Bill would require Idaho medical students to practice in Idaho or repay the state
A controversial bill intended to encourage Idaho medical students to practice in the state after completing their education — by requiring them to stay, or repay state aid they receive — has narrowly cleared the Idaho Legislature.
Senators on Wednesday were split on the legislation, and a tie vote had to be broken by Lt. Gov. Janice McGeachin, who voted in support of the measure. It now heads to Gov. Brad Little’s desk.
The bill, sponsored by House Majority Leader Mike Moyle, R-Star, would mandate that students in Idaho who are accepted into the Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) regional medical education program or the University of Utah School of Medicine practice in Idaho for four years — or agree to repay the state for public funds used for their education. Moyle did not respond to a request for comment.
WWAMI is a partnership between the University of Washington School of Medicine and Washington, Wyoming, Alaska, Montana and Idaho. The program reserves 40 slots for Idaho students every year.
According to the bill, students would have to enter into a contract with the State Board of Education that says if they do not practice in Idaho, they will reimburse the state for the subsidy it provides within one year of obtaining a license to practice medicine, finishing a residency or completing a medical education fellowship.
Supporters of the bill said it was necessary to deal with a lack of physicians in Idaho. But opponents said it could create a chilling effect and discourage Idaho students from applying to the program.
Facing opposition to the bill, the Senate abruptly went at ease, then held the bill after about 15 minutes of debate Tuesday. On Wednesday, there was no further debate before senators approved the measure.
Resolution supports more WWAMI seats
A separate concurrent resolution adopted by the Legislature encourages the State Department of Education to request five more WWAMI seats beginning in 2025, and another five in 2027, with the goal of having 50 seats in the program.
Under the WWAMI program now, the Idaho students attend medical school on the University of Idaho campus. Their first 18 months are in Idaho before they begin their clinical phase, which can be anywhere in the WWAMI region.
Nearly all of Idaho is designated as a primary care health professional shortage area by the federal government, the resolution said.
The resolution said a lack of physicians is associated with poorer health outcomes in communities, and that investing in WWAMI is one step to alleviate the state’s shortage. According to the Association of American Medical Colleges, Idaho ranks 49th among U.S. states for active physicians per capita.
“This is a resolution that hopefully will really move Idaho forward in the number of primary care physicians we have in Idaho,” Sen. Janie Ward-Engelking said. “We have a huge shortage of primary care health care professionals throughout Idaho, and many of our physicians are nearing the age of retirement.”
Senators worry about impacts of legislation
Sen. Robert Blair, R-Lewiston, who carried the legislation on the Senate floor, said the bill gives Idaho a “better chance of getting good doctors into our medical pipeline and back to those rural areas.”
But several lawmakers raised concerns about the impact the bill could have on prospective medical students.
“I am here to debate for the students and the parents who raise their children in Idaho and expect equal treatment for their children’s education no matter what profession they choose,” Sen. David Nelson, D-Moscow, said on the Senate floor Tuesday. “We do not treat any other higher education like this.”
The state pays about $160,000 over the course of four years. Lawmakers said the bill could result in students not applying to the program, and instead suggested the state focus on adding more residency seats.
“I really believe this bill could cause a chilling effect, and that people will choose not to apply or perspective medical students may not come to Idaho,” Ward-Engelking said. “The reality is, once again, we’re going to single out one group and treat them differently. … I think this is bad for Idaho and I think it’s bad for the students.”
Sen. Fred Martin, R-Boise, disagreed. He said he wanted Idaho medical students to return to practice in the state.
“We’re spending a lot of money to pay for these students to get their medical degrees. Shouldn’t we have a return on our investment?” he said.
During debate, lawmakers in support of the legislation said similar bills had been passed in other participating states — Wyoming, Alaska and Montana. Idaho’s bill was modeled after legislation from those states. States where the legislation has been in effect long enough have seen an impact on their return rates, Blair said.
But Sen. Grant Burgoyne, D-Boise, said Idaho does not take action solely based on what other states are doing.
“We chart our own course. We’re proud of it. We’re independent. We don’t do things just because other states are doing it,” he said.
University of Idaho previously opposed bill
Jeff Seegmiller, regional dean and director of the Idaho WWAMI program, said a bill like this has come up in the past, and the university has been against it.
Seegmiller said he’s “not a fan” of any legislation for academic programs, but strongly supports the resolution that goes hand in hand with the bill to grow the number of WWAMI spots. This year, he testified in support of the bill during committee hearings.
“We’re not jumping for joy over required service to our state, but we understand that unfortunately we have great needs in our state for physicians,” Seegmiller told the Idaho Statesman.
About 50% of WWAMI graduates come back to practice in Idaho now, Seegmiller said. That’s above the national average of about 40%. But it’s not enough, he said.
“It becomes this really desperate situation where we have an aging population of physicians, we have a lot of needs in rural areas, and our current pipeline programs, both undergraduate medical education and residencies, is not enough to meet the needs of our state,” he said.
Idaho is particularly challenged because of its lack of medical residencies in certain areas, such as emergency medicine and general surgery, so students could have to leave the state to do their residencies and then come back, he said. Students often remain in the place where they do their residency, Seegmiller said.
The University of Idaho has been pursuing other programs to attract students to practice in Idaho and help connect them to the region, including the Rural Underserved Opportunities Program, which gives students an experience to work with rural and underserved communities.
“I’m more of a fan of the carrot model rather than the stick model,” he said. “But when states become so desperate and you rank the lowest in the country, I think this is the result.”
This story was originally published March 23, 2022 at 3:57 PM.
