A Looming Crisis - Arkansas

Fewer Enter Health Care Fields As Baby Boomers Age, Threatening a Shortage of Care

Crystal Coble has seen how a health care shortage can affect a community - and it alarms her to think about the same thing happening on a statewide scale.

After the closing of Eastern Ozark Regional Health System hospital in Cherokee Village in 2004, residents of Sharp County were left with one medical clinic, but no emergency services.

"After hours there is nothing for you," says Coble, who grew up in Sharp County in Williford.

Coble, who is a nursing student at Arkansas State University in Jonesboro, says she doesn’t think most people realize the seriousness of a health care shortage, especially in Arkansas’ rural communities. Sharp County residents, about half of which were 45 and older in the 2000 census, now have to drive 90 miles to the nearest hospital.

“I don’t think you can understand unless you are in the situation,” Coble says.

Members of the Baby Boom generation may have held up The Who’s “My Generation” as something of an anthem in 1965, chiming in with the lyrics, “I hope I die before I get old.”

But that sentiment simply isn’t holding up in this modern, medically advanced world.

With the oldest boomers now reaching retirement age and life expectancy figures at an all-time high, members of this generation are predicted to survive well into old age.

Some health care experts believe boomers’ longevity has contributed to a looming crisis. Just as more Americans reach retirement age, the number of people entering health care professions has remained stagnant. The resulting gap between patients and available health care is alarming — and only expected to get worse.

“This is not just a nursing shortage,” says Dr. Susan Hanrahan, dean of Nursing and Health Professions at Arkansas State University. “It’s about every aspect of care delivered in the health care system.”

According to Dr. Peter Kohler, vice chancellor of the Northwest Arkansas campus of the University of Arkansas for Medical Sciences, vacant nursing positions number close to 3,000 in Arkansas. The state also suffers from shortages of about 800 primary care physicians, 1,500 specialists, 1,300 pharmacists and more than 3,100 allied health care workers.

“These are huge numbers,” Kohler says. “As the population ages, it’s going to get worse because more people are going to need healthcare.”

Hanrahan gathered data from 47 Arkansas hospitals for the Arkansas Hospital Nursing & Allied Health Workforce Data Set 2007-2009. She found that critical vacancies exist in a number of health disciplines. The largest vacancy percentages are in medical/surgical RNs, nursing assistants, LPNs, radiographers, respiratory therapists and medical record coders. Shortages also were noted among case managers, medical transcriptionists, social workers, biomedical technologists, physicians and polysomnographers.

“If you look at the numbers coming down the pike, it’s very scary,” Hanrahan says.

Arkansas’ popularity as a haven for retirees further complicates the shortage.

“It only exacerbates the problem,” says Kevin W. Ryan, executive associate director of the Arkansas Center for Health Improvement.

As a predominantly rural state, Arkansas has less-populated areas, such as Sharp County, that already are feeling the pinch of the health care worker shortage.

Out of concern for her community, Coble, a weekend librarian at the Williford Library, began offering vaccinations, cancer awareness programs and other resources through the library to residents of Sharp County. Coble soon will graduate with a nursing degree and, while many new college graduates set off to see the world, she wants to return home to work as a nurse—if medical facilities ever reopen there.

“My dream is to get a hospital back in Sharp County,” she says. “I love my home, and we need a hospital.”

Coble says funding is the biggest hindrance in getting the hospital reopened. And if her dream does come true, the hospital still will face the challenge of keeping the facility staffed. This has become a staggering problem nationwide, especially in the nursing field, according to Paul Cunningham, senior vice president of the Arkansas Hospital Association.

The gap in pay between nurse salaries and nurse educator salaries has created a shortage in nursing school faculty, Cunningham says. As a result, not as many students can gain admission to nursing schools.

“Right now, there is no comparison between what a practicing nurse makes and what a nursing educator makes,” he says.

Nationwide, the U.S. Bureau of Labor predicts more than 1 million new and replacement workers will be needed by 2012 in the nursing field alone, and as many as 5.3 million health care worker vacancies could exist by then. As boomers continue to age, the gap will continue to expand.

“People 65 and older need three times as much health care as the general population,” Kohler says. “People over 85 need five times the health care. It will continue to get worse and there is an urgency to start doing something now.”

Although the figures present a dire situation, leaders in state health care are working now to formulate solutions. One of them is the Governor’s Roundtable on Health Care, which is facilitated by the Arkansas Center for Health Improvement. Established to build upon successful efforts undertaken by state leaders to address comprehensive health care in Arkansas, the Roundtable brings together stakeholders and interested parties to a common table — a vital first step in solving the shortage, Ryan says.

“We have to have a good understanding of the distribution of health care providers,” Ryan says. “We have to know where the gaps are in order to fill them.”

Roundtable meetings are open to the public and are scheduled bi-monthly. Public input is sought on the health care worker shortage, as well as other issues pertaining to health care in Arkansas.

“We are working to create a more rational health care system,” Ryan says.

On the educator end, medical and nursing schools are taking steps to increase the number of graduates entering medical fields. The Fayetteville campus of UAMS has been created to combat the shortage of health care professionals in the state. The campus will include the UAMS colleges of Medicine, Pharmacy and Health-Related Professions.

Prompted by a 2006 Association of American Medical Colleges report that cited growing evidence of a physician shortage and recommended a 30 percent enrollment increase in medical schools nationwide, UAMS forged the new campus as part of an effort to increase its enrollment by 20.4 percent by 2010.
“The Little Rock area is reasonably well-saturated with medical care,” Kohler says. “The satellite campus is a strategy to draw health care workers into other parts of the state.”

Ryan also notes the need to even out the distribution of medical professionals in Arkansas.

“Arkansas is still predominantly a rural state,” he says. “Health care is not as accessible in rural areas.”

The Northwest Arkansas UAMS campus will begin accepting students when fundraising for the expansion is completed. Kohler says about half the necessary funds have been secured.

Nursing schools also are working to increase their numbers of graduates. On June 23, the Willard and Pat Walker Charitable Foundation renewed and expanded its five-year pact with the University of Arkansas at Little Rock by announcing a $1 million endowment to perpetuate the Walker Nursing Scholarship Program. The endowment will fund five full-time nursing scholarships and two LPN or paramedic licensing scholarships each school year.

And nursing schools, not just in Arkansas, but nationwide, will have to address the issue of nursing faculty salaries, Cunningham says.

“They have got to offer better pay rates and more incentives,” he says. “It won’t cure the problem, but it would help it.”

To encourage young people to consider health-related careers, the Medical Application of Science for Health Partnership has been offering medical enrichment experiences to high school students throughout Arkansas for 15 years. Established to address the declining number of medical professionals in Arkansas, MASH offers two-week camps free of charge through corporate funding through members of the partnership. MASH partnerships include Arkansas Farm Bureau, Arkansas Blue Cross Blue Shield, the Arkansas Health Department’s Office of Oral Health, UAMS Area Health Education Centers and the Rural Hospital Program. According to MASH, a number of MASH graduates are now enrolled at UAMS or in nursing schools or are practicing in regional and community medical systems.

Health care leaders agree that more work must be done to solve the statewide health care worker shortage. Growing awareness of the severity of the issue partnered with commitment on the part of leadership is a solid step in the direction of finding solutions, Ryan says.

“This issue won’t be solved overnight,” he says. “It will definitely require a lot of planning. But I’m very hopeful that this is a solvable problem.”

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