Report on Primary Care in Arkansas Reveals Mixed Outcomes

A new report assessing the state of primary care in the U.S. reveals both positive signs and persistent challenges in Arkansas.

Published February 18 by the Milbank Memorial Fund, the report, “The Health of U.S. Primary Care: 2025 Scorecard Report — The Cost of Neglect,” evaluates measures including financing, workforce and access, training, technology, and research. The analysis is intended to help deepen understanding of the primary care landscape, particularly in areas of high social deprivation. The Milbank Memorial Fund also released an interactive dashboard that allows users to explore state-specific data, including trends.

The report and dashboard use the Social Deprivation Index (SDI) to identify areas where socioeconomic factors may limit access to healthcare services. The SDI is a composite measure of disadvantage, incorporating indicators such as the percentage of people living in poverty, the percentage of adults with less than a high school education, the percentage of single-parent households, and the percentage of households without a vehicle. A higher SDI score indicates greater levels of social deprivation.

In 2022, Arkansas had 104 primary care clinicians — including physicians, physician assistants, and nurse practitioners — per 100,000 people, which matched the national average. The state had 40 nurse practitioners per 100,000 people, compared to 26 nationally, and 48 nurse practitioners per 100,000 people in areas with higher social deprivation (i.e., areas above the median SDI).

Arkansas also had higher rates of community-based and rural-focused training of primary care residents compared to the national average:

• 28% of medical residents in Arkansas were trained in community-based settings, primarily outside of hospitals or large academic centers, compared to 16% nationally.
• 60% of primary care residents in Arkansas were trained in rural or medically underserved areas, compared to 54% nationally.

Still, challenges remain in sustaining and growing the state’s primary care workforce. The number of primary care physicians per 100,000 people in Arkansas was below the national average in 2022 (58 in Arkansas compared to 67 nationally). Physician assistants were underrepresented, with only 5 per 100,000 people in Arkansas, compared to 10 nationally.

In areas with higher social deprivation, Arkansas had 64 primary care physicians and 6 physician assistants per 100,000 people, compared to national averages of 69 and 12 per 100,000 people, respectively. In areas below the median SDI, the state had 48 primary care physicians and 2 physician assistants per 100,000 people, compared to national averages of 27 and 9 per 100,000 people, respectively. Areas below the median SDI tend to attract more physicians due to economic advantages, better infrastructure, and more professional opportunities.

The distribution of physician assistants may be influenced by restrictive practice laws and the limited number of training programs. The state could see physician assistants increase in the future due to Arkansas Act 303 of 2023, which recognizes physician assistants as rendering providers for Medicaid.

Arkansas saw declines in the percentage of clinicians working in primary care between 2021 and 2022:

• The percentage of nurse practitioners working in primary care fell by nearly 10%, from 41% to 37%.
• The percentage of physician assistants working in primary care dropped by 25%, from 36% to 27%.
• The overall percentage of clinicians in primary care declined by 6%, from 33% to 31%.

According to the report, these declines, which mirrored national trends, were likely driven by more nurse practitioners and physician assistants moving into specialty care — trends that may reflect growing financial and workload pressures across the primary care system.

The report suggests that the pipeline of new physicians entering primary care is shrinking. Nationally, only 24% of new physicians entered primary care in 2022 — or 20%, if hospitalists, i.e., physicians who work exclusively in hospital settings, are excluded. In Arkansas, 33% of new physicians entered primary care in 2022, or 20% if hospitalists are excluded, but like the nation, Arkansas has seen a decline over time. There was a 6% decrease in the number of new physicians entering primary care in Arkansas from 2021 to 2022, or 20% if hospitalists are excluded. This decline could have long-term impacts on access to care, especially as current providers retire or leave practice.

According to the report, five reasons why accessing primary care continues to be challenging for many nationwide are:

• Primary care is underfunded, and fee-for-service payment models are limiting clinicians’ ability to meet patients’ needs.
• The primary care workforce is declining, and patients are unable to get timely care because there are not enough clinicians.
• Graduate medical education funding is not producing enough primary care physicians, and most residency training happens in hospitals rather than community settings.
• Technology, including electronic health records, creates administrative burdens that take time away from patients.
• Primary care research is underfunded, limiting evidence-based improvements in care.

ACHI has published a report and a dashboard profiling the state’s primary care workforce, including the number of active primary care physicians, their levels of activity, demographics, and the payer mix. We also published an analysis of graduate medical education data showing that the number of first-year residency slots in Arkansas has not kept pace with the number of medical graduates, although the gap is closing.

A bill filed in the 2025 regular session of the Arkansas General Assembly would establish the Arkansas Primary Care Payment Improvement Working Group. The group would assess current spending levels, examine the adequacy of the primary care system, and develop recommendations, including a primary care spending target for the state. Its work would build on a legislative interim study that focused on primary care investment. Similar legislation in other states has led to policies for evaluating primary care spending and, in some cases, establishing minimum thresholds.