UAMS adds residency slots

Plan is for doctors to stay in the region

Dr. Mikaila Calcagni, a resident physician, speaks March 22 at the Veterans Health Care System of the Ozarks in Fayetteville. University of Arkansas for Medical Sciences, the veterans center and Mercy Hospital are partnering to add more resident slots.

More medical school graduates will be able to do residencies in Northwest Arkansas starting this summer, increasing the likelihood they will stay and practice in the region, officials said.

The University of Arkansas for Medical Sciences Northwest Regional Campus in Fayetteville has partnered with Mercy Hospital in Rogers and the Veterans Health Care System of the Ozarks in Fayetteville to add three residency slots in its internal medicine program, said Dr. Thomas Schulz, residency director at the university.


UAMS had its largest-ever number of graduates matched to residencies this year. Each of the 160 students who wanted a residency got one.

Source: UAMS

"It's really on-the-job training," Schulz said. "When you finish medical school, you have the MD or DO behind your name, but you're not ready to practice. You have the very basics. Residency is a very intensive experience where you're actually taking care of patients under the watchful eye of attending physicians."

The program will have 11 residents per year, Schulz said. It previously could accept eight.

Federal law caps federal financial support for graduate medical education at the number of resident slots a facility had in 1996, but when a hospital starts a residency program, it has five years to add slots before being capped, Schulz said. The UAMS internal medicine residency program began in 2016.

Medicare reimburses some of the costs of residency slots, but hospitals have to find money to pay for the slots while waiting for the federal money, Schulz said. And, hospitals can add more slots after they are capped if they can cover all the costs for them.

The federal cap began in 1997 when medical educators agreed the United States was nearing an oversupply of physicians. They recommended Congress freeze the number of residency slots paid for by Medicare, according to a Congressional Research Service review of the funding.

The situation has changed.

The Association of American Medical Colleges has projected a shortage of up to 121,000 physicians by 2030, in part because of a growing and aging population, but also because of the cap on federally supported residency positions, said John Buarotti, spokesman for the association.

A bottleneck

Matthew Shick, the association's senior director of government relations and regulatory affairs, said the lack of residency slots because of the federal cap is a nationwide problem. Medical schools around the country have been taking in more students, in part because the country needs more doctors, but that creates a bottleneck when those students graduate medical school and need a residency.

"Many hospitals are training above their caps, but they can only do that so much before it becomes financially burdensome," Shick said.

Shick said more doctors are needed in part because of the aging Baby Boomer generation, which not only means more patients but more retiring doctors.

Mercy's residency program is in its third year, said Dr. Steve Goss, president of Mercy Clinic. Mercy will sponsor the three additional slots, Schulz said. The residents rotate through the veterans center, UAMS and Mercy, but, at any given time, eight will be at Mercy while three are at the veteran's hospital.

Medical school graduates need a place to do their residency to practice, Goss said. Part of the struggle is that while medical schools are expanding and taking in students who are paying tuition, residency programs have to pay residents' salaries and provide oversight.

Residents make about $50,000 a year, Schulz said. Most residencies last three years.

The Walmart Family Foundation gave $750,000 to Mercy to help cover initial costs of the residency program, such as salaries for residents and staff members involved in the program.

"It doesn't cover all of it. It's to help out until we get that reimbursement from (Medicare)," said Jennifer Cook, spokeswoman for Mercy.

Close to home

First-year internal medicine resident Mikaila Calcagni plans to stay in Northwest Arkansas when she finishes her residency, she said. Calcagni is from Bentonville, got her undergraduate degree from the University of Arkansas, started at UAMS in Little Rock before transferring to the Northwest Campus to complete medical school.

Calcagni starts her day at 6:30 a.m. six days a week reviewing her patients' overnight charts. She develops a treatment plan and reviews that plan with staff members.

If there's one thing Calcagni has grown to appreciate more during her first year of residency, it's that medicine is both a science and an art, she said. Veterans at the medical center want their doctors to hear their stories. Patients need their doctors to believe them when they say they are in pain.

"Patients don't want to feel like something is being done to them. They want an active role in their care," she said.

Calcagni spends about half her time at Mercy, 40 percent of her time at the veterans center and 10 percent of her time at UAMS, she said. Calcagni said the experience has allowed her to work with a diverse group of patients.

UAMS has a free clinic for Marshallese residents.

"We get to be the ones to provide that care," she said.

About half of the physicians in Arkansas completed their graduate medical education in Arkansas, according to a report by the Association of American Medical Colleges.

"Those that have done their residency in an area many times stay in that area," said Pamela Austin, administrative officer for the research and education department at the veterans center. "And that's one of the reasons why Northwest Arkansas wanted residents and because of our population growth. We need additional physicians, and what better way than to train them ourselves?"

The three internal medicine residency slots at the veterans center are paid with a grant from the Office of Academic Affiliation in Washington, D.C., Austin said.

The center provides an interdisciplinary experience for residents because it has social workers, dentists and mental health providers in addition to doctors and nurses, Austin said. Veterans are also a unique population with specific needs.

Other hospitals

Other hospitals in the area have met their federal caps.

Northwest Health has nine family practice residents, said Beth Wright, spokeswoman. The hospital is capped at three slots, but pays for six slots itself.

"We would be open to adding more residency positions if there were additional funding opportunities," Wright said in an email.

Washington Regional Medical Center has also met its cap of 29 family practice residents, said Cynthia Crowder, spokeswoman.

"Washington Regional recognizes the significant progress that has been made in increasing the number of medical school graduates in Arkansas," Crowder said in an email. "However, there remains a significant need to encourage growth in the physician workforce for both primary care and specialty care: to increase graduate medical education and fellowship programs so that Arkansas-trained medical students remain in Arkansas."

The hospital is working to find the money to support more residents and ways to recruit physicians who want to teach residents, Crowder wrote.

The Northwest Arkansas Council, a nonprofit organization made up of executives from the region's largest companies, schools and health care systems, released a report in January that estimated the region is missing out on $950 million a year in the health care economy, partly because of a lack of specialty care physicians. The report said expanding graduate medical education is a priority for the next couple of years.

The UAMS internal medicine program will have up to 33 residents total by 2021 because of the three additional slots added this year.

"Doing this is along the lines of what the Northwest Arkansas Council is envisioning because quite honestly, the 24 was perfect for right now, but we're setting the numbers for 50 years from now because given the current political climate, we don't see Medicare coming and saying, 'Hey, we're going to give you some more residency slots,'" Schulz said.

The council's president, Nelson Peacock, said in January the group's role would be to bring leadership together and develop plans to increase graduate medical education. The first step is to hire a staff member by July 1 to focus on health care in the region.

UAMS has applied with the American Council for Graduate Medical Education to start a transitional year program that would have eight slots for people who have completed their residencies and are looking to go into specialties such as dermatology or radiation oncology, Schulz said. He anticipates knowing whether it's approved by September.

NW News on 03/31/2019