Nearly all of Montana’s 56 counties are designated primary-care shortage areas, according to information from the Montana Primary Care Office in Helena. Some have no primary care doctors at all, some don’t have enough and some are short of doctors to serve low-income folks. Yellowstone and the few other counties that aren’t designated shortage areas have federally subsidized clinics that serve low-income/rural populations that otherwise would be underserved.

Primary-care doctors — a term that includes family physicians, internal medicine, pediatricians and obstetrician-gynecologists — are in great demand nationwide. There simply aren’t enough of these basic-care providers to go around. An aging population needs more primary care, but this field has become less popular with new physicians. New doctors with hundreds of thousands of dollars in educational debts have a strong incentive to opt for better-paying specialties.

Montana State University in Bozeman is formulating a proposal to turn that trend around. An informational item presented at the Board of Regents’ meeting last week in Bozeman calls for providing more Montanans with the opportunity to become primary-care doctors while assuring that they will practice in our state.

MSU proposal

The preliminary proposal would:

• Double the number of Montana medical-student slots from 20 per year to 40.

• Provide all four years of medical-school education in our state, thus eliminating the year Montana students now spend in Seattle. Boise and Spokane are working on WWAMI branch campus models similar to what MSU is proposing.

The idea of expanding the supply of Montana-trained primary care doctors makes perfect sense. Since 1973 when Montana began paying a portion of the costs of educating Montana students in the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) program at the University of Washington Medical School, Montana’s population has increased by 30 percent, but the number of slots the state sponsors hasn’t increased at all. Our state population is aging rapidly. About 14 percent of Montanans are over age 64; by 2025 the over-64 population is expected to be 25 percent, making Montana one of the oldest-population states.

The MSU proposal includes the possibility of requiring the 20 additional students to apply for National Health Service Corps scholarships, which would fully fund their medical education, obligate them to choose primary care and to work for some years in underserved communities. MSU spokeswoman Cathy Conover said the university is  working on getting an agreement for restricting NHSC scholarship service to Montana communities.

The American Recovery and Reinvestment Act that became law earlier this year included a $200 million boost for National Health Service Corps programs that provide scholarships and educational loan repayment, according to John Schroeck, of the state Primary Care Office.

Policy change needed

Along with increasing medical-school slots, the state would need to expand its medical residency availability. The Montana Family Medicine Residency, based at RiverStone Health in Billings, is the state’s only medical residency. Director Roxanne Fahrenwald is enthusiastic about expanding the residency, which has been highly successful in training doctors who stay in Montana. Fahrenwald told a Gazette reporter that she also supports the expansion of Montana WWAMI slots.

However, federal policy must change before Montana can train more family doctors. The federal government, which subsidizes medical residencies, has capped the number of training slots.

Both the House-passed health reform bill and the bill that Senate Majority Leader Harry Reid is bringing to the Senate floor for debate next week would redistribute training slots with a priority on increasing primary care. The Senate bill, partly written by Sen. Max Baucus, includes a provision “to ensure the availability of residency programs in rural and underserved areas” by establishing “teaching health centers” that sound exactly like the Montana model with the residency based at the RiverStone community health center.

MSU’s planning for future medical education is timely. It takes at least seven years to train a new doctor. If MSU presented a plan next year to expand medical training, if the regents supported it, if the 2011 Legislature agreed and launched it in 2012, the first doctors trained in the additional slots would start practicing in underserved Montana communities in 2019. By that time, Montana’s senior-citizen population will have increased by tens of thousands.

Data shows that doctors tend to practice near the places they train. To get the additional doctors Montana needs, our state must educate them here.