Dr. David Schmitz: Want more doctors? Boost family medicine training

Since the Sept. 15 meeting of the Legislative Interim Committee on Medical Education, there has been considerable press about the WWAMI program, the cooperative agreement between the University of Washington and the states of Washington, Wyoming, Alaska, Montana and Idaho to provide medical education slots to residents of those states. The Idaho debate has focused on whether WWAMI is capable of meeting Idaho's long-term physician work force needs.

I am writing to suggest that the debate needs to be refocused to graduate medical education where Idaho has proven models that work. As noted in Kevin Richert's Sept. 18 column, residency training is the best predictor of where a physician and his or her family will eventually decide to practice.

Idaho has two family medicine residency models already in operation. The mission of the Family Medicine Residency of Idaho (FMRI), where I am on the faculty, is training family physicians for rural and underserved Idaho and providing outstanding care to patients. FMRI does both education and patient care extremely well. FMRI is the largest Medicaid provider in Idaho and is one of the top family medicine programs in the country. Over the last 30 years, FMRI has trained 221 physicians, 56 percent who have stayed in Idaho and who in combination have provided the equivalent of 16 million patient visits.

The American Academy of Family Physicians, in September of 2006, released a report which suggests that Idaho will experience serious shortages of family medicine physicians by 2020. We need to double our current physician capacity in 10 years time. I can testify to the shortages. As the rural director at FMRI, I am contacted regularly to fill three or four times the number of Idaho vacancies as the number of graduates we currently have each year. One or two more Idaho family physicians can make the difference for an entire community clinic or hospital and retain the resources and funding in that community and access for its citizens.

In that role, family physicians are uniquely qualified to provide the broadest range of services to patients of any specialty, from hospital, to clinic, to obstetrical, to emergency services. In an already understaffed work force environment, the value of a locally trained family physician in leading the patient-centered medical home is critical for both service and efficiency.

The 2007 Idaho Family Physician Rural Workforce Assessment Pilot Study illustrated several key points: the physician work force is aging, younger physicians now in Idaho are more likely to have been trained in Idaho, and physicians practicing in Idaho have a high rate of satisfaction overall with their practice. So why not do more?

The timing is right for expansion of residency training and dollar for service, Idaho is well served by broadly trained family physicians happy to serve in our state. Residents trained in Idaho are not just in Boise and Pocatello, but all across the state, living in and experiencing over 25 rural and urban Idaho communities. Whether treating a heart attack in Weiser, delivering a baby in Salmon, or setting a bone in Bonners Ferry, it is good to have these well-trained Idaho physicians there when you and your family need them.

Graduate medical education is a proven solution that should be immediately expanded for the benefit of Idaho communities and the patients who live in them.

In a set of otherwise complex decisions, I believe that the Legislature and the governor, along with the support of our communities and physicians, will realize the immediate benefits of expanding family medicine training in Idaho.

David Schmitz, M.D., is the associate director of Rural Family Medicine at the Family Medicine Residency of Idaho.