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Youthful brains

Montana’s doctor shortage will be on the agenda when the Legislature’s Children, Families, Health and Human Services Interim Committee convenes in Billings.

More than 20 percent of Montanans live in areas with a shortage of physicians, according to the U.S. Health Resources and Services Administration. Solutions are more difficult because other states also are shorthanded.

The Montana Family Medicine Residency, based at RiverStone Health, has a proven track record of training family doctors who stay to practice in Montana. The Billings Clinic Internal Medicine Residency, now in its second year, this summer admitted a class of 11 new doctors, including eight who grew up in Montana or Wyoming.

The primary care shortage is serious, the shortage of psychiatrists is even more acute. Now is the time to start training psychiatrists in Billings.

As noted in a June 21 Gazette opinion, the state of Idaho and the University of Washington Medical School have already created a successful psychiatric training track that can be a model for Montana. On Nov. 19, Dr. Eric Arzubi, chief of psychiatry at Billings Clinic, is scheduled to present a psychiatric training track proposal to the interim committee.

Arzubi provided the committee with a succinct advance summary of the problem:

  • Montana is facing a mental health crisis due in part to a shortage of psychiatrists.
  • Recruiting and retaining psychiatrists in Montana has proven to be very challenging and expensive.
  • Montana, along with Wyoming and Alaska, ranks highest in the U.S. in terms of suicide completion rate.
  • Montana, Wyoming and Alaska are the only three states in the U.S. without a psychiatric training program.

The solution, Arzubi wrote, includes:

  • Training and retaining up to four psychiatrists in Montana every year by creating a Montana psychiatry training track in collaboration with the University of Washington and the U.S. Department of Veterans Affairs.
  • Designing the training track based on an existing, very successful model pioneered by the University of Washington in Idaho and Washington, which has retained more than 60 percent of graduating psychiatrists in Idaho and more than 80 percent in Washington.

The state of Montana has difficulty hiring psychiatrists for institutional work. The VA couldn’t hire enough psychiatrists to keep a new inpatient unit open in Helena. Sen. Jon Tester, a member of the U.S. Senate veterans affairs committee, is supporting VA participation in a Montana psychiatric residency. Even in community mental health care in Billings, it’s hard to recruit and retain psychiatrists.

The committee members need to listen and learn so they can effectively advocate for the state to be a substantial partner in a psychiatric residency that would benefit the entire state.

Children's mental health

Billings is fortunate that two local lawmakers serve on this interim panel. Sen. Roger Webb also serves on the appropriations subcommittee that would vet state support for the residency. Rep. Jessica Karjala serves on the House health and human services committee.

Next week’s meeting is unusual because interim committees generally stay in Helena. It’s good for this panel to gather in Billings, and hear from professionals in the state’s largest health care center. In addition to hearing an important proposal for training psychiatrists, lawmakers will be briefed on local efforts to meet the mental health needs of youth in crisis. Much of the second meeting day (Nov. 20) will be devoted to a study of guardianship laws and services for Montanans with Alzheimer’s disease.

Addressing Alzheimer's issues

The 2015 Legislature recognized that Montana guardianship laws need to be updated and clarified. Standards must be set to assure that guardians are qualified to take on the tasks required of them. The situation is urgent because Montana’s rapidly aging population will require the services of more guardians. The need is compounded by the increase in Alzheimer’s and other dementia.

Our aging population will require more health care, and more doctors, including psychiatrists. The interim committee must look ahead to pave the way for 2017 legislation that will help safeguard the health of Montanans of all ages.

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