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Arizona Primary Care Residency Training Assessment and
Development Project
Funded by the Arizona Area Health Education Centers (AHEC) Program at the
University of Arizona, Tucson, AZ
Doug Campos-Outcalt, M.D., M.P.A.
Joe Tabor, Ph.D., M.P.H.
Phil Lopes, M.A.
Ed Paul, M.D.
Communication regarding the report should be sent to [email protected]
2
Introduction
Arizona has a physician shortage. The state ranks 35th in the country with 218.3 physicians per 100,000
population compared to the national average of 255.8/100,000.1 (See Figure 1) In Arizona there are 14,398
active allopathic physicians and 1,615 active osteopathic physicians. To arrive at the national average we would
need an additional 2,475 physicians (a 15% increase over the current number).
Figure 1
Active Physicians per 100,000 Population by Degree Type, 2009 1
3
The physician shortage is more pronounced for primary care physicians than for specialists in Arizona and the
U.S. Only 38.2% of active physicians in Arizona are in primary care practices, defined as family medicine, general
practice, general internal medicine, general pediatrics, and obstetrics and gynecology2. As of June 30, 2011 in
the U.S. there were 6,422 primary care Health Professional Shortage Areas (HPSA’s) representing 66.6 million
people in both urban and rural areas. This equates to an estimated national shortage of 17,696 primary care
providers.3
The physician shortage is also more marked in rural areas than urban. Figure 2 shows the physicians per
population rate for all physicians for four rural-urban commuting areas (RUCA) of residence--urban, large rural
towns, small rural towns, and isolated small rural towns-- for the years 2002 through 2006. RUCAs are a
standard, nationwide classification of rural at postal zip code resolution. They are based on their proximity to
urban areas and the portion of the population that commute between rural and urban areas and are
approximately the same as US Office of Management and Budget’s metro classification. 4,5 Table 1 lists the
primary care physicians per population rate and Table 2 the specialists per population rate in the four RUCA
categories. These two tables illustrate that primary care physicians distribute themselves more evenly
throughout the state than do specialists. This is likely due in part to the population base needed to support
highly specialized practices.
Figure 2 2
Total Physicians (MD and DO) per 100,000 Population Profile for Arizona’s Four Rural Urban Commuting Areas:
2002-2006
Sources: Arizona Board of Medical Examiners Allopathic Physician Files 2008 and Arizona Department of Health Services, Arizona Primary Care Area Pro-
gram, Primary Care Area Osteopathic Physician Statistical Files, 2002-2006. Population estimates provided by Claritas.
4
Table 12
Primary Care Physicians (MDs and Dos) per 100,000 Population: Arizona’s Four Rural Urban Commuting Areas
(RUCA) Changes between 2002 and 2006
Table 2 2
Specialist Physicians (MDs and Dos) per 100,000 Population: Arizona’s Four Rural Urban Commuting Areas
(RUCA) Changes between 2002-2006
This report describes the current status of medical student and residency training in Arizona. It examines Arizona
physician workforce data to understand current supply and shortages by geography and specialty and explores
the current composition of the Arizona physician workforce to determine what contribution physicians trained
in the state, either in medical school and/or residency, are making to the workforce numbers in urban and rural
areas and in each county. The project also explores the characteristics of hospitals and hospital systems that do
and do not sponsor residency programs and reports on a survey of hospital directors about their interests, or
lack of, in sponsoring residency programs and the reasons behind these attitudes. Finally there are suggestions
about how the state’s training capacity might be expanded.
5
Medical Student Training in Arizona
Training to become a physician involves completing medical school, either allopathic (MD) or osteopathic (DO),
followed by residency training. Medical school lasts four years and residency training duration varies by
specialty, with three years of training required for most primary care specialties and three or more years for
specialty training. Some physicians complete multiple residencies, which further increases the lag time from
beginning medical school to becoming a practicing physician. It is possible to practice as a “general practitioner”
in Arizona after only one year of residency, which by definition means the physician has no specialty board
certification. However, very few new medical school graduates choose to be a general practitioner.
There are currently four medical school campuses in Arizona. Two are allopathic campuses of the University of
Arizona College of Medicine; one in Tucson and one in Phoenix. The Tucson campus was established in 1969 and
the Phoenix campus was established in 2006. There are two colleges of osteopathic medicine in the state. One is
the Midwestern University/Arizona College of Osteopathic Medicine (MWU/AZCOM), located in Glendale, the
other is the A. T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), located in Mesa. The
MWU/AZCOM was established in 1996 and ATSU-SOMA in 2007. In addition, the Kirksville College of
Osteopathic Medicine (KCOM), located in Missouri, sends approximately 30 students per year to Arizona for
their third and fourth year of training.
Table3 shows the growth of the Arizona population from 1990 to 2010 and the percentage of the U.S.
population living in Arizona. During this time period the Arizona population grew from 3.7 million people and 1.5
per cent of the U.S. population to 6.6 million people and 2.1 per cent of the U.S. population.
Table 3
Arizona Population Growth 1990-2010
1990 2000 2010
Arizona Population 3,665,000 5,130,000 6,596,000
U.S. population 248,710,000 248,100,000 307,000,000
Arizona % of the U.S. 1.5 1.8 2.1
Data obtained from the U.S. census bureau at http://quickfacts.census.gov/qfd/states/04000.html
Table 4 describes the trends in allopathic medical student education in Arizona and Table 5 the trends in
osteopathic medical student education. While the number of allopathic students trained in the state has
increased from 360 to 575 and the proportion of all medical students in the country who are trained in Arizona
also increased from 0.55 % to 0.8 %, the rate of medical students trained per 100,000 population has actually
declined from 9.8 to 8.7 and we remain well below the national rate of 24/100,000. These statistics will become
more favorable as the Phoenix campus grows and expands its class size. Within the next 10 years, the total
number of allopathic students being trained in the state should be 920, with 230 graduating each year.
6
The number of osteopathic students has grown at a much faster rate than allopathic. In 2010 20.8 per cent of all
medical students in the country were osteopathic, compared to 10 per cent in 1990. In Arizona the rate of
osteopathic students per 100,000 population (18.2) is well above the national rate of 6.3 and over 6 per cent of
all osteopathic students in the country are trained in Arizona. In Arizona 68.3 per cent of all medical students are
osteopathic compared to 20.8 per cent nationally. These numbers are also changing as the MWU/AZCOM is
expanding to 250 students per class, and if ATSU-SOMA remains at 100 per class there will be 1400 osteopathic
students trained in the state with 350 graduating each year.
In Arizona, if both allopathic and osteopathic training are taken into account, medical education has expanded
markedly and our current rate of medical students per 100,000 population (26.9) in 2010 is very close to the
national rate (30.3) and will exceed the national rate as growth in medical student education continues.
Table 4
Arizona Allopathic Medical Education 6-8
1990 2000 2010
Total Number of Medical Students USA
65,150 66,500 73,800
Number of Medical Students in Arizona
360 407 575
Az % of the total 0.55 % 0.6 % 0.8 %
Az Medical Students /100,000 population
9.8 7.9 8.7
US Medical Students /100,000
26.2 23.6 24.0
Table 5
Arizona Osteopathic Medical Education
1990 2000 2010 Total Number of Medical students USA
7,200 11,000 19,427
Number of Medical Students in Arizona
60 400 1200
Az % of the total 0.8 % 3.6 % 6.17 % Az Medical Students /100,000
0.16 7.8 18.2
US Medical Students /100,000
2.9 3.9 6.3
% of Arizona Medical Students who are Osteopathic
14% 50 % 68.3 %
% of all U.S Medical Students who are Osteopathic
10 % 14.4 % 20.8 %
7
Graduate Medical Education Training in Arizona
In contrast to the growth in medical student educational opportunities, the growth in post medical school
training in medical residencies (Graduate Medical Education or GME) has been more modest. Table 6 illustrates
this growth in GME training in Arizona from 1990 to 2010. These data were obtained from JAMA Medical
Education Issues. 9-11 The number of allopathic residency programs has increased between 1990 to 2010 from 67
to 114 and the number of trainees from 842 to 1,395. The proportion of residents in the country trained in
Arizona increased from 1.05 % to 1.27 %. However, the rate of residency positions per 100,000 population has
actually decreased, from 22.97 to 21.15 and remains far below the U.S. rate of 35.76. To equal the U.S rate
Arizona would need an additional 964 resident positions, or about 250 new first year positions.
Residency growth nationally is lagging behind growth in medical student education. This situation is especially
acute in Arizona because of its rapid growth in medical student training capacity and modest increase in the
number of allopathic residency programs and number of residency positions. Osteopathic training has not
contributed in any significant way to increasing residency capacity, although there have been several
osteopathic residencies started in rural parts of the state. The current 6 osteopathic residency training programs
in Arizona, with capacity for 76 residents, account for 3 per cent of the state’s total capacity for residency
training.
Table 6
Allopathic Residency Training in Arizona 9-11
1990-2010
1990 2000 2010
Number of Residency Programs in AZ
67 79 114
Number of AZ residents 842 1,039 1,395
Number of US residents.
80,200 98,000 109,800
National % in Arizona 1.05 % 1.06 % 1.27 %
Az residents /100,000 22.97 20.24 21.15
US residents /100,000 32.25 34.83 35.76
Difference 9.28 14.59 14.61
Appendices that relate to and further define the status of allopathic and osteopathic residency education in
Arizona appear at the end of this report. Appendix 1 lists, by specialty, the number of allopathic residency
training programs located in Arizona, the total number of programs in the U.S. and the number of resident
training positions available in the state. Appendix 2 lists, by specialty, the number of osteopathic training
programs in Arizona and their training capacities. Appendix 3 lists the specialties that have no training programs
8
in the state and the number of programs in those specialties in the U.S. Information on allopathic residency
programs for Arizona and the U.S. was obtained from the latest Graduate Medical Education Directory published
by the AMA.12 Information on Osteopathic residency programs was obtained from the AOA web site.13 For this
analysis and the Arizona physician workforce analysis that follows, primary care is defined as internal medicine,
pediatrics, family medicine and general practice; obstetrics and gynecology is not classified as primary care.
Currently about 39% of the allopathic residency training capacity in the state is for training of primary care
physicians (621 out of a total of 1593 positions) while 70% of the osteopathic residency capacity is for primary
care (53 out of 76 positions). The Arizona primary care residency programs are graduating around 230 physicians
each year. The number who will actually go on to practice primary care is smaller, however, because
traditionally half or more of pediatricians and internists continue in training to subspecialize.
Historically approximately one-fourth or more of all residency positions in the country have been filled by
international medical graduates (IMGs), including U.S citizens that study abroad. It is likely that the combination
of a growth in medical student training in the U.S. and the slow growth in the number of residency positions will
result in a smaller proportion of IMGs accepted into U.S. residency programs. Unless residency training capacity
increases the overall increase in the U.S. physician workforce will therefore be very slight, in spite of increases
that have occurred in the number of medical students trained.
In Arizona the current trends may result in more Arizona medical students remaining in the state for residency
training, although this is uncertain because many variables factor into the decisions residency program faculty
and medical students make regarding residency training location. The total number of physicians being trained
in Arizona residencies, those most likely to remain in the state to practice, may increase marginally through
increases in the size of existing residency programs but it will not keep up with population growth unless
residency capacity is expanded by the creation of new programs.
Arizona Physician Workforce Analysis
Methods
The dataset for Arizona allopathic and osteopathic physicians was obtained from the American Medical
Association (AMA) in January 2011. The classifications of practice specialty were based on the two self-identified
specialties listed in the database. This study classifies primary care physicians as those whose specialty includes
family medicine, internal medicine, or pediatrics. Physicians that were not providing direct patient care were
excluded from the analysis, such as administrators (except for those in private practice and HMOs), some
research positions, and government positions not associated with hospitals. Residents in training and physicians
80 years of age or greater were also excluded. The algorithms used to aggregate and classify practice and
specialty types are available upon request.
Communities in Arizona were classified into rural-urban commuting areas (RUCA) using postal zip code
geography to compare differences in the levels of community rurality in the state. The RUCAs are based on US
Census tract data and provide a standard, nationwide classification of rural. RUCA’s were converted to zip code
geographies by the University of Washington (http://depts.washington.edu/uwruca/). The three categories of
9
RUCAs that were used are: urban areas (e.g., Phoenix), large rural town areas (e.g., Payson), and small rural
town areas (e.g., Chinle, Ashfork and Tombstone) (Map 1 and Appendix 7). This three-category classification is
commonly used for health related projects. It divides urban and rural areas approximately the same way as the
US Office of Management and Budget’s metro classification. Population estimates by zip codes were provided by
Nielsen-Claritas, a marketing research company.14
Map 1
Rural Classification by Rural-Urban Commuting Areas that are based on Zip Code Geography in Arizona.
Workforce summaries are presented as total counts and relative counts of currently licensed, direct patient care
physicians. These values likely over estimate the number of practicing, full-time equivalent (FTE) physicians.
County and state population numbers were obtained from the U.S. census. The relative counts are presented as
a rate, the number of physicians per 100,000 population by counties (US Census data) or by RUCA (Nielsen
Claritas data). The US Census and Nielsen Claritas population numbers are not necessarily the same; the relative
counts of physicians at the state-level can be slightly different between estimates based on county and RUCA
geographies.
Results
Table 7 shows the number of primary care, specialist and total physicians (MD and DO) and the location of their
medical school and residency training, categorized as in state or out of state. The important points illustrated in
this table include:
10
66.4% of active physicians in direct patient care in Arizona did not complete either medical school or
residency in Arizona.
10.8% completed medical school in Arizona
30% completed residency in Arizona.
7.2% completed both medical school and residency in Arizona.
A higher proportion of primary care physicians completed medical school (13%) or residency (36.8%) in
the state than did other specialists (9.6% and 26.4%).
Table 7
Arizona Physicians by Specialty and Medical Training
Primary Care Non Primary Care All Physicians
All Direct Care Physicians 4,980 9,175 14,155
No Arizona Training (%) 2,982 (59.9%) 6,421 (70.0%) 9,403 (66.4%)
Arizona Medical School, no Arizona Residency (%)
162 (3.3%) 337 (3.7%) 499 (3.5%)
Arizona Residency, no Arizona Medical School (%)
1,352 (27.1%) 1,877 (20.5%) 3,229 (22.8%)
Both Arizona Medical School and Residency (%)
484 (9.7%) 540 (5.9%) 1,024 (7.2%)
Arizona Medical School +/- Residency (%)
646 (13.0%) 877 (9.6%) 1,523 (10.8%)
Arizona Residency +/- Medical School (%)
1,836 (36.9%) 2,417 (26.3%) 4,253 (30.0%)
Table 8 shows the physicians per population rate for in each category of training history for each of the three
rural categories. This shows the comparative contribution of each category to the physician workforce in these
three categories and allows for inter category comparisons. Important points to notice in this table are:
All three urban/rural categories appear to recruit primary care physicians trained out of state at about
the same rate (44.1-48.6 per 100,000 population)
The more rural a location the fewer specialists there are on a per capita basis, regardless of training
background.
11
Arizona medical students who complete a residency out of state currently contribute very little to the
state’s physician workforce. This is especially true for non-primary care specialists where only 5.4 of the
148/100,000 state total comes from this category). However, those who return to practice primary care
contribute at a higher rate in rural areas than urban (3.7 and 3.5 vs. 2.4 per 100,000). This may be a
reflection of some medical students who desire rural training who need to go out of state to obtain it.
Those who complete a residency in the state but medical school elsewhere remain predominantly in
urban areas to practice. These are probably areas in close proximity to their training programs.
However, this group contributes to rural workforce at a higher rate than Arizona medical students who
leave the state for residency.
Residency training accounts for higher physician rates than medical school training in all areas of the
state. However, the difference between these two options is much more marked in urban areas than
the two rural categories.
It should be noted that these data reflect the training of physicians who are currently practicing in the state and
do not reflect what any cohort of students do. For instance we are not reporting on what proportion of medical
students who are trained in Arizona end up practicing here. It should also be noted that the small contribution
of in-state medical school training to the state’s physician workforce totals reflects the relatively small number
of medical students trained in the state up until the past decade and the time it takes to progress from the start
of medical school to location in practice, which is about a decade.
Table 8
Physicians per 100,000 Population by Specialty and Location of Medical Training in RUCA Categories
Arizona 2010
Physician per 100,000
RUCAs Primary Care
Non Primary Care
All Physicians
All State wide 80.3 148.0 228.4
Urban 84.1 164.0 248.1
Rural, large towns 58.1 74.5 132.7
Rural, small towns 59.7 42.2 101.9
No Arizona Training State wide 48.1 103.6 151.7
Urban 48.6 113.4 162.0
Rural, large towns 44.1 61.6 105.7
Rural, small towns 46.5 35.7 82.2
Arizona Medical School no Arizona Residency
State wide 2.6 5.4 8.1
Urban 2.4 6.0 8.5
Rural, large towns 3.5 2.8 6.2
Rural, small towns 3.7 1.4 5.1
12
Arizona Residency, no Medical School State wide 21.8 30.3 52.1
Urban 24.4 34.5 59.0
Rural, large towns 7.8 8.5 16.4
Rural, small towns 6.1 4.1 10.1
Arizona Medical School and Residency State wide 7.8 8.7 16.5
Urban 8.6 10.0 18.6
Rural, large towns 2.8 1.6 4.4
Rural, small towns 3.5 1.0 4.5
Arizona Medical School +/- Residency State wide 10.4 14.1 24.6
Urban 11.1 16.0 27.1
Rural, large towns 6.2 4.4 10.6
Rural, small towns 7.1 2.4 9.5
Arizona Residency +/- Medical School State wide 29.6 39.0 68.6
Urban 33.1 44.5 77.6
Rural, large towns 10.6 10.2 20.8
Rural, small towns 9.5 5.1 14.6
There are currently 40 physicians practicing in rural Arizona who graduated from an Arizona residency program
between 1990 and 2009. The specialty of these physicians is described in Table 9. Fifty-three percent are family
physicians; 65% in the most rural areas. Time trends show a declining interest in rural practice among graduates
from Arizona residencies. There are 28 primary care physicians in rural Arizona who graduated from an Arizona
residency between 1990-1999 but only 12 who graduated between 2000-2009. Only one internal medicine
physician in rural Arizona graduated from an Arizona residency in the last 10 years.
Table 9
Primary Care Physician Graduates from Arizona Residency Programs, 1990-2009,
Practicing in Rural Areas, by RUCA Category
Rural Large Towns Rural Small Towns Total Rural
# (%) #(%) #(%)
Family Medicine 8 (40) 13 (65) 21 (53)
Internal Medicine 8 (40) 5 (25) 13 (32)
Pediatrics 2 (10) 0 (0) 2 (5)
Internal Medicine/Pediatrics 2 (10) 2 (10) 4 (10)
Total 20 20 40
13
Table 10 explores the age distribution of primary care physicians in each county and rural category by illustrating
the proportion of physicians in ten-year age groups. Rural areas have a slightly larger percentage of active
physicians age 60-79 than the other age groups but only by 1-2 %. The more rural areas do have a smaller
proportion of the two youngest groups, with there being a 10% or greater difference compared to urban.
Several counties have a significantly larger proportion of physicians in the two older age groups; Cochise over
40% and Gila, La Paz and Yavapai over 30%. Several small counties have few or no primary care physicians under
age 50; Santa Cruz and Greenlee.
Table 10
Proportion of Primary Care Physicians by Age Groups for Each County and RUCA
Arizona 2010
Table 11 illustrates the age distribution of non primary care physicians in each county and rural category by
illustrating the proportion of physicians in ten-year age groups. The two more rural categories have a smaller
Proportion of specialists under age 50 and a larger proportion age 60 and above. Forty percent or more of
specialists are age 60 or older in Cochise, Gila, Greenlee, and Santa Cruz counties.
0%10%20%30%40%50%60%70%80%90%
100%
STA
TE (
49
80
)
UR
BA
N (
44
34
)
RU
RA
L LA
RG
E TO
WN
S (2
52
)
RU
RA
L SM
ALL
TO
WN
S (2
94
)
AP
AC
HE
(3
9)
CO
CH
ISE
(6
4)
CO
CO
NIN
O (
14
7)
GIL
A (
41
)
GR
AH
AM
(2
6)
GR
EEN
LEE
(5
)
LA P
AZ
(1
2)
MA
RIC
OP
A (
31
37
)
MO
HA
VE
(1
14
)
NA
VA
JO (
80
)
PIM
A (
96
5)
PIN
AL
(7
7)
SAN
TA C
RU
Z (
17
)
YAV
AP
AI
(15
0)
YUM
A (
99
)
70-79
60-69
50-59
40-49
<40
14
Table 11
Proportion of Non Primary Care Physicians by Age Groups for Each County and RUCA
Arizona 2010
Hospital Sponsorship of Residency Programs in Arizona
Table 12 lists the hospitals that sponsor allopathic residency programs in Arizona and Table 13 lists the hospitals
and other facilities that sponsor osteopathic residency programs. Appendix 1 lists the allopathic residency
programs that are available in the state, Appendix 2 lists the osteopathic programs available in the state, and
Appendix 3 lists the allopathic training programs that are available elsewhere in the U.S but not in Arizona.
Information on allopathic residency programs for Arizona and the U.S. was obtained from the latest Graduate
Medical Education Directory published by the AMA.12 Information on Osteopathic residency programs was
obtained from the AOA web site.13
Some hospitals participate in training residents without actually sponsoring the program they collaborate with.
This collaboration takes the form of having residents on their sites for part of their training. Some hospitals
sponsor their own residencies and participate in other hospitals’ programs. Table 14 lists hospitals in Arizona
that participate in residency programs but do not sponsor them and Table 15 lists other institutions that also
participate in residency training.
0%10%20%30%40%50%60%70%80%90%
100%
STA
TE (
91
75
)
UR
BA
N (
86
44
)
RU
RA
L LA
RG
E TO
WN
S (3
23
)
RU
RA
L SM
ALL
TO
WN
S (2
08
)
AP
AC
HE
(2
7)
CO
CH
ISE
(6
9)
CO
CO
NIN
O (
24
0)
GIL
A (
26
)
GR
AH
AM
(5
)
GR
EEN
LEE
(2
)
LA P
AZ
(2
)
MA
RIC
OP
A (
60
98
)
MO
HA
VE
(1
82
)
NA
VA
JO (
46
)
PIM
A (
19
99
)
PIN
AL
(8
8)
SAN
TA C
RU
Z (
14
)
YAV
AP
AI
(22
6)
YUM
A (
15
1)
70-79
60-69
50-59
40-49
<40
15
Table 12 12
Hospitals Sponsoring Allopathic Residency Programs
Arizona, 2010
Hospital Number of programs
University of Arizona (UMC) 39
Banner Good Samaritan 15
St Joseph’s 15
Maricopa Medical Center 8
University Physicians Hospital Kino 6
Phoenix Children’s Hospital 5
Phoenix Baptist 1
Scottsdale Osborn 1
Tucson Medical Center 1
Total 91
Table 1313
Hospitals and Other Facilities Sponsoring Osteopathic Residency Programs
Arizona, 2010
Institution Number of programs
Kingman Regional Medical Center 2
Sierra Vista Regional Health Center 2
Valley Medical Center, Cottonwood 1
Alta Dermatology, Mesa 1
Desert Dermatology, Peoria 1
Total 8
16
Table 1412
Hospitals participating in but not Sponsoring Allopathic Residency Programs
Arizona, 2010
Hospital Number of programs participating in
Mayo Hospital/Clinic* 26
VA Tucson 21
UPKH 12
VA Phoenix 9
St Joseph’s 6
Phoenix Children’s Hospital 2
Scottsdale Shea 1
Scottsdale Osborn 1
Banner Sun City 1
Total 79
*Mayo hospital operates these residency programs in Arizona but they are sponsored by Mayo Medical
School in Minnesota.
Table 1512
Other Institutions Participating in Allopathic Residency Training in Arizona
Institution Number of programs
Maricopa county medical examiner 1
NIH Phoenix branch 1
Orthopedic clinic associates 1
Trans genomic Institute 1
ASU student health 2
Tucson orthopedic 1
U of A student health 1
University orthopedic specialists 1
Total 9
Appendix 4 lists all hospitals in Arizona by number of beds. Appendices 5 and 6 compare characteristics of
hospitals and hospital systems that sponsor residency programs and those that do not. Data were secured from
the AZ Department of Health Services Uniform Accounting Reports for 2009 and 2010, and updated March
2011.15 Variables that are examined include number of licensed beds, gross patient revenues and annual
patient-bed days. Six hospital systems and five individual hospitals sponsor residency programs across the state.
The Phoenix metropolitan area is served by four of these hospital systems (Abrazo, Banner, Catholic Healthcare
17
West, and Scottsdale Healthcare) and two of the individual hospitals (Maricopa Medical Center and Mayo
Clinic). The Tucson metropolitan area is served by one of the hospital systems (University Medical Center/UPH
Kino) and one of the individual hospitals (Tucson Medical Center). One hospital system, Northern Arizona, and
three hospitals that sponsor residency programs are located in non-metropolitan areas: Kingman Regional
Hospital located in Kingman, Sierra Vista Hospital in Sierra Vista, and Verde Valley Hospital (part of the Northern
Arizona Health System) in Cottonwood. Kingman is the only one licensed as a rural hospital.
The six systems and five individual hospitals that sponsor residency programs currently have 8,715 beds
available. The available bed number ranges from 88 at Sierra Vista to more than 3,000 in the Banner System.
The systems and hospitals together generate over 2 million patient days. Kingman and Sierra Vista each have the
fewest patient days, 36,237 and 17,845 respectively. All others exceed 100,000 Patient Days with Banner having
the most at 843,548.
Kingman, Sierra Vista, and Northern Arizona Health System have gross patient revenue of $559, 282, 675,
$264,555,029, and $877,366,200 respectively. Each of the other systems and hospitals that sponsor residencies
generate gross patient revenue in excess of $1 billion. The range for the latter group is from $1.26 billion at
Tucson Medical Center to more than $9.97 billion at Banner. Mayo generates the highest gross patient revenue
per available bed, $5,481,299, which is more than double the median for all systems and hospitals. Catholic
Healthcare West has the second highest at $4,672,950. Northern Arizona Health System has the lowest at
$2,302,798.
University Medical Center has two facilities affiliated with the state’s allopathic medical school campus in Tucson
and has the highest number of residents at 588; the next highest number is 260 at Banner. Sierra Vista has the
fewest at 16.(Northern Arizona has only 8 but they are in their first years of operation and will have up to 18
when fully operational) All others range from 21 to 230.
Available beds per resident ranges from a high of 47.63 at Northern Arizona and 46.71 in the Abrazo System to
0.87 in the University Medical Center System. The median for all is 6.40 beds per resident.
Similarly the number of patient days per resident is highest at Northern Arizona (29.54) and lowest at University
Medical Center (0.72) and the median for all is 3.97.
Abrazo has the highest gross patient revenue per resident ($112 million) and University Medical Center the
lowest ($3 million). The median is $22.37 million.
Among the systems and individual hospitals that do not sponsor residency programs, the Carondolet System in
Tucson has the highest number of available beds at 945 followed by IASIS Healthcare and John C. Lincoln
systems with 497 and 469 beds respectively. Yuma Regional is the single hospital with the highest number of
beds, 333. Carondolet and Yavapai Regional also have the highest number of patient days at 195,750 and
121,063. Of the single hospitals Yuma has the highest number of patient days at 64,142.
The Carondolet system generates the highest gross patient revenue at over $2.1 million. For single hospitals
Yuma has the highest gross patient revenue at almost $887,689,223.
18
Where Could Other Residency Programs be Located in Arizona?
Among the hospitals systems that sponsor residency programs there is much variation in hospital size measured
by available beds, patient days, and gross patient revenue. Sierra Vista with 88 beds, slightly less than 18
thousand patient days, less than $300,000 in gross patient revenues, and gross patient revenue per available
bed of slightly more than $3 million, sponsors 16 residents.
If 100 beds, 20,000 patient days, $300 thousand in gross patient revenue, and more than $3 million of gross
patient revenue per available bed, was considered the minimum capacity for sponsoring residency programs,
then 16 additional Arizona hospitals could sponsor residency programs. These would be:
Arrowhead, Glendale
Banner Boswell
Banner Baywood
Banner Estrella
Banner Gateway
Chandler Regional
Flagstaff Medical Center
John C. Lincoln, Deer Valley
John C. Lincoln, North Mountain
Mercy Gilbert Medical Center
Mountain Vista Medical Center, Mesa
Northwest Medical Center, Tucson
Scottsdale, Shea
West Valley, Goodyear
West AZ Regional, Bullhead City
Yavapai Regional, Prescott
If using the single criterion of gross patient revenue per available bed, and using the lowest one of these among
hospitals that does sponsor residencies (Tucson Medical Center at $2,227,006), as the minimum, then 18
Arizona hospitals could sponsor residency programs, including:
Banner Thunderbird
Banner Desert Medical Center
Banner Dell Webb
Carondolet St Josephs
Carondolet Holy Cross
Cobre Valley, Globe
Copper Queen, Bisbee
Gilbert, Higley
Scottsdale Healthcare, Shea
19
Kingman Regional
Little Colorado Medical Center, Winslow
Northwest, Oro Valley
Payson Regional
Southeast AZ Medical Center, Douglas
Summit Healthcare Regional, Payson
St Lukes, Tempe
Valley View Medical Center, Fort Mohave
Yavapai Medical Center, Prescott Valley
Yuma Regional
If the number of beds is the sole criteria, then hospitals with 100 beds or more are potential and these are listed
in Appendix 7.
Survey of Hospitals
Methods
An electronic survey was sent to 57 hospital Chief Executive Officers (CEOs). Responses were received from 39
for a response rate of 68%. Of hospitals with 50+ beds there were 51 in the universe of which 35 responded for a
response rate of 70 %. All (100%) of the hospital systems responded.
The survey questions were divided into two categories; those that currently have residency programs and those
that do not. For the first group questions included number and specialty of programs, number of residents, and
plans for expansion or reduction of positions or programs. For the second group questions included: previous
attempts at establishing programs and in what specialties, or if no previous attempts, reasons for not doing so,
and what information or assistance would be needed to plan for establishing programs.
Of the hospitals not sponsoring residency programs, none of the directors at the present time are thinking about
doing so except at Yuma Regional, which is in the process of establishing 4 primary care residencies. Seven
responses indicated that they had, in the past, considered establishing residencies. The reasons for not doing so
included:
Issues and uncertainties related to direct medical education and indirect medical education funding by
Medicare.
Financial concerns.
Lack of Board interest in the GME process at a community hospital.
A perceived need to partner with another organization.
Not enough physician support of the project.
20
In answer to the question “What would be useful to you if you were to consider whether or not to sponsor
residencies?” the answers were:
Information on the costs associated with residencies and the reimbursement.
Accreditation requirements associated with such a commitment.
In answer to the question “what factors will most affect a decision whether or not to sponsor a residency
program?” the answers were:
Cost and reimbursement.
Resources, i.e. time, money, and staffing.
Ability to partner with another organization to fill in gaps in our institution
Survey of Community Health Centers
Other institutions such as community health centers (CHCs) can sponsor residency programs but the way
programs are funded through Medicare and Medicaid, with reimbursement going to hospitals, makes this
difficult. The Affordable Care Act appropriates money through the Health Resources and Services Administration
for CHCs to plan for and operate residencies, with funding going directly to the health centers. This potentially
offers a small number of CHC’s the opportunity to sponsor residencies.
The staff at the Arizona Association of Community Health Centers was asked to survey directors of the
community health centers in the state to ascertain if any are considering sponsoring residency programs.
Currently, two report that they are; one in Tucson and one in Flagstaff. However, only the CHC in Flagstaff,
North Country CHC, is actively working toward establishing a program. The North Country CHC has plans to start
a family medicine residency for 4 residents per year to start in July 2013.
Remaining Questions
There are several questions regarding medical education in the state and its impact on the Arizona physician
workforce that are pertinent for planning purposes and that currently are unanswered.
1. What proportion of medical students trained in Arizona eventually practice in the state?
a. Does this proportion vary between those who received residency training in Arizona and
elsewhere?
b. Does this proportion vary by location of residency training (rural vs. urban)?
2. What proportion of residents trained in Arizona will stay and practice in the state following completion
of residency?
a. Does this proportion vary between those who grew up in Arizona and those who did not?
b. Does this proportion vary by location of medical school training (in state vs. out of state)?
21
It is commonly believed that those most likely to practice in the state, in order of likelihood are:
Those who grew up in Arizona and who complete both medical school and residency in Arizona
Those who grew up in Arizona who complete medical school out of state and residency in state
Those who did not grow up in Arizona who complete residency in state
Those who grew up in Arizona who complete medical school in state and residency out of state
However, data to support these beliefs are not currently available and will not be provided by this study.
Prospective or retrospective cohort studies would be needed to explore these issues.
3. Given the concerns raised by community hospital CEO’s, what real incentives exist and what incentives
can be created to move CEO’s and hospital boards to develop new residency programs?
Recommendations From the Advisory Group
The final component of this project involved presenting the findings to an advisory group of stakeholders to seek
their input on the analyses and to develop ideas for addressing the need for more residency training in Arizona.
A half-day meeting was held at the University of Arizona College of Medicine, Phoenix Campus, on June 28,
2011. Appendix 9 lists those who attended.
The data in the report were presented and discussed and then time was devoted to brainstorming about
possible approaches. The recommendations made by the Advisory Group can be divided into two categories;
those pertaining to workforce tracking, analysis and technical assistance; and ideas for potential state policies.
Work Force Tracking, Analysis and Technical Assistance
The Advisory Group recommended to:
1. Establish a state health care workforce commission.
a. Have the AHEC convene the advisory group periodically until such a commission is established.
b. Explore sources of funding from foundations.
c. Include the Bureau of Primary Care at the Arizona Department of Health Services.
2. Look for any evidence that shows that residencies in a hospital are associated with higher quality.
3. Develop a pool of consultants on GME funding, accreditation standards, practical aspects of starting a
program.
4. Bring to AZ someone from a CHC-sponsored program that currently receives CMS GME funding so they
can educate us on how that is achieved.
5. Explore with the Colleges of Medicine the potential for 1-2 programs in collaboration with rural
hospitals. (1-2 programs are describe in Appendix 10)
6. Engage the business community by involving the Chamber of Commerce. Demonstrate to them the
economic impact of residency training.
7. Have regional AHECs track rotations from medical students from out of state.
22
Policies to Increase the Number of Residency Programs
The Advisory Group came up with some suggested policy actions, including:
1. Creating incentives to start programs for hospitals that do not currently sponsor programs.
2. Developing additional incentives to start primary care residency programs, especially in rural areas.
3. Concentrating on the Banner system and possibly meeting with their leadership.
4. Meeting with the Arizona congressional delegation to discuss modification of the GME funding cap
rules for new programs to advocate for more time to phase in a series of programs at new hospitals
before they are capped. (More than the current three year period)
5. Emphasizing to policy makers that quality of life in Arizona affects recruitment and retention of
physicians.
6. Developing a source of bridge funds that can be used to support a program until federal GME
funding kicks in.
23
References
1. AAMC. 2011 State Physician Workforce Data Release. March 2011.
https://www.aamc.org/download/181238/data/state_databook_update.pdf
2. Eng HJ, Tabor J, Hughes A. Arizona Rural Health Workforce Trend Analysis. University of Arizona Rural
Health Office, 2011.
3. U.S. Dept of Health & Human Services, Health Resources and Services Administration. Shortage Designation: Health Professional Shortage Areas & Medically Underserved Areas/Populations. June 2011 http://bhpr.hrsa.gov/shortage/
4. Office of Management and Budget. Update of Statistical Area Definitions and Guidance on Their Uses. Washington, DC. 2009. http://www.whitehouse.gov/sites/default/files/omb/assets/bulletins/b10-02.pdf
5. Rural Health Research Center. RUCA Data. University of Washington, Seattle. http://depts.washington.edu/uwruca/ruca-uses.php
6. Jonas HS, Etzel SI, Barzansky B. Undergraduate medical education. JAMA 1989;262:1011-1019. 7. Medical Schools in the United States. JAMA 2000;284:1149-1157. 8. Medical Schools in the United States, 2009-2010. JAMA 2010;1247-1254.
9. Etzel SI, Egan RL, Shevrin MP, Rowley BD. Graduate medical education in the United States. JAMA
1989;262:1029-1037.
10. Graduate Medical Education. JAMA 2000; 284:1159-1172.
11. Brotherton SE, Etzel SI. Graduate Medical Education 2009-2010. JAMA 2010;304:1255-1270.
12. AMA. Graduate Medical Education Directory 2010-2011. Chicago 2010
13. AOA. Approved Internships and residencies.
http://opportunities.osteopathic.org/search/search.cfm?searchType=1&CFID=1481109&CFTOKEN=cd70
e784d6364d16-243EABFB-FDFF-13FB-
692F5C8F3E08FB20&jsessionid=f030ecbe1d1ef6943d5a16183d6481569742
14. Nielsen. SiteReport. http://www.claritas.com/sitereports/Default.jsp
15. AZ Department of Health Services, Uniform Accounting Reports 2010, updated March 2011.
http://www.azdhs.gov/plan/crr/cr/hospitals.htm
24
Appendix 1
Allopathic Residency Programs in Arizona, 2010 12
Number of Programs in Arizona (number of programs in U.S.)
Capacity, number of trainees approved for
Primary Care
Family medicine 6 (459) 141
Geriatrics 3 (141) 9
Internal medicine 6 (383) 302
Internal medicine/Pediatrics 1 (80) 24
Pediatrics 3(195) 145
Total 19 (1258) 621
Non Primary Care
Anesthesiology 2 (130) 45
Dermatology 1 (109) 6
Emergency medicine 3 (143) 108
Medical toxicology 1 4
Sports medicine 2 (97) 4
Hospice and palliative care 1 1
Cardiovascular disease 3 (177) 38
Clinical cardiac electrophysiology 1 (95) 1
Endocrinology 2 (122) 9
Gastroenterology 3 (154) 25
Hematology and oncology 2 (127) 10
Infectious diseases 1 (141) 5
Interventional cardiology 3 (130) 6
Nephrology 1 (139) 6
Pulmonary medicine 1 (25) 2
Pulmonary and critical care 2 (130) 16
Rheumatology 1 (109) 4
Transplant hepatology 1 2
Molecular genetic pathology 1 1
Neurological surgery 2(97) 34
Endovascular surgical neuroradiology
1 2
Neurology 4 (124) 51
Child neurology 1 (69) 3
Clinical neurophysiology 2 (91) 4
Vascular neurology 2 2
Obstetrics and gynecology 3 (247) 83
Ophthalmology 2 (118) 12
Orthopedic surgery 2 (153) 35
25
Adult reconstructive orthopedics 1 1
Orthopedic sports medicine 1 (78) 2
Otolaryngology 1(104) 10
Pain Medicine 1(92) 1
Pathology—Anatomical and clinical
2(150) 26
Hematology 1 (79) 1
Neuropathology 1(35( 1
Pediatric emergency medicine 1 (46) 6
Pediatric endocrinology 2 (67) 6
Pediatric hematology/oncology 1 (66) 6
Pediatric pulmonology 1 (47) 3
Pediatrics/ Emergency medicine combined
1 (3) 10
Plastic surgery 1 (87) 4
Psychiatry 4 (181) 106
Child psychiatry 2 (121) 7
Radiation oncology 1 (80) 6
Radiology 3 (188) 53
Neuroradiology 2 (86) 10
Pediatric radiology 1 (43) 3
Vascular and interventional radiology
1 (93) 1
Surgery, general 5 (251) 160
Surgery, critical care 1 (90) 2
Vascular surgery 3(96) 9
Thoracic surgery 1 (79) 2
Transitional year 2 (124) 18
Urology 2 (118) 14
Total 94 972
Primary care and non primary care Total
113*** 1593
** Can be under either Internal Medicine or Family Medicine
*** Does not total 114 as in Table 6 because Mayo ended its family medicine program which is included in Table
6 but not in Appendix 1
26
Appendix 2
Osteopathic Residency Programs in Arizona
Number of programs Number of slots
Dermatology 2 7
Emergency medicine 1 16
Family medicine 2 23
Internal medicine 2 30
Total 7 76
Appendix 3
Allopathic Residency Programs Not Available in Arizona 2010
(Numbers of programs available in the U.S.)
Allergy and immunology (71)
Critical care medicine (49)
Adult cardiothoracic anesthesiology (38)
Pediatric anesthesiology (46)
Colon and rectal surgery (45)
Dermatopathology (54)
Procedural dermatology (42)
Medical genetics
Nuclear medicine (56)
Hand surgery (55)
Blood banking (46)
Cytopathology (85)
Selective pathology (56)
Neonatal medicine (97)
Pediatric emergency medicine (21)
Pediatric cardiology (47)
Pediatric critical care (61)
Pediatric gastroenterology (51)
Pediatric infectious diseases (61)
Pediatric nephrology (37)
Physical medicine and rehabilitation (79)
Preventive medicine (71)
Geriatric psychiatry (60)
Pediatric surgery (34)
27
Appendix 4
Hospitals in Arizona by Number of Beds
HOSPITAL CITY SYSTEM BEDS (Licensed)
300 Beds or more
St. Josephs Hospital & Med. Ctr. Phoenix CHW 738
Maricopa Med. Ctr. Phoenix 718
Banner Good Samaritan Phoenix Banner 662
Banner Desert Med. Ctr. Mesa Banner 649
Tucson Medical Center Tucson 628
Banner Thunderbird Glendale Banner 513
Carondolet St. Josephs Tucson Carondelet 478
Scottsdale Healthcare-Shea Scottsdale Scottsdale Health 433
Banner Boswell Sun City Banner 430
Banner Del Webb Sun City West Banner 404
Carondolet St. Mary’s Tucson Carondelet 402
University Medical Ctr. Tucson UMC 355
Phoenix Childrens Phoenix 345
Banner Baywood Mesa Banner 340
Scottsdale Healthcare-Osborn Scottsdale Scottsdale Health 337
Yuma Regional Med. Ctr. Yuma 333
Northwest Med. Ctr. Tucson Community Hlth. 300
200-299 Beds
Flagstaff Medical Center Flagstaff Northern AZ Hlth. 271
John C. Lincoln North Mt. Phoenix JCL 266
Mayo Clinic Phoenix 244
Phoenix Baptist /AZ Heart Phoenix Abrazo 236
Kingman Regional Kingman 235
Maryvale Hospital Phoenix Abrazo 232
St. Luke’s Med. Ctr. Phoenix IASIS 232
Chandler Regional Chandler CHW 225
Arrowhead Hospital Glendale Abrazo 220
Banner Estrella Phoenix Banner 214
Mercy Gilbert Med. Ctr. Gilbert CHW 206
John C. Lincoln Deer Valley Phoenix JCL 204
100 TO 199 BEDS
UPH at Kino Tucson UMC 197
Casa Grande Regional Casa Grande 187
28
Havasu Regional Med. Ctr Havasu City 181
Mountain Vista Med. Ctr. Mesa IASIS 178
Banner Gateway Gilbert Banner 165
West Valley Hospital Goodyear Abrazo 164
Northwest Med. Ctr. Oro Valley Community Hlth. 144
West AZ Regional Med. Ctr. Bullhead City 139
Paradise Valley Hospital Phoenix Abrazo 136
Yavapai Regional Med. Ctr. Prescott Yavapai Regional 136
Verde Valley Med. Ctr. Cottonwood Northern AZ Hlth. 110
AZ Regional Medical Center Mesa 103
LESS THAN 100 BEDS
Sierra Vista Regional Sierra Vista 88
Tempe St. Luke’s Tempe IASIS 87
Summit Healthcare Reg. Med. Ctr. Show Low 81
Hualapai Mt. Med. Ctr. Kingman 70
Scottsdale Healthcare-Thompson Peak Scottsdale Scottsdale Health 64
Mt. Graham Reg. Med. Ctr. Safford 55
Yavapai Reg. Med. Ctr. East Prescott Valley Yavapai Regional 50
Payson Regional Med. Ctr Payson 44
La Paz Regional Parker 39
Banner Ironwood San Tan Valley Banner 36
Carondolet Holy Cross Nogales Carondelet 25
Cobre Valley Hospital Globe 25
Little Colorado Med. Ctr Winslow 25
Page Hospital Page Banner 25
Sage Memorial Ganado 25
Southeast AZ Med. Ctr. Douglas 25
Northern Cochise Community Willcox 24
Benson Hospital Benson 22
Gilbert Hospital Higley 19
Wickenberg Community Wickenberg 19
White Mt. Reg. Med. Ctr. Springerville 16
Copper Queen Hospital Bisbee 14
29
Appendix 5
Available beds, patient days, and $1M gross patient revenue/resident
Systems/Hospitals with Residency Programs
SYSTEM/HOSPITAL #
Hosps Avail.
Beds(1) Pat
Days(1) Gross Pat.
Rev.(1) Rsidnts Avail.
Beds/Res. Pat
days/Res $1m
GPR/Res. GPR/Avail.
Bed
ABRAZO SYSTEM 5 981 154,802 $2,354,951,000 21 46.71 14.74 112.14 $2,400,562
BANNER SYSTEM 10 3,156 843,548 $9,977,111,119 260 12.14 8.89 38.37 $3,161,315
CATHOLIC HEALTHCARE WEST 3 1,175 313,227 $5,490,716,674 225 4.72 3.81 17.85 $4,672,950
NORTHERN AZ HEALTH SYSTEM 2 381 86,255 $877,366,200 8 47.63 29.54 109.67 $2,302,798
SCOTTSDALE HEALTHCARE SYSTEM 3 834 178,195 $2,573,856,613 25 33.36 19.53 102.95 $3,086,159
UNIV. MED. CENTER SYSTEM 2 514 154,692 $1,813,936,242 588 0.87 0.72 3.08 $3,529,059
Kingman Regional
160 36,237 $559,282,675 25 6.40 3.97 22.37 $3,495,517
Maricopa Med. Ctr. 614 134,691 $1,585,631,011 230 2.67 1.60 6.89 $2,582,461
Mayo Clinic 244 65,100 $1,337,437,000 150 1.63 1.19 8.95 $5,481,299
Sierra Vista Regional 88 17,845 $264,455,029 16 5.50 3.06 16.53 $3,005,171
Tucson Medical Center 568 145,615 $1,264,939,507 45 12.62 8.87 28.11 $2,227,006
TOTAL (last 4 cols. are averages) 8,715 2,130,207 $28,099,683,070 1593 24.75 14.24 56.93 $3,224,290
MEDIAN 514 134,691 $1,337,437,000 45 6.40 3.97 22.37 $3,086,159
30
Appendix 6
Available Beds, Patient Days, Gross Patient Revenue & Gross Patient Revenue/Available Bed
System/Hospitals without Residency Programs
SYSTEM/HOSPITAL # Hosps Avail. Beds(1) Pat Days(1) Gross Pat. Rev.(1) GPR/Avail. Bed
CARONDOLET SYSTEM 4 945 195,750 $2,178,246,945 $2,305,023
COMMUNITY HEALTH SYSTEM 2 414 69,009 $1,483,624,294 $3,583,634
IASIS SYSTEM 3 497 74,445 $1,309,338,000 $2,634,483
JOHN C LINCOLN SYSTEM 2 469 121,063 $1,860,090,382 $3,966,078
YAVAPAI REGIONAL SYSTEM 2 180 35,770 $567,725,103 $3,154,028
AZ Regional Medical Center 103 10,694 $145,972,525 $1,417,209
Benson Hospital 19 1,404 $18,695,683 $983,983
Casa Grande Regional 187 33,975 $367,175,903 $1,963,508
Cobre Valley Hospital 25 5,041 $57,476,791 $2,299,072
Copper Queen Hospital 14 1,752 $43,068,918 $3,076,351
Gilbert Hospital 19 5,574 $158,095,207 $8,320,800
Havasu Regional Med. Ctr 181 26,476 $378,119,000 $2,089,055
Hualapai Mt. Med. Ctr. 70 7,162 $85,701,000 $1,224,300
La Paz Regional 35 3,854 $63,016,022 $1,800,458
Little Colorado Med. Ctr 25 3,889 $71,169,394 $2,846,776
Mt. Graham Reg. Med. Ctr. 55 9,292 $117,941,253 $2,144,386
Northern Cochise Commty 24 3,837 $37,727,555 $1,571,981
Payson Regional Med. Ctr 44 8,184 $229,082,374 $5,206,418
Sage Memorial 25 3,198 $21,199,678 $847,987
Southeast AZ Med. Ctr. 25 1,736 $246,325,921 $9,853,037
Summit Healthcare Reg. Med. Ctr. 81 11,955 $256,126,484 $3,162,055
Valley View Med. Ctr. 66 16,129 $225,209,000 $3,412,258
West AZ Regional Med. Ctr. 139 27,435 $623,610,930 $4,486,410
White Mt. Reg. Med. Ctr. 16 1,563 $25,297,565 $1,581,098
Wickenberg Community 19 2,051 $22,256,234 $1,171,381
Yuma Regional Med. Ctr. 333 64,142 $887,689,223 $2,665,733
TOTAL (last col. is average) 4,234 816,839 $12,953,434,347 $2,880,278
MEDIAN 66 9,292 $225,209,000 $1,800,458
31
Appendix 7
Hospitals in Arizona That Do Not Sponsor Residency Programs by Number of Beds**
HOSPITAL CITY SYSTEM BEDS (Licensed)
Banner Desert Med. Ctr. Mesa Banner 649
Banner Thunderbird Glendale Banner 513
Carondolet St. Josephs Tucson Carondelet 478
Scottsdale Healthcare-Shea Scottsdale Scottsdale Health 433
Banner Boswell Sun City Banner 430
Banner Del Webb Sun City Wst. Banner 404
Carondolet St. Marys Tucson Carondelet 402
Banner Baywood Mesa Banner 340
Yuma Regional Med. Ctr. Yuma 333
Northwest Med. Ctr. Tucson Community Health. 300
200-299 Beds
Flagstaff Medical Center Flagstaff Northern AZ Health. 271
John C. Lincoln North Mt. Phoenix JCL 266
Maryvale Hospital Phoenix Abrazo 232
St. Lukes Med. Ctr. Phoenix IASIS 232
Chandler Regional Chandler CHW 225
Arrowhead Hospital Glendale Abrazo 220
Banner Estrella Phoenix Banner 214
Mercy Gilbert Med. Ctr. Gilbert CHW 206
John C. Lincoln Deer Valley Phoenix JCL 204
100 TO 199 BEDS
Casa Grande Regional Casa Grande 187
Havasu Regional Med. Ctr Havasu City 181
Mountain Vista Med. Ctr. Mesa IASIS 178
Banner Gateway Gilbert Banner 165
West Valley Hospital Goodyear Abrazo 164
Northwest Med. Ctr. Oro Valley Community Health. 144
West AZ Regional Med. Ctr. Bullhead City 139
Paradise Valley Hospital Phoenix Abrazo 136
Yavapai Regional Med. Ctr. Prescott Yavapai Regional 136
AZ Regional Medical Center Mesa 103
50-99 BEDS
Tempe St. Lukes Tempe IASIS 87
Summit Healthcare Reg. Med. Ctr. Show Low 81
Hualapai Mt. Med. Ctr. Kingman 70
Scottsdale Healthcare-Thompson Peak Scottsdale Scottsdale Health 64
Mt. Graham Reg. Med. Ctr. Safford 55
Yavapai Reg. Med. Ctr. East Prescott Valley Yavapai Regional 50
** Did not include hospitals with under 50 beds.
32
Appendix 8
List of Town and Cities in Arizona and their Ruralness Classifications
Town-City County Zip Code-RUCA
Ajo Pima Small rural town
Ak-Chin Village Pinal Urban
Amado Santa Cruz Urban
Apache Junction Pinal Urban
Arizona City Pinal Small rural town
Arizona Village Mohave Small rural town
Ash Fork Yavapai Small rural town
Avondale Maricopa Urban
Avra Valley Pima Urban
Bagdad Yavapai Small rural town
Benson Cochise Small rural town
Big Park Yavapai Small rural town
Bisbee Cochise Small rural town
Bitter Springs Coconino Small rural town
Black Canyon City Yavapai Urban
Blackwater Pinal Small rural town
Bluewater La Paz Small rural town
Bouse La Paz Small rural town
Buckeye Maricopa Urban
Bullhead City Mohave Small rural town
Burnside Apache Small rural town
Cameron Coconino Small rural town
Camp Verde Yavapai Small rural town
33
Town-City County Zip Code-RUCA
Canyon Day Gila Small rural town
Carefree Maricopa Urban
Casa Grande Pinal Large rural town
Casas Adobes Pima Urban
Catalina Pima Urban
Catalina Foothills Pima Urban
Cave Creek Maricopa Urban
Chandler Maricopa Urban
Chilchinbito Navajo Small rural town
Chinle Apache Small rural town
Chino Valley Yavapai Urban
Chuichu Pinal Large rural town
Cibecue Navajo Small rural town
Cibola La Paz Urban
Cienega Springs La Paz Small rural town
Clarkdale Yavapai Large rural town
Claypool Gila Large rural town
Clifton Greenlee Small rural town
Colorado City Mohave Small rural town
Congress Yavapai Urban
Coolidge Pinal Small rural town
Cordes Lakes Yavapai Urban
Cornville Yavapai Small rural town
Corona de Tucson Pima Urban
Cottonwood Yavapai Large rural town
Dennehotso Apache Small rural town
34
Town-City County Zip Code-RUCA
Desert Hills Mohave Large rural town
Dewey-Humbolt Yavapai Urban
Dilkon Navajo Small rural town
Dolan Springs Mohave Large rural town
Douglas Cochise Large rural town
Drexel Heights Pima Urban
Dudleyville Pinal Small rural town
Duncan Greenlee Small rural town
Eagar Apache Small rural town
East Fork Navajo Small rural town
East Sahuarita Pima Urban
Ehrenberg La Paz Large rural town
El Mirage Maricopa Urban
Elgin Santa Cruz Small rural town
Eloy Pinal Small rural town
First Mesa Navajo Small rural town
Flagstaff Coconino Urban
Florence Pinal Large rural town
Flowing Wells Pima Urban
Fort Defiance Apache Small rural town
Fortuna Foothills Yuma Urban
Fountain Hills Maricopa Urban
Fredonia Coconino Small rural town
Gadsden Yuma Urban
Ganado Apache Small rural town
Gila Bend Maricopa Urban
35
Town-City County Zip Code-RUCA
Gilbert Maricopa Urban
Gisela Gila Large rural town
Glendale Maricopa Urban
Globe Gila Large rural town
Gold Canyon Pinal Urban
Golden Valley Mohave Large rural town
Goodyear Maricopa Urban
Grand Canyon Village Coconino Small rural town
Greasewood Navajo Small rural town
Green Valley Pima Urban
Guadalupe Maricopa Urban
Hayden Gila Small rural town
Holbrook Navajo Small rural town
Hotevilla-Bacavi Navajo Small rural town
Houck Apache Small rural town
Huachuca City Cochise Large rural town
Jeddito Navajo Small rural town
Jerome Yavapai Large rural town
Kachina Village Coconino Urban
Kaibab Mohave Small rural town
Kaibito Coconino Small rural town
Kayenta Navajo Small rural town
Keams Canyon Navajo Small rural town
Kearny Pinal Small rural town
Kingman Mohave Large rural town
Kykotsmovi Village Navajo Small rural town
36
Town-City County Zip Code-RUCA
Lake Havasu City Mohave Large rural town
Lake Montezuma Yavapai Small rural town
LeChee Coconino Small rural town
Leupp Coconino Urban
Litchfield Park Maricopa Urban
Littletown Pima Urban
Lukachukai Apache Small rural town
Mammoth Pinal Urban
Many Farms Apache Small rural town
Marana Pima Urban
Maricopa Pinal Urban
Mayer Yavapai Urban
McNary Apache Small rural town
Mesa Maricopa Urban
Mesquite Creek Mohave Small rural town
Miami Gila Large rural town
Moenkopi Coconino Small rural town
Mohave Valley Mohave Small rural town
Mojave Ranch Estates Mohave Small rural town
Morenci Greenlee Small rural town
Mountainaire Coconino Urban
Munds Park Coconino Small rural town
Naco Cochise Small rural town
Nazlini Apache Small rural town
New River Maricopa Urban
Nogales Santa Cruz Large rural town
37
Town-City County Zip Code-RUCA
Oracle Pinal Urban
Oro Valley Pima Urban
Page Coconino Small rural town
Paradise Valley Maricopa Urban
Parker La Paz Small rural town
Parks Coconino Small rural town
Patagonia Santa Cruz Small rural town
Paulden Yavapai Urban
Payson Gila Large rural town
Peach Springs Mohave Large rural town
Peeples Valley Yavapai Urban
Peoria Maricopa Urban
Peridot Gila Small rural town
Phoenix Maricopa Urban
Picture Rocks Pima Urban
Pima Graham Large rural town
Pine Gila Large rural town
Pinetop-Lakeside Navajo Small rural town
Pinon Navajo Small rural town
Pirtleville Cochise Large rural town
Pisinemo Pima Small rural town
Poston La Paz Small rural town
Prescott Yavapai Urban
Prescott Valley Yavapai Urban
Quartzsite La Paz Small rural town
Queen Creek Maricopa Urban
38
Town-City County Zip Code-RUCA
Queen Valley Pinal Urban
Red Mesa Apache Small rural town
Rio Verde Maricopa Urban
Rock Point Apache Small rural town
Rough Rock Apache Small rural town
Round Rock Apache Small rural town
Sacaton Pinal Small rural town
Safford Graham Large rural town
Sahuarita Pima Urban
Salome La Paz Small rural town
San Carlos Gila Small rural town
San Luis Yuma Urban
San Luis Pima Small rural town
San Manuel Pinal Small rural town
Santa Rosa Pima Small rural town
Sawmill Apache Small rural town
Scottsdale Maricopa Urban
Second Mesa Navajo Small rural town
Sedona Coconino Small rural town
Seligman Yavapai Small rural town
Sells Pima Small rural town
Shonto Navajo Small rural town
Show Low Navajo Small rural town
Shungopavi Navajo Small rural town
Sierra Vista Cochise Large rural town
Snowflake Navajo Small rural town
39
Town-City County Zip Code-RUCA
Somerton Yuma Urban
Sonoita Santa Cruz Small rural town
South Tucson Pima Urban
Spring Valley Yavapai Urban
Springerville Apache Small rural town
Stanfield Pinal Urban
Star Valley Gila Large rural town
Steamboat Apache Small rural town
Stotonic Pinal Small rural town
Strawberry Gila Large rural town
Summit Pima Urban
Sun City Maricopa Urban
Sun City West Maricopa Urban
Sun Lakes Maricopa Urban
Sun Valley Navajo Small rural town
Superior Pinal Urban
Surprise Maricopa Urban
Swift Trail Junction Graham Large rural town
Tacna Yuma Urban
Tanque Verde Pima Urban
Taylor Navajo Small rural town
Teec Nos Pos Apache Small rural town
Tempe Maricopa Urban
Thatcher Graham Large rural town
Three Points Pima Urban
Tolleson Maricopa Urban
40
Town-City County Zip Code-RUCA
Tombstone Cochise Small rural town
Tonalea Coconino Small rural town
Tonto Basin Gila Large rural town
Top-of-the-World Gila Large rural town
Tortolita Pima Urban
Tsaile Apache Small rural town
Tuba City Coconino Small rural town
Tubac Santa Cruz Small rural town
Tucson Pima Urban
Tucson Estates Pima Urban
Tusayan Coconino Small rural town
Vail Pima Urban
Wellton Yuma Urban
Wenden La Paz Small rural town
Whetstone Cochise Large rural town
Whiteriver Navajo Small rural town
Wickenburg Maricopa Urban
Wilhoit Yavapai Urban
Willcox Cochise Small rural town
Williams Coconino Small rural town
Williamson Yavapai Urban
Willow Valley Mohave Small rural town
Window Rock Apache Small rural town
Winkelman Gila Small rural town
Winslow Navajo Small rural town
Winslow West Coconino Urban
41
Town-City County Zip Code-RUCA
Yarnell Yavapai Urban
Young Gila Large rural town
Youngtown Maricopa Urban
Yuma Yuma Urban
Source: Rural Urban Commuting Areas (RUCA) Classification. Population estimates provided by Nielsen-Claritas
42
Appendix 9
Advisory Group Members
Wendy Armendariz, Director of Outreach & Enrollment/SEARCH (Student/Resident Experiences and Rotations in Community Health) and the Community Development Program for the Arizona Association of Community Health Centers Conrad J. Clemens, MD, MPH, Interim, DIO & Associate Dean for Graduate Medical Education, University of Arizona College of Medicine, Tucson Sean Clendaniel, Executive Director, Northern Arizona Area Health Education Center Gail E. Emrick, MPH, Executive Director, Southeast Arizona Area Health Education Center Michael Grossman, MD, MACP, Associate Dean for GME, University of Arizona College of Medicine, Phoenix Beth Lazare, Governors Office, Policy Advisor for Health and Human Services Laurie Liles, President and Chief Executive Officer, Arizona Hospital and Healthcare Association John C. McDonald, RN, MS, CPHQ, Chief Executive Officer, Arizona Association of Community Health Centers Thomas E. McWilliams, D.O., FACOFP, Interim Dean, A.T. Still University School of Osteopathic Medicine in Arizona Ellen Owens-Summo, M.Ed., DTR, Director of Health Education and Professional Development, Greater Valley Area Health Education Center Sally Reel, PhD, RN, FNP, BC, FAAN, FAANP, Director, Arizona AHEC Howard M. Shulman, DO, FACP, FACOI, Associate Dean Postdoctoral Education, Midwestern University Osteopathic Postdoctoral Training Institution (MWU/OPTI), Chair Osteopathic Graduate Medical Education Committee, Associate Professor, Midwestern University Arizona College of Osteopathic Medicine Project Team
Doug Campos-Outcalt, M.D., M.P.A.
Joe Tabor, Ph.D., M.P.H.
Phil Lopes, M.A.
Ed Paul, M.D.
43
Appendix 10
“1-2” or Rural Training Track” Programs
In considering potential sites for residency training in Arizona, the specialty of Family Medicine supports a 1-2
model or Rural Training Track model for rural areas. This model allows the first year of training to occur in an
academic teaching center or large teaching community hospital followed by the next two years of training at a
geographically distant, rural clinical site.
Participation in this model would allow small hospitals to experience residency education without committing to
the large financial investment, including the employment of informed GME staff that is required for the
development of new GME programs. These small hospitals would benefit from the recruitment of many of the
residents assigned to their institution and in some instances, after experiencing the inclusion of clinical teaching
in their environment, may spark a commitment to sponsor their own programs. The 1-2 track model for Family
Medicine does not exist in any current Family Medicine program in Arizona but it is a means to expand the
numbers of primary care residency positions and to expose more residents to rural Arizona communities.
Approximately 30 Rural Training Track programs exist currently in the U.S. and the most recent survey shows a
75% recruitment rate of graduates to rural sites. 11