Columns » Warwick Sabin

Somebody call a doctor

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Someone recently provided to me an internal UAMS document titled “Healthcare Shortage: Physicians and Nurses.” Organized as a numbered progression of facts and projections, the memorandum leads the reader to infer one inevitable conclusion: Arkansas already does not have enough doctors and nurses to meet its current needs, and a crisis looms as the “Baby Boom” generation reaches retirement age. 4. 374,019 Arkansans are over the age of 65 (14.2 percent of state population and 9th in nation) 5. 747,646 Arkansas Baby Boomers (born 1946-1964), 28 percent of Arkansas population 6. By 2025 Arkansas is expected to have the 5th highest proportion of elderly in nation 7. Rural areas have greater percentage of elders than urban 16.4 percent vs. 11.8 percent. 12 of Arkansas 75 counties are urban — the rest are rural. As sobering as those numbers are, they are not shocking. After all, the existence of the Baby Boomers is no secret. The shocking part is how unprepared we are to confront the challenges of a completely predictable phenomenon. 10. When it comes to doctors per 1,000 residents Arkansas is near the bottom with 1.9/1000 (only ahead of [six other states]) 11. UAMS admits 150 medical students each year, which is governed by legislature and is consistent with [Association of American Medical Colleges]. AAMC is recommending a 15 percent increase in admissions of new medical students. 12. Too few applicants and clinical rotation sites 13. 25 percent of residency slots, filled by foreign medical graduates Items eight and nine mentioned that 340,000 Baby Boom physicians nationwide are expected to begin retirement in 2010, and that the national physician shortage will number between 85,000 and 200,000 by 2020. That means the competition among states for qualified doctors will be even fiercer in the years ahead, and without some kind of extra effort to address the problem, the situation in Arkansas could get much worse than it already is. The outlook for our nursing corps is even more dire. These statistics show that even though UAMS is graduating only about one-third of the nurses we need, it actually turns away qualified applicants: 14. [. . .] the U.S. will need one million new and replacement nurses by 2012 [. . .] 17. [In 2004] UAMS had to turn away 140 qualified [Bachelor of Science in Nursing] applicants, and will have to do the same for the masters program due to an insufficient number of faculty 18. Arkansas needs 1,925 new RNs a year to deal with the nursing shortage 19. Currently the state graduates 683 nurses each year. 20. Trying to figure out how we can dramatically increase the size of our BSN class. The economics are a problem. There has been a great deal of discussion about the rising costs of health care, especially in Arkansas, where there is a higher percentage of poor people and senior citizens who don’t have private health insurance and therefore depend on public programs like Medicare and Medicaid to cover their medical bills. But can you imagine what will happen when there are simply not enough doctors and nurses to care for everyone who needs medical attention? There will be waiting lists for basic treatments, and prices will skyrocket as the increased demand ensures that those willing to pay the most will get the quickest and best care. Arkansas takes advantage of some federal physician recruitment programs, according to Bill Rodgers, director of rural health and primary care for the Department of Health. But the state has only one program of its own — the Rural Physician Incentive Program — that currently claims only two working doctors. “There is more that could be done,” Rodgers said. Indeed, we need a large-scale effort to address the impending crisis. In a state where the only medical training facility is part of the public university system, our government should marshal its resources and put forth a plan to recruit more medical and nursing students and ensure our hospitals are adequately staffed in the years ahead. That might mean establishing additional UAMS campuses around the state, and launching initiatives to encourage in-state college students to enroll in pre-med curricula, and out-of-state students to complete their residencies at Arkansas hospitals. It definitely means proposing concrete policy solutions for a problem that we can see coming, instead of crafting the state’s approach to public health around public relations gimmicks like press conferences, book launches and running marathons.

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