Primary Care Workforce

toddSpring 2013

Expanding Capacity Improves Access

By Nate Hinkel

Watching classes taught via webcam at UAMS South Central in Pine Bluff are (from left) David Nguyen, M.D., LaTrisha Hall, D.O., pharmacy student Lindsey Akin, medical student Jordan Stanley, and pharmacy student Crystal Colclough.

Watching classes taught via webcam at UAMS South Central in Pine Bluff are (from left) David Nguyen, M.D., LaTrisha Hall,
D.O., pharmacy student Lindsey Akin, medical student Jordan Stanley, and pharmacy student Crystal Colclough.

Not everyone who needs a primary care provider can readily find one in Arkansas.

Some live in a rural part of the state with no physician in their town. Or the few physicians there might already be overtaxed with the number of patients they care for. Even in Arkansas’ more populated cities, the demand for health care is outstripping the available resources given the number of baby-boomer physicians who are at, or nearing, retirement.

According to the U.S. Department of Health and Human Services, more than half a million of Arkansas’ 2.9 million people reside in areas with a shortage of primary care professionals.

UAMS, as the state’s only academic medical center, has for several years been preparing to address this challenge in innovative ways. It includes recruiting minority students and faculty. It embraces participation in a new federal partnership to improve access to quality health care at lower cost. And it relies heavily on two educational programs UAMS is beginning this year that are expected to increase the number of providers by preparing physician assistants and advanced-degreed nurses.

Minority Participation

Since much of rural Arkansas is made up of minority residents, UAMS tries to target potential health care providers from those areas, said Billy Thomas, M.D., vice chancellor for diversity and inclusion.

The UAMS Center for Diversity Affairs offers several programs, matches and scholarships as incentive for highly trained health care professionals to return to work in rural parts of the state.

“The key is to expose, recruit and retain them in the health and research fields when they’re young,” Thomas said. “Mentoring programs have also shown some success. But getting out into rural parts of the state and getting them interested early, and then going back and helping their community will go far in the future of health care in this state.”

Federal Partnership

UAMS was chosen last year for the Comprehensive Primary Care Initiative. The Centers for Medicare and Medicaid are paying certain private care practices in eight states, including Arkansas, a monthly per-patient fee to provide enhanced, coordinated care. The intent is to create more provider involvement on the front end, resulting in better patient health and reduced use of health care resources.

Physicians and other providers may offer longer and more flexible hours, use electronic records, coordinate care with patients’ other providers, and better engage patients and caregivers in managing their own care.

The initiative includes selected family medicine clinics within UAMS and its regional centers in Fayetteville, Fort Smith, Jonesboro, Springdale and Texarkana.

Training More Providers

The College of Health Professions is enrolling students in May in its 28-month physician assistant (PA) program, while the College of Nursing this fall will offer its first class for advanced practice nurses looking to earn a doctorate of nursing practice (D.N.P.)

Physician assistants and nurse practitioners conduct physical exams, order diagnostic tests, write prescriptions, diagnose disease and manage care of patients. Physician assistants work with supervision of a physician. Nurse practitioners in Arkansas work under a collaborative agreement with a physician to practice or write prescriptions.

“At this point, I think we are all familiar with the statistics and the fact that we have to do something to improve Arkansans’ access to top-notch health care not only in the future, but right now,” said Lorraine Frazier, Ph.D., R.N., dean of the UAMS College of Nursing. “The leadership at UAMS across the state is all on the same page in this exciting endeavor to meet those goals.”

The new programs are a way to get more primary care providers to the communities where they are needed quickly and efficiently.

“It’s simply not feasible for UAMS to produce enough primary care physicians to keep up with an aging population and new patients entering the system because of health care reform,” said Patricia Kelly, Ph.D., chair of the Department of Physician Assistant Studies. “These new health care providers who are entering these programs can immediately contribute at a very high level and alleviate a lot of the stress on the system.”

Adding Physician Assistants

The PA program at UAMS will have 26 students enrolled in the full-time program this year. In 2014, 30 more will enter the program, and in 2015, 34 new students will be admitted.

More than 4,000 square feet of space within the UAMS College of Health Professions has been renovated to accommodate the program. That includes physical examination rooms, procedural laboratories, and classroom and meeting space.

While advanced practice nurses have been common in Arkansas since the 1970s, the physician assistant profession is less well known. Both professions require a master’s degree that includes clinical rotations in primary care.

With about 150 practicing in Arkansas, the state ranks 49th nationally in the number of physician assistants. Until 2005, students had to leave the state to train, making it difficult to entice them back to Arkansas to work. With the second PA program in the state, UAMS aims to have a workforce that will remain here after graduating. Despite the unfamiliarity of the profession, Kelly said, the student interest has been overwhelming.

“There aren’t a whole lot of role models out there right now for prospective students to see and say, ‘Hey, I’d like to make a career out of that,’” Kelly said. “But just by word of mouth and partnerships throughout the state at other universities, we have had great response that will only snowball once the program is in full swing.”

The program has won support through two philanthropic grants and a gift supporting a scholarship.

Last December, the Blue & You Foundation of Arkansas Blue Cross and Blue Shield awarded $117,000 to the PA program to raise awareness of the program among Arkansas physicians and prepare physicians to host PA students while they gain further clinical experience. A $20,000 grant was also awarded by the Verizon Foundation to develop curriculum materials on domestic violence awareness and prevention for students in the PA program. In December, the program received $2,500 from the Arkansas Medical, Dental, & Pharmaceutical Association Foundation to establish a scholarship in Physician Assistant Studies. The scholarship will be awarded to an outstanding student in the program’s inaugural class.

“It is exciting to receive these grants and philanthropic gifts as they lend more momentum to the high-quality programs that we are hoping to build,” Kelly said.

New Wave of Nursing

Last fall, the UAMS College of Nursing conducted a survey of working nurses to determine the interest level for pursuing the Doctor of Nursing Practice degree in Arkansas. More than 500 responded, with nearly 150 of them planning to enter a D.N.P. program.

With 26 students enrolled for the fall, the program will allow advanced practice nurses to further prepare in the delivery, management and care of patients.

“This is something we’ve been working on for nearly seven years and now have all of the faculty and curriculum ready to go,” Frazier said. “We expect this program to immediately begin making an impact on the health care landscape across the state.”

Nurses with a D.N.P. will be experts in translating the best evidence from rigorous research into clinical practice to improve the quality and cost of health care as well as patient outcomes, allowing them to provide the best care to more patients. The D.N.P. also prepares students in leadership and health care policy.

“That’s perhaps the most exciting part,” said Matthew V. Hadley, R.N., D.N.P., clinical assistant professor in the UAMS College of Nursing and coordinator of the D.N.P. program. “We expect that our D.N.P. graduates will immediately step into roles where they can impact change from a policy and leadership standpoint, which is an appropriate role for these UAMS graduates.”

An added benefit of the program is that it will reach working students in every corner of the state via its online capabilities and through UAMS Regional Programs.

“Students don’t have to come to Little Rock for school and get situated,” Frazier said. “The D.N.P. program will allow the students to continue working where they are as a nurse practitioner while earning the D.N.P. and then put those new skills to use in those parts of the state where it’s needed most.”