BOISE - Idaho Gov. C.L. "Butch" Otter is offering limited support for a 10-year, $16.3 million plan that could dramatically increase the number of doctors practicing in the state.
Supporters call the proposal a "once-in-a-generation opportunity" to benefit Idaho citizens that, if missed, will leave the state mired in 49th place for the number of physicians per 100,000 in population.
And if something isn't done, that ranking could get worse: During a presentation to the joint budget committee Wednesday, Dr. Ted Epperly, executive director of Family Medicine Residency of Idaho, warned that more than a quarter of the state's practicing physicians are expected to retire in the next decade.
"We have a hole in Idaho, and it's important that we start filling it now, because the problem isn't going away," Epperly said.
Otter has long been aware of this issue. For example, he has overseen a sharp increase in medical education funding since his first term in office, doubling the number of slots for Idaho students in the WWAMI regional medical school program that serves Washington, Wyoming, Alaska, Montana and Idaho.
However, Epperly noted that medical school graduates must undergo additional training in residency programs before they can practice independently.
"Studies have shown that 50 to 70 percent of residents will stay within 100 miles of their training location," he said. Consequently, expanding residency programs is the key to increasing the number of doctors in Idaho.
Two years ago, Otter asked the Idaho State Board of Education to work with stakeholders - including the Idaho Medical Association, hospitals and current providers - to develop a plan for increasing medical residency training in the state.
The proposal they came up with calls for a 10-year, $16.3 million investment that would boost the number of residency and fellowship training slots statewide from 141 to 356 by 2028. The state board unanimously recommended approval of it in December.
Epperly presented the plan to the budget committee Wednesday. In addition to increasing residency slots, the proposal would increase the overall number of programs, from 13 to 30. New residencies would be offered in communities such as Nampa, Idaho Falls and Sandpoint. Moscow and/or Lewiston would likely get one as well.
The number of residents graduating from these programs each year would more than double, from 52 to 124, Epperly said. The total number of graduates trained during the 10-year period would nearly quadruple, from 520 under the status quo to 2,000.
If even half those doctors remain in Idaho, he said, they would likely generate more than $1.3 billion in economic activity and 10,000 jobs, based on economic impact estimates from the American Medical Association.
"This is a once-in-a-generation opportunity," Epperly said.
Nevertheless, even though the plan was developed at his request, Otter only included partial funding for it in his 2019 budget request. He also wants an independent, third-party review of the overall proposal.
"Before making a multi-million dollar, ongoing investment, it is imperative that we have an objective analysis of the proposal to ensure that limited state resources are used where they'll have the greatest impact," he said in a recent letter to the state board.
The plan calls for an initial investment of $5.2 million in fiscal 2019, followed by smaller, incremental increases through 2028. The bulk of that first-year funding would go toward the cost of existing residency slots.
Epperly said a typical residency program takes three years to complete and costs $150,000 to $224,000 per doctor, depending on their medical specialty. More than 80 percent of that money comes from patient fees and other fees paid to the resident and the hospital where they practice. The state also chips in an average of $30,000 per position.
Under the stakeholders' proposal, the state contribution would increase to $60,000, or about one third of the overall cost. The idea is that this would be an incentive for programs to offer more residency slots.
Jani Revier, Otter's budget director, said the governor remains supportive of efforts to expand residency positions in Idaho, but thinks it would be prudent to get an independent review before fully funding the proposal.
"The stakeholders (who helped developed the plan) would directly benefit from it," she said.
Revier also noted that Otter is recommending nearly $1.1 million of the $5.2 million request. That would provide partial funding for a new internal medicine residency program at Eastern Idaho Regional Medical Center in Idaho Falls and an additional slot at the Idaho Physicians Clinic residency in Blackfoot, as well as help develop a new psychology intern program.
"The governor is committed to doing what he can and knows something needs to be done (to increase residency training in Idaho)," Revier said. "The question is, how?"
Susie Pouliot, CEO of the Idaho Medical Association, said she was disappointed that the governor didn't fully support the residency plan. Pouliot noted that the new Idaho College of Osteopathic Medicine in Boise is set to enroll its first class this fall.
"If we don't have a dramatic increase in the number of Idaho residencies, there won't be adequate space to train those graduates," Pouliot said. "If we don't act soon, Idaho will become an exporter of medical school graduates."
The Legislature could choose to fund the entire first year of the 10-year plan, but it's unclear if Otter would veto the bill.
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