More Than A Medical School
Hosted by Casey Pearce, More Than A Medical School provides a high-level briefing on the academic architecture and strategic vision of the NYITCOM at Arkansas State partnership. Featuring deans and clinical directors, the series offers an "under-the-hood" look at how a world-class medical curriculum is engineered to solve the regional physician shortage. This is the definitive source for institutional credibility, proving how the convergence of academic rigor and global medical heritage creates an elite pipeline for the future of healthcare.
More Than A Medical School
Training Local: Growing the Arkansas Physician Pipeline
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There are two key components to adequately addressing a physician shortage, and they both involve opportunity. First, you have to create medical schools in the geographic areas where you need more doctors to practice, and then you have to open new residency programs for those future doctors, where those new doctors receive their specialty training. We sit down with Dr Amanda Deel, a family medicine physician and Associate Dean of Graduate Medical Education and Academic Affairs at NYIT College of Osteopathic Medicine in Arkansas, to explain how graduate medical education really works and why residency creation is the clearest path to building a stable physician workforce.
We dig into the numbers that drive everything, including how often doctors practice near where they train and what Arkansas retention looks like when medical school and residency both happen in-state. From there, we talk about the statewide shift from years of little to no program growth to dozens of new residency programs, and what hospitals and communities had to do to make that turnaround real. We also unpack why bringing residents and medical students into community hospitals lifts quality, strengthens teamwork, and can even make it easier to recruit specialty care.
Then we look forward, including plans to train family physicians in rural Arkansas for rural Arkansas through a Mississippi County partnership, with a focus on access, maternity care, telemedicine support, and the realities of practicing with fewer specialists nearby. If you care about rural health, physician pipeline strategy, and healthcare access in Arkansas, this conversation connects the dots. Subscribe, share this with someone who cares about local healthcare, and leave a review with the one workforce question you want us to tackle next.
@Arkansasstatemedianetwork.com.
00:00 - Guest Introduction: Dr. Amanda Deel
03:00 - What is GME? Explaining Residency to the Public
07:00 - The 100-Mile Rule: Where Doctors Actually Practice
09:45 - The Power of In-State Training Statistics
12:15 - Arkansas’s Stagnant History: 1992 to 2014
14:50 - The 2015 Turnaround: NYITCOM’s Massive Impact
17:30 - Community Hospitals and the DO Advantage
20:10 - The Mississippi County Hospital Partnership
23:00 - Current GME Needs in Arkansas and the Delta
25:40 - How to Pitch Hospitals on New Residency Programs
28:15 - Dr. Deel’s Final Word on Healthcare Access
Why Arkansas Needs More Doctors
SPEAKER_01Welcome to the More Than a Medical School podcast on the Arkansas State Media Network. I'm Casey Pierce with NYIT College of Osteopathic Medicine. Today we're going to be talking about creating a physician workforce, and we're going to specifically be talking about residency creation, residency growth, the state of graduate medical education in Arkansas, and our medical school's role in addressing some of that, the efforts that we've made. I'm joined by Dr. Amanda Deal. Dr. Deal is a family medicine physician. She's also the associate dean of graduate medical education and academic affairs for our medical school here in Jonesboro. So she's kind of devoted her life's work to creating residency programs. Now, Dr. Deal, thanks for joining us. First of all, just tell me about who you are and where you're from.
SPEAKER_00Oh, yeah, sure. So, like you said, I'm Dr. Amanda Deal. I'm an osteopathic family physician. I also practice obstetrics as part of my uh practice here in Jonesboro. Uh I'm from a small town called New Edinburgh, Arkansas. Try and find that on the map. Um, Cleveland County, so Southeast Arkansas. Um I'm an Arkansas State University grad uh and went on to medical school in Kansas City uh through a military scholarship. So I found my way back to Arkansas State University with my family in 20 in 2009, and I completed a family medicine residency program here in Jonesboro, stayed on there in the graduate medical education world as a faculty member for a few years, and then was recruited to NYIT um in 2015 to uh to begin to begin this medical school.
SPEAKER_01Awesome. Well, thank you for all that you do. Let's start from the beginning of this conversation.
What Residency Training Really Means
SPEAKER_01So, to be a doctor, typically you go to undergrad for four years. Um, that can take you a little bit more, a little bit less, whatever. Right. You go to medical school for four years, and then you go to residency training. We're gonna also refer to that as GME graduate medical education throughout our conversation. So you hear GME means basically the same thing as residency uh for the purpose of this conversation. What is residency?
SPEAKER_00So residency, um, you once you graduate medical school, like you said, you can't go on to practice medicine. You don't have a license, you you you have a degree, but no, no way of gaining privileges at a hospital or a clinic. So you have to go on into specialty training. And that specialty training might be in family medicine, like I I chose, that takes three more years or about 20,000 more hours of uh of a directly supervised um care and education. Or it may be into general surgery, which takes at least five years, might be internal medicine another three years, pediatrics, another three years. So depending on your specialty and on the skills that are within that specialty, it's anywhere from three to about seven years of training beyond medical school. And that really hones you into your specialty practice. So in my residency, I got to see babies and children, adolescents, adults, elderly, um, some surgical cases, some obviously some obstetric cases. So you get this rounded education, and then you can go into your to your specialty and make your your clinic and your um your practice what it uh what you would like it to be.
SPEAKER_01And to clarify, the the first four years, your medical school education is the same for everybody across the board. It's when you get to that residency that if you're an OBGYA and you deliver a lot of babies and focus on female reproductive, or if you're a general surgeon, you're learning to take people's skull bladders out and so forth.
SPEAKER_00Right. Yeah. The undergraduate medical education um is either governed by the COCA or the accrediting body for osteopathic medical schools or LCME, the accrediting body for allopathic or MD schools. And um, yeah, yeah, we have basic requirements that are that everyone has to meet. Um, within that, you might be able to tailor some of your third or fourth year into something that that you think would uh would benefit you best going into a specialty that you're really interested in. Um, but yes, we have the basic core things are are all the same.
The Numbers That Predict Where Doctors Stay
SPEAKER_01So you and I can stite some of these statistics in our sleep. Um, the reason why residency's programs are so important, um, upwards of 70% of physicians practice within 100 miles of where they go to residency. We joked on the way over here, you practice within one mile of where you went to residency, which is great for us. That's right. Um, it's not that complicated. You open new programs where you want physicians to practice.
SPEAKER_00Right. And and the cool thing about that is that that, you know, for me, when I came to train here in Jonesboro, I got to know the area. Uh, joined a church, um, I had a child here. Um, I I brought my family with me and expanded my family. But sometimes you go into that residency uh program and you meet your family there. You meet the person that you marry there. Um beyond that, I got very comfortable with all the specialists that are in Jonesboro and and they get comfortable with me. So now I have their cell phone number and you know, that that that level of comfort for consultations when needed as well. And you begin to develop uh you begin to develop a patient panel even while you're in residency. I I thankfully have some patients that are still mine that that that began to see me as a as a senior resident uh in my residency. So that level of comfort and that level of uh the longevity that you have in a community, and then just the welcoming, the welcoming aspect of the community. Um that that's a big draw and it and it keeps you in the community.
SPEAKER_01Yeah, we're gonna build on that a little bit about how when you create a residency program, you're creating your own physician pipeline, but also meeting the needs of the communities around you. Another stat that you and I know well, uh, because I want to back up a step to go to where the medical schools play a role in this. In Arkansas, 57% of physicians practicing here went to residency in state. For those that did both medical school and residency in Arkansas, that number goes up to 80%. And that's why it's important to have both medical school and residency opportunities in those same areas where you want people.
SPEAKER_00That's right. That's right. And I'll go even one step beyond if you're from Arkansas, if you live in Arkansas, you went to elementary school in Arkansas, high school. If if your life and your and your community is in Arkansas, you you really want to stay. I mean, uh, and and you're much more likely to stay. Um and you're much more likely to understand the people and the population that you're caring for. Um, I have so many patients that they just they they want to make sure that the person that's seeing them for their care understands them. So they want to understand, no, want to know that you understand the culture that they're coming from. They want to understand that you that you hear them and um community that shared um language that you have.
SPEAKER_01And that's another of my favorite stats I say all the time of our graduates. It's a pretty small sample size, about four years of our, you know, we opened 10 years ago. So those that have finished residency, it's basically our first four classes. Of ours that are from Arkansas and went to residency in Arkansas, 98% have stayed here to practice. And we're really proud of that stat as well.
SPEAKER_00A fantastic, fantastic stat. And and, you know, from our campus, we we continue to reach into the high schools, the K-12 programs. Um, because honestly, to to get someone to even think about uh a four-year college um education, getting to to those those individuals and inspiring them early is is key. And um, and our students do that really well. Sometimes the the elementary students don't necessarily want to hear from someone with with as much gray hair as I have, but they are so welcoming to our students. Um, and we we do. We want our students to be inspirations to um to to to uh students that are in the K-12 programs in the state of Arkansas.
SPEAKER_01So again, long-term game plan of addressing a physician workforce here. We opened, we were just the second medical school to open in the state. We're very fortunate. It's now just osteopathic one. That's right. And we're now fortunate to have four medical schools in our state. Um, so we had to get those undergraduate medical education at numbers up to then filter those into a growing number of residency programs. You
How Arkansas Restarted Residency Growth
SPEAKER_01know, um, for several years, we did not see much growth in residency in Arkansas, and it created a conversation about the significant needs there. Um, between 1992 and 2014, there were actually no new programs open. But since 2015, we've had 28 new residency programs open in Arkansas that account for about 230 physician positions every year. Now, we don't take 100% credit for all that, but we did have a role in that. And tell me, when we went to open a medical school, our leadership, we knew that we had to have a place, places here for our graduates to go. And you and Dr. Barbara Ross Lee and Dr. Spites all kind of led some of those efforts. Tell us what that looked like and how that happened.
SPEAKER_00Sure. That that um took a lot of vision from our founding dean, Dr. Barbara Ross Lee, and our current dean, Dr. Spites. Um, I came in, that was one of my first tasks was hey, we have this grant from Arkansas Blue Cross Blue Shield to expand the um the education around graduate medical education. So, how do you open a residency program? Um, so we went around the state hosting GME information sessions. And we brought in GME or graduate medical education experts from uh from around the nation and within the state to talk to hospital leadership, to community leaders, and say, hey, um, here's how you could open a residency program. This is how you could be your own sponsor of that program. And we had some communities like Circe that really got that information and ran with it. Uh, we had entities like uh NEA Baptist here in Jonesboro and St. Bernard in Jonesboro that said, hey, we want to capitalize on the medical students that are going to be in our backyard. Um, and we want them to have a place to go that's here in the state of Arkansas. One of the things that we had asked uh asked of us when we started was, well, where are your graduates going to go for residency? And the answer is absolutely everywhere. Our graduates are sought after across the nation. And, but we want them to have places here in the state of Arkansas. We want them to feel at home here. We want them to feel that this is a place that they could grow, that they could put down roots, um, that they could get their wonderful graduate medical education here, just like they got an excellent undergraduate medical education.
Education That Lifts Whole Hospitals
SPEAKER_01Yeah. And one thing, you know, we've talked a lot about osteopathic physicians, DOs, MDs, and kind of some of the differences, but similarities. One thing that from an outcome data standpoint, osteopathic physicians are twice as likely to practice in primary care specialties. They're twice as likely to practice in commun in rural or underserved areas. So again, at the beginning of this conversation, there was one institution in the state, a large academic medical center that was uh operating residency programs. That conversation that we led was with these community hospitals that could go train osteopathic physicians and MD physicians as well, but uh for for our uh interest and sake, um, they were training physicians that had interests and uh a special kind of gear toward practicing in communities like the ones that they served. And so we're fortunate. You mentioned Unity in Cersei and Conway Regional and St. Bernard's and NEA and White River and Batesville and so on and so forth. I don't want to leave anybody out, but these are the Baptists and Mercy Hospital.
SPEAKER_00I mean, there there were so, so, so many that that really took that opportunity and said, hey, our community has had a hard time recruiting certain types of physicians, uh, family medicine physicians, internal medicine physicians. But the cool thing about it is when you bring medical education and graduate medical education into a community, that rising tide raises all ships. So you have a better education network and an education environment for your nursing students, for your pharmacy students, for your MA students, for your paramedic students. It becomes a hub for education where everybody's asking these really inquisitive questions about why are we doing this? What's the best evidence on how to treat this? Um, what are our outcomes on that? So we begin to have this really um uh a flood of curiosity into medicine that that really improves patient care and outcomes. So that's also the beauty of this. It is a workforce, but it is a quality educated and an elevated workforce that that you're getting.
SPEAKER_01Well, and you hear the term often in medical education that physicians are lifelong learners. You're always learning. So when you have young people that are constantly asking the how and the why, that keeps even the most um veteran physicians Oh, it keeps us on our toes.
SPEAKER_00Oh my gosh, I've been practicing medicine for about 22 years now. And I'll have medical students in my office and they'll say, What about this? I'm like, well, we'll talk about that after lunch. I'll go, you go read about that and tell me about it. Um, meanwhile, I'm looking things up and and and trying to educate myself. But they do, they keep you on your toes, and it's so refreshing. It's not, it's not intimidating at all. It's refreshing. Honestly, as I am teaching medical students or residents, I teach a lot of times in front of our patients. So now my patient is more educated about why I'm doing what I'm doing. My nursing staff is more educated about why I'm doing what I'm doing. It it truly rises. It, I mean, it just lifts everyone.
Replacing Retirements Without Losing Trust
SPEAKER_01You know, the the current state of GMA in Arkansas, we're scientists like yourself. We love numbers, hard numbers. One of the stats that we cite for why there was a need for new medical schools, also a need for new residency programs. About a third of the physician workforce in Arkansas is age 60 or older. So at that retirement place. So I set you up for my next question. And even with all this growth, we still have tremendous needs. And a lot of that is driven by that aging physician workforce, isn't it?
SPEAKER_00That's right. That's right. I can remember a student, I won't, I won't call him out, but um, he was saying, Hey, I'm going to return to my hometown um to practice medicine. And I just said, Hey, are you sure? Because, you know, I I'm related to a lot of people in my hometown. I don't, that's a lot of pressure. And he looked at me and he said, That town raised me. Why would I not want to give back and and and go and and give back to the people who gave so much to me? That sort of commitment is what we get in our medical students. Um, and I would like to say that's that's only in osteopathic medicine or only on our campus. It's what I see on our campus, but I think that is the generation that we're getting of medical students. They do want to make a big difference in their communities. Um, that aging workforce, you know, we have physicians that are working probably years, if not decades, beyond where they would have liked to have worked because they feel that need to stay and provide care to people who've depended on them. They don't want to seemingly abandon them. Um, so as you're training that workforce, you're training that those individuals that can come in and relieve that, um, relieve that physician who's dedicated their life to the community. Not in a we're going to replace you sort of a way, but hey, uh, you've cared for this community. Now you can, you can calmly hand it over to someone who's also going to care for this community. And that's just, that's just a beautiful thing.
SPEAKER_01And we were speaking, uh, we have specific examples of our graduates at our two local hospital partners in the A Baptists and St. Bernards who went through their internal medicine residencies and then kind of, like you said, tagged out one of their mentors and took over their patient panel and provided that soft landing. I don't know if that's an appropriate term, but the continuity of care was not interrupted because you had a young physician to take over that practice.
SPEAKER_00Exactly. And and in those two instances, the physician, the older physician, the retirement age physician was able to mentor personally to the person, to the physician that was then going to take over the care of their patient panel. And that's got to be a real relief to the patients and to the physician that is saying, okay, I'm I'm I'm passing this along to you. It's time and you're competent and and I know your character, I know your education, and I I trust you with with the care of these these individuals. And that that really is from a primary care physician standpoint, family physician. I I really take pride in in caring for my patients and knowing them. And um to say, okay, you can you can take care of that person, that that's a big honor.
SPEAKER_01It's a big deal. And it's uh why we're doing a lot of what we are is to create those, that pipeline.
Training Family Doctors In The Delta
SPEAKER_01So speaking of pipeline, last summer we at our medical school announced plans to open a new family medicine residency in Mississippi County, uh, Blyval, Oceola specific communities with the Mississippi County hospital system. Why is that program so crucial for both that medical, for our medical school and that community?
SPEAKER_00Well, um, certainly our medical school, um, we see that as an as an opportunity to um to further our mission and train physicians in the Delta for the Delta, um, train physicians in rural Arkansas for rural Arkansas. So um that that just that just meets our mission every day uh with that partnership with the the Blyville area specifically, um, that hospital is one uh is is a is a community hospital that still delivers babies. And if we if we look at the state of Arkansas, we only have about 31 facilities in our state um that are actively doing that, that are intentionally delivering. So when I talk to our medical students, our paramedic students, intentionally delivering, there are facilities that are delivering babies unintentionally. They they show up in the emergency room and and they're they're delivering a baby because the drive time has now extended. We see um the outcomes uh of uh of maternal health and and infant health in the Delta is not where we want it to be. We want it to be higher. Um, and we see that that the ability for that hospital in Blyville to continue to deliver babies and to continue to deliver high quality care in that area is just crucial. I mean, it's crucial for the people that live there. It's crucial for the ability for larger institutions like NEA Baptists and St. Bernard's, who are just a county over, not to not to have to um absorb all of those deliveries because that then puts a burden on those hospitals too. Um, but I think it's going to be a great partnership for education, for quality care, um, for sustainability for that uh that that program. And uh and for us, it's going to allow us to train family physicians in a rural area for the rural area and make sure that they have the skills, the education, um, the communication skills, the understanding of social determinants of health and population health to really play a big part, not only in the healthcare delivery, but also policies that affect the the health outcomes of people that live in that community.
SPEAKER_01And a rural track is going to be a little bit different because you don't have all these specialists to hand off to. So you really have to do more. You have to be trained to do more.
SPEAKER_00Right, right. If um, you know, we've we've we've only begun the very initial process of putting in an application. But if that is approved, um, it will be a great, a great partnership. Um, we'll be using um utilizing telemedicine to to help um help the residents become more comfortable with managing patients in a rural setting. Uh, but also we'll we'll have a partnership with a larger institution of St. Bernard in that as well. Um, so I think that that view of a larger institution with multi specialty care, partnering with uh in an entity that that has um fewer of those specialty resources readily available on site, but available via telemedicine and really be able to see oh, this is how we help a community. Thrive. This is how we help people stay in place and have the care that is still high quality and still what they need and go to those larger institutions when they need that specialty care on site.
SPEAKER_01Yeah.
What It Takes To Start A Program
SPEAKER_01So when you have a conversation with the hospital like Mississippi or other places about potentially opening a GME program, a residency program, where does that conversation start? And what are some of the benefits?
SPEAKER_00Yeah, we just gotta uh we begin with the interest. You know, what what is what is the goal of the community and and who all who all is at the table? Uh if it, if it's if it's only the hospital, it it might not go over very well. I know that sounds that sounds unusual, but you really need a community to come around something like this because you're bringing in people, you might be bringing in people from all over the nation to to work in that area and to be residents there. So you really want them to feel welcomed by Rotary, by Chamber of Commerce, um, by the local school system. You want them to be welcomed because they are bringing a skill that that community needs and you would love for them to stay and continue to provide that skill to the community. So those are some of the beginnings of those conversations. Um then there are other conversations about um just about capacity. So um if if uh if it's a really small community, they might not have a capacity to have a really large residency program. Maybe it's a small residency program, maybe it's something in a primary care specialty. Uh, maybe we need that community and a larger community to come together with that. Maybe we need that hospital and an FQHC or federally qualified health center to come together to um, you know, how can we combine resources and get the the maximum benefit for the community at large? So we it's it's bigger conversations. They're usually multiple conversations before before things um happen. Usually building graduate medical education is a it is a long game. Yeah. Um, but it is definitely worth it.
SPEAKER_01Yeah, I'm gonna backtrack just a little bit. Dr. Spite shares the story before he was at our medical school. He was a VP of medical affairs, a local hospital, and we only had one internal medicine residency in the entire state of Arkansas, producing um, I think 24-ish uh internal medicine physicians a year. And most of them were going to subspecialize, which we obviously have a need for, but we also have a significant need for internal medicine physicians that see patients in a clinic that uh work as hospitalists that take care of our. He could not hire hospitalists or outpatient primary care internal medicine positions because we just didn't have them in Arkansas. Um, so what did he do? He helped these hospitals create these programs. And now both of our local hospital partners, NEA Baptists and St. Bernard's, are both raising their own hospitalists and their own clinicians through their own programs. And that's exactly the way that it's supposed to work.
SPEAKER_00Right, right. The other benefit of having um having that primary care workforce that is really, really robust in a community, it actually helps you recruit specialty care because the specialty care uh knows that they have people who are going to be able to admit patients to the hospital, see them as follow-up, um, and refer to them. So that they see that that robust primary care base as a draw for specialty care.
SPEAKER_01A good reporter always closes every good conversation with the the question, what did I forget to ask? So what what what did we and we've covered a lot of ground here today, and it's encouraging to see the work that we're doing that um other institutions in the state are doing to address physician workforce and access uh issues in our state. Um give me give me a final word on the topic and your thoughts or anything I forgot to
Healthcare Teams And Community Impact
SPEAKER_01hit on.
SPEAKER_00Well, um, I'll go a little bit off topic, and I know that's gonna surprise you. Uh, a little bit off topic from graduate medical education, but we have to also understand that workforce includes so many people. I could not do my job without my uh front office staff, my nursing staff, um, tech staff. Uh uh I have a patient in the hospital today in labor. I could not, I couldn't, I couldn't do what I do without all of the supporting staff, laboratory technicians, uh, respiratory therapists, paramedics, EMTs. So when we're looking at that workforce, graduate medical education is one part of that workforce, but having that, um having that bolstered and um and reinforced with all the other key components. Um, I think that's just so vital for communities, large and small, to have those, have those there.
SPEAKER_01Well, and and a piece of that is that there's a statistic that one family medicine physician has a $1 million economic impact on a community because they're hiring nurses, they're purchasing things, they're bringing people into town that are going to shop in their grocery stores and pay property taxes and so on and so forth.
SPEAKER_00That's right. That's right. Uh, physical therapists, um, occupational therapists, they're they will come into those, those communities that have a more robust and stable medical community. Yeah. Um, it also, you know, that graduate medical education and that stable medical community draws industry.
SPEAKER_01Yeah.
SPEAKER_00Industry uh then will also bolster the education system. So it is, it's just so many things that are all kind of tied together. I know we were talking about graduate medical education, but it it's just one piece to to a puzzle of um of really strengthening a community.
SPEAKER_01And going back to raising that that tide that that we're uh dedicated to doing. Dr. Deal, this has been a great conversation. Thank you for your work and and all you do in this area. And uh thank you for listening to us today. We hope you've enjoyed our conversation. If you'd like to learn more about our medical school, you can visit us online at nyit.edu slash Arkansas. You can follow us on social media. Our handles are at NYIT com AR, as in New York Institute of Technology, College of Osteopathic Medicine, Arkansas. We really appreciate you for tuning in to us today, and we'll hope you'll join us again next time. Thanks so much.