June 23, 2012 in Health

Program bringing medical students to rural areas

KATIE ROENIGK Moscow-Pullman Daily News
Geoff Crimmins photo

In this Friday, May 25, 2012 phoo, Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) regional medical education program student Benjamin Moresco talks about a survey he will be distributing to learn how much knowledge and awareness women have of congenital Ctyomegalovirus, at his office at the University of Idaho in Moscow, Idaho. WWAMI works to advance regional excellence in medical education and provide doctors needed in rural and underserved areas.
(Full-size photo)

MOSCOW, Idaho (AP) — 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 — live in rural locations, while 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 advance regional excellence in medical education and provide doctors needed in rural and underserved areas.

It receives funding from each of its participating states to provide reduced tuition rates for their students in the program.

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 deep recession.

Andrew Turner, director of the WWAMI programs at Washington State University and the University of Idaho, said the State Board of Education 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 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 seats for students who have a particular interest in rural health care.

Turner said TRUST 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 their 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.

Dr. Francis Spain of Moscow Family Medicine, who graduated from WWAMI’s founding class in 1972, is one physician who is in favor of the TRUST initiative in Idaho. He also 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 of R/UOP). “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 is looking forward to gaining firsthand knowledge of the rural lifestyle this summer when he fulfills his R/UOP requirement in Twin Falls.

“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 WWAMI 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 their R/UOP location during their WRITE placement.

“That way they can build their skills and relationship with that community,” Turner 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 added, federal reimbursement programs also incentivize rural placements for new doctors. WWAMI graduates can choose to work in an assigned location, and in return, the federal government will pay a portion of their medical school debt.

Idaho also has a rural physician incentive program, Turner added.

“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,” Turner said.

Though TRUST does not yet exist in Idaho, Alaska or Wyoming, Turner said it already is in place in Montana and Washington. So at WSU, where 20 students are part of the WWAMI program, Turner said his first priority is to increase the number of admissions to WWAMI for Washington students.

That goal contributed to the creation of a two-year pilot program through the UW and WSU that will allow 20 more WWAMI students to complete their second year at WSU’s Riverpoint Campus in Spokane beginning next fall. The plan should put less pressure on UW’s medical campus, where, until now, students from all five WWAMI states have spent their second year.

WSU officials say the new campus also is being developed to help increase the number of physicians in the rural Northwest. Turner said the creation of the Spokane campus should lead to more training programs on the east side of the state, which will bring additional students to Washington’s more remote communities. He hopes those students will be more likely to stay in eastern Washington after they graduate.

“The reality is, if you do your training in Puget Sound, you’re probably going to stay there because you’ve had exposure to local doctors and openings,” Turner said. “So (we hope) eastern Washington will have the opportunity to try to increase their workforce for physicians.”

According to the Spokesman-Review, Washington already brings 80 percent of its doctors from other states.

Idaho’s WWAMI funding has been cut for the past three years, but this year Turner said the group was spared.

“There haven’t been any Idaho seats added since 2007, when we got back up to 20,” Turner said.

WWAMI was initiated in 1972, and at that time Turner said Idaho was able to fund 10 seats for state residents. That number quickly doubled to 20 seats, but in the 1980s Turner said the program had to be cut back to 15 or 16 people.

It was only five years ago that the total was restored to the record high number of seats, but Turner said it is time for another increase.

“We want to cross this barrier and keep growing,” Turner said. “It’d be great if they went to 40 Idaho students.”

He said the population in Idaho has doubled in the 40 years since the state became part of WWAMI, and last year 149 people competed for the 20 spots reserved for Idaho students.

“So we’re still going to be way under-served 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 state’s WWAMI program.

“The state basically makes it so (Idaho students) can receive in-state tuition,” Turner said. “They also have 20 protected seats only for Idaho students in that school.”

In fiscal year 2011, the average state support per WWAMI student per year was set at $41,877, and during that same year the average WWAMI student paid tuition and fees of about $23,000. Their peers in other public programs paid about $25,000, while students attending private medical schools spent $42,399 per year.

Turner pointed out that many students pay for tuition using loans, scholarships and financial aid.

Statistics show Idaho with a 72 percent return on its investment in the WWAMI program, with almost 120 non-Idaho WWAMI graduates having practiced in the state.

The return rate for Idaho WWAMI graduates is 49 percent. As of June 2011, there were 515 Idaho WWAMI graduates in practice nationwide, with 254 of those having practiced in Idaho.

___ Information from: The Moscow-Pullman Daily News, http://www.dnews.com

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