As a 55-year-old Idaho primary care physician in Boise, I am constantly reminded of the crumbling infrastructure that is necessary for patients to have a therapeutic relationship with a medical provider. As our population ages and patients with serious chronic illnesses multiplies, we need stronger primary care more now than ever.
When I moved to Idaho in 1988 to train as a geriatrician, we knew of a looming shortage of doctors to care for our elderly. When it later became obvious that we would never have enough geriatricians, I became alarmed about even the lack of general internists, doctors who specialize in the care of adults with serious illness. Now we face a potential crisis for patients to find any primary care, much less care that is equipped to address the needs of those suffering from chronic medical conditions that threaten a patient’s life or well-being.
I am in Idaho today because of a fellowship, a sort of advanced residency. I do not believe that a medical school will relieve our physician shortage without sufficient residency positions. Doctors are much more likely to choose their practice location based on where they complete their residency, not where they go to medical school. There has been a clarion call for more residency positions since Gov. Butch Otter held a summit on medical workforce needs in 2008. Testimony overwhelmingly supported expanding residencies; residency slots are important for a medical school to exist, not vice-versa.
There was also broad support for providing loan forgiveness to new doctors facing huge educational debt in return for service commitment. There has been incremental progress with increases in residency positions for internal medicine, family medicine, and psychiatry.
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Sadly, the medical professionals in this state are now being ignored and our citizens will suffer for the reckless decisions made by our state officials. Who are the “special interests” that representatives Rice, Packer, and Hagedorn speak of? When they pass other laws concerning public safety, do they disregard the input of police, firefighters or scientists like they have disregarded the advice of Idaho physicians? They say that they seek support from leaders in the community without even consulting with them in the first place, suggesting arrogance and ignorance. From data published by the Association of American Medical Colleges, successful matriculation from Idaho over the past 10 years is 39.3 percent with national average at 42.5 percent, a gap that can easily be closed without giving tax breaks to a medical school factory that will export physicians to other states.
Kudos should go to the Joint Finance-Appropriations Committee for recently approving a 5.6 percent increase in medical school seats at Washington and Utah. This action also modestly adds to the residency slots in Idaho.
In times of tight fiscal budgets, numerous uninsured Idahoans, and inadequate access to comprehensive primary care, we need to continue logical approaches to our medical workforce shortages with help from our elected officials. We should not support a private-public partnership that makes no sense to many of Idaho’s current physician leaders.
Stephen Montamat M.D. is a Boise physician.