Arizona has been facing a health care workforce shortage for years, but until now there has never been a bill introduced in the Arizona legislature to address the crisis.
“We’ve been talking about these issues since the first day I was elected,” Senator Heather Carter (LD-15) said. “We’ve never put it in a bill format. So, I put together some of the most shovel ready ideas in a package and put them forth as one large package to address the health care workforce shortage from a pipeline perspective.”
Arizona ranks lower than the national average for number of primary care physicians (PCP) with 126.1 – including general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics and internal medicine – per 100,000 residents.
Carter put forward Senate Bill 1354, a multi-part package addressing the PCP and nurse shortage by providing more money for medical programs and clinical rotations around the state.
S.B. 1354 is a $50 million budget bill that creates new spots for in-state medical students and Graduate Medical Education (GME), loan repayment programs and clinical rotation programs.
Part One: Medical School Spots
“We need more medical school spots,” Carter said. “We [would be] increasing the funding to our public medical schools to increase class size.”
S.B. 1354 would put $11 million towards the University of Arizona Health Sciences to help address the shortage by increasing the state’s number of medical students and providing additional support for students willing to practice in rural and underserved areas.
“[If] we direct appropriately to the medical school we could increase the class size of the public medical schools,” Carter added.
Carter gave the example of the University of Arizona’s Phoenix Medical Campus, which was built for 120 students, receives roughly 6,000 annual applicants but currently serves only 80 because of funding.
“We need more medical students,” U of A President Dr. Robert Robbins said at a Senate committee hearing. “These resources are much needed to invest in the overall health of the state.”
Part Two: Graduate Medical Education/ Residency Opportunities
“Once we have more medical students in Arizona, we need to build more spots for them to stay in Arizona [during] their residency program,” Carter said. “Once [students] graduate…if they leave Arizona, they’re likely to not come back.”
It is proven that 75 percent of physicians will stay in the state where they complete their residency, meaning if a state has more residency slots it will statistically have an increased number of physicians.
“We need more GME slots because when medical students decide to go into their residency… they generally will stay in the state where they do their training,” Robbins said.
According to Dr. Brandon Abbott at North Country Healthcare, Arizona ranks in the bottom for the number of GME spots but has a high retention rate among those who complete their residency training here.
“We have a 72 percent retention rate if the student goes to medical school GME residency training [in Arizona],” Abbott said. “The problem is that we have a lack of funding for GME in the state.”
Midwestern University, which has a campus in Glendale, graduates approximately 250 physicians each year but can only keep 30 percent of the graduates in the state for GME programs.
“We have to send people who want to stay, students who want to stay and do a residency in Arizona, out of state because we do not have enough residency spots in Arizona. [This] is absolutely critical,” Midwestern University representative Kelsey Lundy said.
S.B. 1354 proposed $20 million towards increasing GME programs in rural and urban underserved areas.
If passed, the Arizona Health Care Cost Containment System (AHCCCS) will establish a program that puts $5 million towards GME programs in rural areas and $15 million towards GME programs in urban underserved areas.
Part Three: Loan Programs / Clinical Rotations
According to Carter, S.B. 1354 would put $9 million toward loan and loan repayment programs.
Prior to the Great Recession, Arizona had a successful loan program that allowed students to get better-priced loans for medical schools using the state loan program.
The bill gives “$4,000,000 to the department of health services for the primary care provider loan repayment program and $5,000,000 to the board of medical student loans established.”
“If you would like to receive loan forgiveness… you [can] commit to working in high need areas in rural Arizona [and] you can have your loans forgiven,” Carter said.
There will also be $10 million for the Arizona Department of Health Services to establish programs that provide grants to institutions that train and prepare nurses and utilize retired physicians and nurses.
According to Carter, it will be used “for addressing the nursing shortage [by] using our federally qualified health centers to provide places for clinical rotations, re-engaging our retired workforce and so forth.”
Carter is hopeful that the bill will be included in the fiscal year 2020 budget.
“It’s truly a budget issue,” Carter said. “We [have] everybody from the right to the left, from the Democrats to the Republicans, from the senior members to the new members, saying we absolutely need this. We are actually putting precious state dollars into a quantifiable program. You can measure the outcomes of [this] investment of state dollars.”
S.B. 1354 passed through the Senate with a vote of 28-2. In the House, it was amended to include more focus on rural and underserved areas.