It’s no secret that Arizona has a physician shortage that’s getting worse, not better. The shortage is most acute in rural Arizona and worse in the key specialty areas that do the most to improve community health: primary care, family medicine and a very few specialties like obstetrics. According to research by the UA Center for Rural Health, Arizona has a shortage of 560 primary care physicians right now and 1,941 more will be needed by 2030 because of retirements, population increases, higher rates of chronic disease and an aging population.

At first glance most folks might think the solution is simple… just expand the number of medical schools and the sizes of the enrollment per school in Arizona. Makes intuitive sense, right?

Mostly wrong.

The bottleneck in getting more physicians practicing in the field in AZ isn’t the number of medical school students in the pipeline…  it’s mostly the number of residency slots that are available in AZ & geographic and specialty distribution of those residencies.

Nationally, about 42,000 students finish allopathic (MD) medical school each year (2022 data) but the number of residencies available for medical school graduates hasn’t kept pace with the increase in students, meaning that a bit over 20% (8,400) of medical school graduates are left out – unable to get the residency slot they need to complete their training so they can practice.

In 2022 about 80% of the total 42,549 applicants were matched with a residency program. Match rates weren’t equal across the board. 93% of U.S. allopathic (MD) medical students were matched but only 61% of international medical graduates 58% of non-U.S. citizens matched. Doctors of osteopathy (DO) had lower match rates than MD students.

The lowest hanging fruit for getting more of the right kinds of doctors into the field (and in the right places) is building more residency slots in Arizona (especially in things like family medicine, primary care, and obstetrics etc.)… not necessarily graduating more AZ medical students. Placing those primary care residency slots in rural community-based settings is crucial.

Why? Because physicians are likely to practice near where they complete their residency (not where they finish medical school).

We need to expand the number of medical residency training programs in rural areas to fill gaps in care – doctors tend to settle within 100 miles of where they do their residency (especially family medicine specialists).

What Are Some Solutions?

Building teaching health centers at rural federally qualified health centers in collaboration with a rural hospital is a terrific tool for building and retaining a primary care workforce like the Teaching Health Centers at North Country Healthcare and El Rio Community Health Center:

El Rio Health is helping to create a new model of medical education in what is known as a Teaching Health Center. This concept emphasizes multidisciplinary, inter-professional educational opportunities within community health centers. This allows students and residents with a passion for community medicine to obtain their training directly within the community health center environment.

Dr. Doug Spegman, El Rio’s Chief Clinical Officer:

These residencies provide traditional, clinical training in acute and chronic care management and also emphasize preventive care and wellness. This includes a comprehensive approach to understanding healthcare disparities and social determinants of health that are often overlooked barriers to care and patient wellness.

Arizona’s budget agreement this year allocated $5M to the AZ AHEC program to specifically get the pieces together for more teaching health center collaborations like El Rio and North Country going.

“One-Two” residency programs—one year in an urban, academic hospital followed by two years in a rural area are effective in rural recruitment, while providing the amenities of academic residency programs centered around large, academic hospitals.

Other effective strategies are loan repayment programs like Arizona has, and the National Health Service Corps (NHSC says 81% of recent participants remained in rural areas after completion of their service agreements).

There are several pieces that need to come together to get more residency sites up and running. Among the most important are funding the startup costs at new clinical training sites and recruiting qualified primary care and key specialty preceptors.

Focusing solely on getting more medical students to study in AZ and thinking that alone will build more in-state practitioners is off target. Let’s hope public resources go to residency development and not just more medical students.

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