No-MCAT medical school pathway aims to keep physicians in Arkansas

Think of a family physician in a small Arkansas town who is ready to retire. Replacing him could take the better part of a year.

Nationally, the typical physician search takes 121 days to fill, and only about 47% of searches were filled in 2024, according to Association for Advancing Physician and Provider Recruitment 2025 benchmarking data. And these challenges are felt most acutely in areas that are already hard to recruit, such as small towns in rural areas.

Arkansas is trying to fix that problem long before a physician's first job search. It is starting with high school students. The University of Arkansas at Little Rock and the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University (NYITCOM at A-State) have launched a Pre-Med/Doctor of Osteopathic Medicine Pathway Program. It gives a small cohort of Arkansas students a defined route from an undergraduate degree in Little Rock to the D.O. program in Jonesboro. Students who meet every benchmark along the way never have to sit for the MCAT.

Students are selected through a joint admissions process. Applicants must be Arkansas residents, score at least 1100 on the SAT or 26 on the ACT, and pass a joint interview. Each cohort is capped at 10 students.

"Our primary recruitment focus will be high school students who are planning to attend UA Little Rock," Anindya Ghosh, associate dean of UA Little Rock's Donaghey College of Science, Technology, Engineering, and Mathematics said. While the first cohorts are being built, the university has some flexibility to consider qualified first- and second-year students already on campus.

The model is not new to NYITCOM. Shane Speights, D.O., dean of NYITCOM at A-State, said the school now runs similar pipeline programs with three Arkansas undergraduate institutions, all limited to Arkansas natives. Henderson State University seated the inaugural class of its version of the program this year.

Replacing one test with a four-year audition

Removing the MCAT raises an obvious question for any physician who remembers studying for it: What confirms a student is ready?

"The MCAT waiver does not remove academic rigor or ongoing performance expectations," Ghosh said. "Students must maintain a 3.5 science GPA each semester and a 3.5 cumulative GPA throughout their undergraduate education."

Pathway students also take several biological science courses beyond the standard premedical prerequisites. These courses were chosen as preparation for the curriculum they will see at NYITCOM. Faculty and advisors at both schools track students' progress for all four years and can step in when a student starts to slip.

"Rather than students completing their undergraduate education and first interacting with the medical school when they apply, both institutions can help guide pathway students toward their goal, monitor their progress and identify areas where additional academic preparation or support may be beneficial," Ghosh said.

Admission is not automatic. Students must finish their bachelor's degree, earn a favorable recommendation from UA Little Rock's Premedical Committee, and interview with NYITCOM faculty. NYITCOM retains final authority over admission.

The GPA floor has a built-in backstop. UA Little Rock can grant a one-time waiver of the semester GPA requirement. A student who falls short beyond that may be given the chance to submit an MCAT score for consideration.

"The goal is to prepare and evaluate students throughout their undergraduate education rather than relying solely on performance on a single standardized examination," Ghosh said.

Taking cost out of the application

Speights said the program requires no dedicated funding because it is built on UA Little Rock's existing pre-med degree. The financial benefit shows up on the student's side of the ledger.

"The financial relief is tied to the fact that these applicants have a direct path to one medical school. They don't have to pay application fees to several schools," Speights said. "Additionally, the waiver of the MCAT has a financial tie because the test itself has a cost associated, and many students spend upwards of $5,000 to take MCAT prep courses."

He said the change also levels the field. "Students who don't have the ability to take those costly prep courses are no longer at a disadvantage in the med school application process because we've eliminated that necessity altogether," Speights said.

That matters more as borrowing gets harder. Medical Economics reported in November that new federal limits under the One Big Beautiful Bill Act could limit pathways to medical school, particularly for low-income students. "Graduate PLUS Loans have been a financial lifeline for nearly half of all medical students," Hao Yu, associate professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, said at the time. "Eliminating this program will create substantial financial barriers for students and most likely reduce diversity in the physician workforce."

The pathway does not change tuition. But it removes several costs that fall before tuition, and those costs tend to screen out the students rural communities most need.

Retention runs through residency

Neither dean claims the program guarantees that graduates will stay in Arkansas.

"We would not characterize retention as guaranteed," Ghosh said. He cited AAMC data showing 37.6% of physicians practiced in the state where they completed medical school in 2024. That figure rose to 67.5% among physicians who completed both medical school and ACGME-accredited residency in the same state.

Arkansas-specific figures follow the same pattern. Speights said AAMC data show physicians who complete residency in Arkansas stay to practice 53.1% of the time, eighth among states. Those who complete both medical school and residency in the state stay 80.5% of the time, fourth in the nation.

NYITCOM's internal tracking shows an even higher rate. "Our graduates who are from Arkansas and attend residency in state, 95% stay to practice," Speights said.

Those numbers point to the pathway's weak spot: residency capacity. Data show that where physicians complete residency is one of the strongest predictors of where they practice. This means that the location of residency programs is not merely an academic question, it is a workforce strategy.

Federal efforts to add residency slots have not reached rural areas. Medical Economics reported in June that the share of new Medicare-funded positions going to rural counties fell from 6% in the first allocation round to 3% by the fourth, well short of a 10% set-aside Congress wrote into law. That analysis of Medicare's residency expansion found primary care's share of new slots also shrank. "Expanding training slots alone is not enough. How programs distribute those slots matters for addressing physician shortages," said Tarun Ramesh, M.D., the study's lead author.

Speights said NYITCOM has strong existing relationships with GME sponsoring institutions across the state. He noted that about 65% of the school's graduates who matched into Arkansas residencies are from Arkansas hometowns or earned their undergraduate degrees in the state.

"We recognize that medical school is one part of the physician workforce pipeline and that residency training is another important component," Ghosh said. "For that reason, this pathway should be viewed as one part of a broader effort to develop and retain physicians in Arkansas, rather than as a guarantee that every participant will ultimately practice in the state."

Built for rural primary care

Arkansas State University deliberately sought an osteopathic partner when it recruited a medical school, Speights said. He said D.O.s are about twice as likely as M.D.s to practice in rural or underserved areas and twice as likely to enter primary care.

NYITCOM also does not operate its own hospital system. Instead, third- and fourth-year students train with community hospitals, clinics and physician preceptors across the state, spending at least a year in those settings. Speights cited National Rural Health Association data showing that physicians exposed to rural practice during training are nearly twice as likely to practice in a rural community.

"We have graduates practicing in rural Arkansas cities and towns like McGehee, Piggott, Dardanelle, Mena, Crossett, Batesville, Highland and others," Speights said. "That's not by happenstance."

He added a caveat. "While our sample size is small at this point, we can show that the distributive model that we follow for our third-year curriculum is successful."

What it means for practicing physicians

Ten students a year will not end Arkansas' shortage. A student who enters the pathway as a college freshman in 2027 would not finish residency until the mid-2030s. That is too late for the practice recruiting a replacement today.

But the model depends on practicing physicians more than most. NYITCOM's clinical years run on community preceptors, and the pathway's early-engagement design means physicians in Jonesboro, Little Rock and smaller towns will meet these students years before they are ready to hire. For rural practices, taking on students now is one of the few recruiting tools available that works on a 10-year timeline.

"Over time, we will be able to follow the pathway's graduates through residency and into practice and evaluate its contribution to Arkansas's physician workforce," Ghosh said.