Part Two

Arkansas Reflects National Trends in Population, Demand for Services

The national trends of an aging population and increased demand for health care services are reflected in Arkansas, perhaps with greater impact given the state’s smaller, more rural nature.

In 2004, the U.S. Census Bureau projected Arkansas to have a population of 2.75 million. Of those, 381,106 were 65 or older. The state’s 13.8 percent elderly population is among the 10 highest in the United States. (Chart 5)

Like the rest of the United States, the number of elderly residents in Arkansas will begin growing more quickly between 2010 and 2030, as the baby boomer generation reaches retirement age.

The growth of Arkansas’ elderly population will outstrip its overall population growth rate in the coming years as the baby boomers begin retiring. The total population of Arkansas is projected to grow 12 percent between 2000 and 2020, while the 65 and older population is projected to grow 68 percent during the same period, says the U.S. Department of Health and Human Services. By 2025, Arkansas will have the fifth highest percentage of elderly population in the nation.

But while the older population will grow faster, most every age group will see growth in the next 15 years. According to numbers from the University of Arkansas at Little Rock Institute for Economic Advancement, there will be more preschool children and adults of working age then than there are now, with school age children (ages 5-19) being the only demographic to see a population decline.

In addition, the state’s population will become more diverse as the growth of non-white Arkansans accelerates. In data pulled together as part of the Arkansas 2020 project, the Institute for Economic Advancement predicts a 16 percent increase in the minority population by 2020, to total of 620,637, mainly due to Arkansas’ growing Hispanic population.

Arkansas Population Also Unhealthier

The need for more medical care by an aging population is amplified by Arkansas’ consistent standing as one of the unhealthiest states. Chronic diseases require more treatment and care, translating to an increased burden on the state’s health care system.

Across numerous health care categories, the state ranks ahead of the rest of the United States. Arkansas’ death rates for cancer, diabetes, heart disease and stroke are higher than the national rates. (Chart 6)

Arkansas has higher percentages of people with diabetes or high blood pressure than the nation as a whole. The state is ahead of the national average for the number of smokers and those who are considered obese. The state has the seventh highest percentage in the nation of persons who reported being disabled.

Those trends also look to continue upward in the next decade – particularly as the state continues to deal with the impact of growing incidence of obesity. Based on responses to a Behavior Risk Factor Survey in 2005, the UALR Institute for Economic Advancement projected 11 percent growth in the number of Arkansans with diabetes by 2020 and similar growth in incidence of high blood pressure, high cholesterol and arthritis.

Not only will Arkansas have a larger population, it will likely be older and more diverse with a higher number of health problems.

State Already Experiencing Health Care Work Force Shortage

Having an adequate health care work force is critical to meeting health care needs. Work force shortages force hospitals to make staffing and operational decisions that impact patient care by causing overcrowded emergency departments, longer waits for treatment or reduced hours of operation.

Unfortunately, the state’s health care work force already has been found to be lacking in numbers. In a 2003 assessment of Arkansas’ health care work force needs, researchers at the University of Arkansas for Medical Sciences (UAMS) canvassed health care facilities across the state and found thousands of immediate vacancies.

Of the 341 responding facilities to the survey, 3,387 current vacancies were reported in 79 health professions. The number of vacancies is expected to more than double by 2007. When those figures are extrapolated to include all 774 of the facilities surveyed, the estimated number of vacancies by 2007 jumped to more than 14,000.

Compared to the rest of the United States, Arkansas ranks near the bottom for the number of physicians and nurses per capita, as well as for many other health care professions. This illustrates both potential health care access problems for patients as well as the inability to meet current demand.

In the U.S. Department of Health and Human Services’ state-by-state roundup of the health care work force in 2000, Arkansas ranked 48th among the 50 states for physicians per capita, with 154 physicians per 100,000 population. This was well below the national ratio of 198 physicians per capita. The state’s position had slipped from 1998, when the agency ranked Arkansas 44th with 157 physicians per capita. (Chart 7)

From the work force survey conducted by UAMS in 2002, responding health care facilities predicted nearly 700 physician vacancies in the state by 2007. About 300 of those physician vacancies were in primary care.

The 700 registered nurses per 100,000 population in Arkansas was less than the national rate of 780.2. The state had one of the lowest concentrations of nurses in the nation. (Chart 8)

The federal agency’s projections showed a reported 8 percent shortage of RNs in 2000 growing to a 14 percent shortage by 2010 and a more than 34 percent shortage by 2020.

In the UAMS work force study, more than 3,000 vacancies in nursing – including RNs and licensed practical nurses – were projected by 2007 at the facilities responding to the survey. By 2010, a state legislative commission reported recently, Arkansas will need more than 27,000 new nurses — roughly the population of Bentonville.

In 2000, Arkansas had the eighth highest number of pharmacists per capita in the nation with 88.9. That figure was up from 1998, when the state was ranked 26th for pharmacists per capita.

Despite the growing number of pharmacists in Arkansas, industry experts said the profession is not matching demand. Fueled by rising numbers of prescriptions and an aging population that will likely need even more medications in the future, more pharmacists are needed.

The same can be said for other health care professions from respiratory care to physical therapy. The allied health professions, which make up a broad range of jobs including audiologists, laboratory scientists, paramedics and radiologic technologists, are in increasing demand in Arkansas as in the United States.

Arkansas ranked in the bottom third compared to the rest of the nation in 2000 for the number per capita of physical therapists, speech pathologists/audiologists and nuclear medicine technologists. The state had significantly fewer respiratory therapists than the national rate (15.3 versus 29.2) and ranked dead last for the number of dieticians/nutritionists per capita (nine versus the national rate of 15.2).

In the 2002 work force survey by UAMS researchers, all of the varied allied health professions showed growing numbers of vacancies by 2007. Some of the faster growing allied health professions included clinical laboratory technicians, emergency medical technicians/paramedics, radiologic technologists, respiratory therapists and nuclear medical technologists.

Further complicating the health care work force situation is that many current health care professionals are baby boomers themselves. They will be retiring and leaving the work force at the same time demand for health care services is increasing.

A 2004 health professionals licensing survey by the Arkansas Department of Health showed the average age of the state’s gynecologists to be 64. The average age for physicians in nine of the 23 specialties listed in the survey – general practice, surgery, radiology, clinical pathology, cardiology, ophthalmology, psychiatry, urology and gynecology – had average ages of 55 or older, meaning that many of those physicians would reach retirement age by 2014 or 2015.

Arkansas’ mostly rural nature means patients are forced to drive farther for health care. At the same time, the work force shortages mean those patients may have to wait longer when they arrive at a clinic or hospital.

In short, Arkansas does not have enough health care professionals to meet current needs. This situation could worsen in the years to come with overall population growth compounded by the accelerated increase in the number of older residents and increased incidence of diseases, from diabetes to high blood pressure.