Over the past decade in the Legislature I have become keenly aware of Montana’s physician shortage. Our Legislature has addressed this to the extent possible. In 2007, another senator and I passed legislation incentivizing doctors to practice rural medicine. In 2013 we expanded the Montana medical student slots to the max available from the University of Washington School of Medicine (WWAMI). While helpful, these steps fall short in context of the magnitude of our shortage, and particularly with regard to primary care. It is my opinion that our shortage can only be fully addressed by establishing a Montana Medical School.
Let’s define the problem: 1) Medical needs increase with age. Our median age is 40, compared to Utah’s median age of 30. 2) Montana is below average in active in General Practitioners (GPs) per capita. Twelve counties have no primary care physician. 3) Montana has one of the oldest physician workforces in the nation. 32.7 percent of our 2,349 active physicians are 60 or older. It is reasonable to predict 750 will retire in the next decade. 4) While approximately 40 percent (12 of 30 on average) of WWAMI graduates come back to Montana, this number is woefully insufficient to meet our need. Moreover, many WWAMI doctors are specialists, not GPs. 5) Doctors tend to establish practices where they do residencies, but Montana ranks 49th in the U.S. on a per capita basis for residencies. 6) Approximately one-third of U.S. residency slots are filled by foreign medical graduates, suggesting significant excess capacity for American medical school graduates. 7) Training hospitals attract high performing doctors and often offer cutting edge medicine (consider MAYO and Cleveland Clinic); but Montana is one of five states that lack an in-state medical school.
A private entity is considering establishing a Montana school that would graduate approximately 125 doctors annually. This type of medical school will produce a high percentage of General Practitioners. Many of the residents would train in Montana, and establish Montana practices. This proposal has unparalleled merit in addressing our shortage while enhancing opportunities for our Montana students.
Fear of unknowns and a “turf war” are currently creating barriers. Some fear this bodes ill for WWAMI; others feel this private school should not locate in Bozeman (turf). Arguments are also surfacing that a “private school” is somehow bad (Carroll College, Harvard, Yale, etc. are examples of private schools).
We need to replace these fears with the facts before we lose this great opportunity to another state. It could be decades before another private organization considers investing over $100 million in Montana, let alone for the creation of a much needed Montana Medical School. By then it will be too late to effectively address the physician crisis. Failure to work through existing challenges ignores our escalating shortage and limits opportunity for Montana students. As the parent of a doctor who went to Case Western Medical School and now practices in Denver, where he served as a resident, I wish this option had existed 15 years ago.
State Sen. Llew Jones, R-Conrad
Chair of the Senate Finance and Claims
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