MOSCOW — First-year medical student Ben Moresco of Eagle has always been interested in rural medicine.
“The roles doctors can play in a smaller community are more appealing to me than being in a large community,” Moresco said. “You get to be more involved and essential.”
There’s a growing need for health care in remote areas. According to the National Center for Biotechnology Information, about 20 percent of the United States population — more than 50 million people — is in rural locations, but only 9 percent of the nation’s physicians practice there.
The Washington, Wyoming, Alaska, Montana and Idaho regional medical education program through the University of Washington School of Medicine was formed 40 years ago, in part to address that disparity.
WWAMI works to provide doctors in rural and underserved areas. It receives funding from each of its participating states to provide reduced tuition rates.
In 2009, the Idaho State Board of Education made it a goal to double the number of seats funded for Idaho residents in WWAMI. That commitment was made just before the national economy went into a recession.
Andrew Turner, director of the WWAMI program at Washington State and the University of Idaho, said the Idaho board has not been able to make any progress toward its goal.
“The economy tanked, so no funding has been directed to WWAMI since then,” Turner said. “There were just no extra dollars to go around.”
He plans to approach state legislators this summer to request additional funding so more Idaho students can participate.
Turner said Idaho is 49th in the nation in terms of physicians per population. He hopes that the five extra WWAMI seats he will request this year can become part of a program called the Targeted Rural Under-served Track, which reserves spots for students who have a particular interest in rural health care.
Turner said such a program could help Idaho address its need for more doctors in smaller communities.
“We have a shortage of physicians overall, (but) there are also more physicians in our cities than in the country,” Turner said. “We do have communities where small rural hospitals are in trouble because there aren’t enough physicians to keep them open. We have to figure out a way to increase interest in rural health care.”
The State Board of Education will consider the TRUST proposal during its meeting in June, and Turner said he is starting to share the idea with residency programs in the state.
“We haven’t really taken it out to the physicians yet, but I think we’ll have a lot of support when we start presenting it,” he said.
FROM THE START
Dr. Francis Spain of Moscow Family Medicine, part of WWAMI’s founding class in 1972, is one physician who is in favor of the new initiative in Idaho. He has been involved in WWAMI’s Rural/Underserved Opportunities Program, through which students spend a month working with rural physicians during the summer after their first year of medical school.
“It’s always a very beneficial experience,” Spain said. “They get a chance to see what it’s like to be out in the middle of nowhere, (where) your neighbors and friends are also your patients.”
Though he has been interested in rural medicine for some time, first-year student Moresco said he has not been able to gain hands-on experience in remote areas. He will this summer in the Twin Falls region.
“R/UOP gives you the exposure to that type of medical environment,” Moresco said. “You’re living in the community and experiencing the life of a rural physician.”
In their third year, students participate in the Rural Integrated Training Experience, which sends them back to a rural site for five months of clinical work. Turner said the goal is that they return to the same underserved location.
“That way they can build their skills and relationship with that community,” he said. “The community gets to know a developing physician from the beginning to graduation, and the students gets to practice their skills with the same patients and doctors over a period of years.”
After graduation, Turner said, federal reimbursement programs offer incentives to rural placements for new doctors. WWAMI graduates can choose to work in an assigned location, and the government pays a portion of their medical school debt.
Idaho also has an incentive program, Turner said.
“The state supplies up to $50,000 in loan repayment if you go to a community with a demonstrated need for a physician and are willing to work there for up to five years,” he said.
Idaho’s WWAMI funding had been cut for three straight years, but this year the group was spared, Turner said.
“There haven’t been any Idaho seats added since 2007, when we got back up to 20,” he said.
When the program first started, Idaho was able to fund 10 seats for state residents. That number quickly doubled, Turner said, but in the 1980s it had to be cut back to 15 or 16 people.
“We want to cross this barrier and keep growing (now that the total is at 20 again),” Turner said. “It’d be great if they went to 40 Idaho students.”
The state’s population has more than doubled since the program started, and last year 149 people competed for the 20 spots.
“So we’re still going to be way underserved in the state of Idaho because we’re still far behind,” Turner said. “We’ll always be importing physicians. But anything we can do to train more Idaho kids as physicians increases the likelihood they’ll stay here for practice.”
During fiscal year 2012, a total of $3.45 million in appropriations from Idaho coffers will go to the program.
Statistics show Idaho with a 72 percent return on its investment in the WWAMI system, with nearly 120 non-Idaho graduates having practiced in the state.
As of June 2011, there were 515 Idahoans who graduated from the program practicing medicine nationwide, with 254 of those having practiced in the state.