 300 of them in primary care. It also predicted 3,000 vacancies in nursing. It quotes a state legislative panel finding that the state will need 27,000 new nurses by 2010, “roughly the size of Bentonville.”
The AAMC’s June 2006 Statement on the Physician Workforce called for increases especially in “areas where the population is projected to grow rapidly in future years.”
Sending UAMS students of medicine, pharmacy, nursing and health-related professions to the northwest corner of the state will help address the need to increase Arkansas’s doctor numbers and “alleviate stress on local facilities,” Chancellor I. Dodd Wilson, architect of the plan, said. UAMS’ lecture halls are not big enough to accommodate a class size of 180, “which is where we’d like to go,” he said.
Besides the AHEC clinic and the VA hospital, UAMS could teach its students at the Reynolds Center on Aging satellite in Springdale and the Northwest Arkansas Center for Children in Lowell. UAMS will also seek agreements with private hospitals in the region to create residency programs in internal medicine, pediatrics and surgery. Hospitals in Northwest Arkansas have been going up like Hog calls: Washington Regional in Fayetteville and Northwest Health System Hospital in Bentonville are new facilities; St. Mary’s Hospital will open a new hospital in 2007 in Rogers. Northwest’s hospital in Springdale has expanded recently, and the system also operates the Willow Creek Women’s Hospital, built less than five years ago in Johnson. Siloam Springs also has an acute care hospital.
UAMS’ medical school classrooms may be cramped by the addition of 10 new students this year and in following years, but UAMS is adding new facilities all the time. It has broken ground on a $255 million project to add 500,000 square feet to the hospital, build a psychiatric facility and student residences (which are nearly complete). The hospital is raising $25 million to $30 million in gifts to help build a $70 million cancer research center, the remainder of the cost to be paid by a bond issue (which will cost the state more than $120 million in principal and interest by the time it is repaid).
The Pat Walker Tower, a five-story addition to the Jones Eye Institute made possible by a $15 million gift by Walker, who lives in Springdale, was dedicated this spring.
Northwest CEO Looper said response to UAMS’ plans has been positive “in general.” (He qualified that by saying that at some point — though not in the foreseeable future — local doctors may come to regard the UAMS physicians as competitors for patients.) “A Northwest Arkansas campus gives us access to clinical expertise that would not normally be available,” he said, and would help the area recruit new doctors.
His counterpart at Washington Regional Hospital, CEO and president Bill Bradley, in an e-mail to the Times, said the hospital was “assisting UAMS in determining the feasibility of expanding its presence in Northwest Arkansas. At this point, there are many more questions than answers. In addition to Washington Regional’s participation, community-based physicians will need to understand and agree to their role in the programs. UAMS needs to more specifically define everyone’s role in the near future. Certainly, we will continue to work with UAMS toward a successful outcome.” He said that developing new residencies in his region would require “significant preparation.” Bradley added that it would be “more cost effective” for UAMS to use existing hospital facilities than build a new one.
But Looper said he expected UAMS would need a real campus — a “hub, a central core” — that would include laboratories, classrooms and administrative space. He expects to see philanthropic help to provide capital for such a center; a “high level of interest” among the area’s wealthy has been implied, he said.
State Rep. Jay Bradford, chair of the House Health, Labor and Welfare Committee, is in favor of the expansion, in light of the growth and support of the medical community and “the chamber of commerce types.”
“There’s also a lot of foundation money up there,” Bradford said. “I look at the UAMS campus here and see a lot of support [from Northwest philanthropists]. … I expect [they’ll] continue to support right in their back yard.”
The College of Pharmacy, which got an appropriation in the last legislative session to expand, has begun hiring faculty in Northwest Arkansas to accommodate its enrollment increase. In 2004, class size was 90; in the fall, 120 will be in the entering class. Like the College of Medicine, the College of Pharmacy will send 30 third-years and 30 fourth-years to Northwest Arkansas sites, Dean Stephanie Gardner said.
The college has already hired one person, at St. Mary’s in Rogers, to oversee clerkships; UAMS will pay half the new hire’s salary and St. Mary’s the other half. Gardner hopes the College and Wal-Mart will jointly fund a position at corporate headquarters. “We hope to have seven or eight faculty” hired over the next two years, Gardner said.
What’s the precise shortage of pharmacists? “There’s no way for us to know. What I can tell you is there are hospitals and pharmacies that call that are willing to support a student’s entire tuition if [he or she will] sign a contract to move there,” Gardner said.
Class work is still required of third year pharmacy students, so the pharmacy college satellite will need a location that includes classrooms, faculty offices and office space, Gardner said. “We haven’t identified that place,” she said.
The College of Medicine gives priority to Arkansas resident applicants, and until this year accepted 150 students a year. Famously, in 1988, only 222 Arkansans applied for the 150 spots available. Arkansas applicant numbers have grown (as have out-of-state applicants): In 2005-06 there were 694 applicants, 262 of whom were Arkansans, and in 2006-07, there were 949 applicants, 292 of whom were Arkansans. The entering class this fall will have 160 students for the first time.
If the school is to grow to 180 students, in Dean of Academic Affairs Richard Wheeler’s opinion, more out-of-state students must be accepted.
The College of Medicine is required to take an equal number of applicants from the four congressional districts to make up 70 percent of its entering class. This year, that means each of the districts were promised 28 slots. Of the remaining 30 percent, only half may be accepted from out of state.
Given those circumstances, the limit on out-of-state applicant numbers might make it hard for UAMS to fill a class of 180 with top-notch students. “I don’t know that that would be enough,” Wheeler said. “We may very well need to go to the legislature to say we need to relax that.” The quota system may have to go, too, Rep. Bradford said.
Wheeler said the reason for the limits on non-Arkansans — that those who pay state taxes should reap the benefits — doesn’t take into account that doctors tend to stay in the cities they did their residencies in, even if they’re not from the area.
Chancellor Wilson and UAMS are going to have to make the case to expand the school, Sen. Bisbee said. “You won’t get anything through the legislature unless rural Arkansans think they’re going to get their medical needs taken care of.”
For years, Fayetteville and Little Rock have argued the need for two law schools. Can a comparison be drawn? Said Wilson: “Law schools don’t do residencies, they don’t need customers. Med school students need patients.” They’ll find them in his hometown, Rogers, and the rest of Northwest Arkansas.
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