Expanded residencies a critical need
If people were asked to identify a category in which Arizona was the second-fastest growing state in the nation between 2000 and 2010, most likely would say “total population.” While this would be true, many would be surprised to learn that another correct response would be “new medical students.”
Driven by the establishment of two osteopathic medical schools and the expansion of the University of Arizona College of Medicine, Arizona's medical student population expanded by 117 percent in the past decade. This is a positive development, considering Arizona is well below the national average of physicians (220 per 100,000 population, compared with 259 per 100,000 nationwide).
Expanding the supply of medical students is a critical step toward increasing the number of doctors practicing in Arizona. But to truly put a dent in the shortage, there needs to be a corresponding expansion in the number of graduate medical education or residency positions in our state.
After graduating from medical school, physicians complete their training in a residency program in their chosen specialty. Residencies typically occur in a hospital setting and take between three and seven years.
We average 22 residents per 100,000 people, compared with 36 per 100,000 nationally. This is important because physicians often choose to practice in the region where they complete their residency training. So it makes sense to keep Arizona medical school graduates in state to train and ultimately practice here.
The challenge restricting residency programs from expanding in Arizona and across the country is lack of money. Residencies traditionally have been funded primarily by the federal government through Medicare, which directly pays sponsoring hospitals. Medicare has set tight limits on the numbers of reimbursable positions, and GME funding has recently declined. Medicaid has also historically supported GME in most states until recently as state budget shortfalls have cut GME funding. Arizona has not provided state funds since 2009, and hospital budgets continue to be squeezed.
Despite the significant financial challenge, Yuma Regional Medical Center is moving forward with the establishment of Yuma's first residency program. Once fully operational, the program will train 24 to 48 physicians per year and serve as a powerful tool for increasing the number of physicians practicing in southwestern Arizona. With additional financial support, the benefits of the program could be even greater.
A strong health care infrastructure, including a sufficient supply of physicians, is a critical component to the long-term prosperity of Arizona.
The Arizona Chamber Foundation in collaboration with St. Luke's Health Initiatives and the Greater Valley Health Education Center recently released a report entitled “Graduate Medical Education in Arizona: Growing the Physician Pipeline” which highlights the urgency of this issue and outlines some potential solutions.
It is incumbent upon all of us to come together and develop innovative ways to pay for residency training, such as a dedicated public funding stream. This will enhance the return on investments in expanding Arizona medical schools and will help ensure that Arizonans continue to have access to health care.
Suzanne Kinney is the executive director of the Arizona Chamber Foundation, and Pat Walz is the president and CEO of the Yuma Regional Medical Center. The research report can be downloaded at http://www.azchamber.com/policy/foundation.
