Governor Otter partnered with The Burrell Group to open a medical school in Meridian. The rationale for the venture, beyond profit, is to increase the number of physicians in Idaho. Two of my colleagues invited to preliminary discussions were required to sign non-disclosure agreements. Deliberations excluded critical stakeholders and the State Board of Education acknowledges that it lacked critical information before approving the deal. A review of physician training is warranted, as the Idaho State Board of Education and governor's office appear to have not fully considered the proposed school’s limitations.
The initial two years of medical school focus principally on human biology, while the latter two involve apprenticeships requiring a great deal of time and attention from supervising physicians. After four years, medical students graduate with their degrees. In no state are these graduates able to practice medicine. First, they must complete post-graduate training, a so-called “residency.”
Residency training is where physicians specialize. Programs last between three and seven years based on specialty. Only after this training can physicians apply for licensure and enter practice. The five residencies in Idaho open only 41 positions annually. In the Boise area, the ratio of medical student applicants for these training slots is roughly 75:1. You read that right. There are 75 applicants for each position. This fierce competition hardly indicates a shortage of medical students.
It is widely understood that residency training, rather than medical school, predicts future practice location. Acknowledging this in 2009, the State Board made expanding residency training programs its top priority in order to increase the number of practicing physicians in the state.
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The proposed school plans to train 600 students in Meridian and around the region. Each year, 300 of these students will need to be placed in hospitals and doctor's offices. In a surprising admission, the State Board acknowledges that “the potential impact of the school’s students on the current capacity for training in the state for other medical and health education programs is unknown.” Medical educators know training capacity is limited. Flooding the region with the proposed school’s students will increase competition for medical trainees of all types, including nurse practitioners, physician assistants, medical students and residents from existing programs. The school has the potential to harm the very programs best suited to help Idaho retain physicians.
Burrell indicated it would invest to partially fund expansion of medical residency opportunities in Idaho. Burrell, the governor's office and the State Board do not acknowledge that they have little if any ability to expand residency programs through the usual mechanisms. Residency positions are generally funded by Medicare. The number of these positions has been frozen for over a decade.
Montana recently passed on Burrell’s offer. That state did not believe adequate training sites exist for the additional students. If this school is ultimately established, the Burrell trainees will crowd out those from Idaho's state-funded programs. Without an impossibly massive expansion of our in-state residency programs, Idaho will likely become the biggest net exporter of physicians in the United States.
Andrew Wilper, M.D., MPH is a third-generation Idahoan, practicing internist, and Chief of Medicine at the Boise VA hospital, where he has supervised medical students and residents for nearly eight years.