Doctors tell lawmakers rural Arizona lacks specialists; transport costs, training gaps cited

Interventional cardiologists, rural physicians and policy advocates told the Arizona House Health and Human Services Committee that shortages of specialists in rural counties are causing delayed treatment, high transport costs and patient harm — and urged lawmakers to consider short‑term workforce fixes while expanding training pipelines.

Dr. Abdul Maiman, an interventional cardiologist who has practiced in rural Arizona for decades, told the committee that timely heart care is critical and that rural hospitals often lack the staffing and bed capacity needed for emergencies.

“Time is muscle,” Dr. Maiman said. “If we delay transfer, the patients are going to be not as good of an outcome as you would expect.” He said that air transport from Globe to Chandler can cost about $58,000 while insurers often reimburse a maximum of about $18,000, leaving large balances for patients or hospitals.

Local outcomes and capacity

Dr. Maiman described a rural practice that reduced the number of annual cardiac transfers from roughly 334 to fewer than 35 after adding local cath‑lab capacity and staff rotation. He told the committee many new graduates and fellows prefer tertiary centers with colleague backup rather than solo rural practice.

Policy options discussed

Jonathan Wolfson, chief legal officer at the Cicero Institute, described a policy route used by other states that creates a pathway for physicians trained overseas — who have passed equivalency exams and practiced in their home countries — to work in rural or underserved areas without repeating a U.S. residency. Wolfson said 10 states already have laws permitting such pathways and about a dozen states had similar bills in the current legislative session.

Dr. Maiman and Wolfson told lawmakers that safeguards in prior proposals included an initial period of direct supervision (for example, six months), retrospective case review and a commitment to work in an underserved community for a defined period.

Committee questions and context

Members asked about lifestyle and training pipeline issues. Representative Heap noted the long training path to sub‑specialization: college, four years of medical school, three years of internal medicine, three years of cardiology fellowship and additional fellowship for interventional cardiology — a sequence many students are reluctant to endure. Dr. Maiman and other speakers noted Arizona trains relatively few interventional cardiologists annually and said residency capacity and retention are chokepoints that will require federal and state attention.

Speakers urged a two‑track approach: expand long‑term U.S. residency slots and consider carefully structured short‑term pathways to place experienced internationally trained physicians in underserved areas under strict supervision and review.