January 29, 2016
I would like to share some information on a complex issue: medical education in Idaho. Providing medical professionals to ensure the health of our citizens is an important educational mission. Healthcare encompasses many professions: physicians, nurses, pharmacists, physical therapists and more. This letter will focus on physician training or the medical doctorate (M.D.), in which UI plays a critical role. Understanding how medical education is delivered is necessary for making informed decisions about the future of such programs in Idaho – planning for smart and sustained growth.
The WWAMI program
is the primary MD training program in Idaho. WWAMI stands for “Washington, Wyoming, Alaska, Montana and Idaho” – a partnership between the state of Washington, its top-rated medical school at the University of Washington, and the four, more sparsely populated nearby states that do not have their own public medical schools. Through this program, Idaho students receive the M.D. degree from the University of Washington, nationally ranked No. 1 for primary care, No. 1 for family medicine, No. 1 for rural medicine, and highly ranked in many specialties and in research.
For three decades, Idaho had 20 WWAMI seats. Last year, that number rose to 35 Idaho students. And this year, UI requested state funds to enroll 40 students in the Idaho WWAMI program. That growth has contributed to success for students and to a healthier state.
Physician training is long, complex and requires a system of universities, medical schools and residency programs. An excellent resource from which I will draw much of my data is the Association of American Medical Colleges (AAMC) 2015 State Physician Workforce Data Book
and related material on their website.
Preparation for Medical School – 4 years
Most aspiring physicians begin preparation for medical education as undergraduates in a bachelor’s degree program. Few colleges offer pre-medical majors, and prospective medical students may complete any degree program provided the requisite coursework in chemistry, biology, mathematics, physics and English is successfully completed before admission. Just over half of all students entering medical school in 2015 had completed a biology major, but many other majors are represented. All of Idaho’s four-year institutions offer appropriate prerequisite coursework for applying to medical school.
Medical School – 4 years
Physicians may hold an MD or Doctor of Osteopathy (D.O.) degree. As the degree that designates entry into the medical profession, these degree programs are considered Undergraduate Medical Education among medical schools, an often confusing term for a professional degree that follows bachelor’s degree attainment. Traditionally, medical school was a four-year educational curriculum that began with foundational basic sciences, and then introduced clinical experiences in hospitals and doctor’s offices as the curriculum progressed. Increasingly, new curricular approaches are integrating clinical work throughout training, requiring medical schools to have access to clinicians and clinical sites to permit such experiences.
Residency Training – 3-6 years
After completing an MD or DO program, almost all physicians pursue Graduate Medical Education, commonly referred to as residency training, for the purpose of establishing a specialty. Primary care residencies (Family Medicine, Internal Medicine, and Pediatrics) are typically three years of intense clinical experience in supervised settings. Other specialties, such as surgery or radiology, are typically six years and require even more specialized supervision. Many residencies are at academic medical centers, but they can also be at community hospitals. Idaho has residencies in Family Medicine based in Boise, Coeur d’Alene and Pocatello; in Internal Medicine in Boise; and in Psychiatry in Boise.
Physician Workforce Needs
The AAMC is concerned that current physician training may not produce enough doctors to meet the United States needs in the 21st century. AAMC data clearly indicate that Idaho’s physician pipeline is very limited, which is why the University of Idaho has been working hard to increase physician training on multiple fronts.
Idaho ranks 49th in physicians per capita. We have less than 20 percent of the national average of medical residents per capita, and reasonable estimates of medical students from Idaho – enrolled in programs across the U.S. – indicate that our state enrolls Idahoans in medical school at less than half the per capita national average. Idaho students applying to medical school are well-qualified, with MCAT test scores and grade point averages very similar to national peers, and they are admitted at rates similar to all premedical students.
In sum, for its population, Idaho has a low number of practicing physicians and a small, but growing MD production pipeline. While we strengthen that pipeline, we can continue building upon the Idaho WWAMI program’s strengths and expanding capacity.
The University of Idaho’s Current Role
The University of Idaho plays important roles at all three stages of the physician pipeline. It is not certain how many UI students attend medical school after graduation, but we know that about 10 percent of all WWAMI students studied at UI. Clearly, UI plays an important role in pre-medical (bachelor’s degree) education, one we plan to expand.
Second, the centerpiece of UI’s role in medical education is the Idaho WWAMI program. In this program, Idaho students, no matter where they attended undergraduate education, access the UW School of Medicine via the University of Idaho. They complete their first 18 months of physician training in Moscow and surrounding rural communities, facilitated by UI faculty and area physicians. That experience is followed by clinical clerkships in 178 locations across Idaho and other WWAMI states. Students then complete an eight-week clinical rotation in one of the University of Washington’s highly specialized quaternary care hospitals, and may choose clinical rotations throughout the WWAMI network. Fortunately, most Idaho WWAMI students complete the bulk of their MD training in Idaho.
Last, WWAMI graduates, like most physicians, will complete residencies before practicing. WWAMI staff play an integral role for the residencies in Idaho. Residency is often the primary determinant of where a physician will practice. We are fortunate that despite the limited residency opportunities currently available within the state, 51 percent of all Idaho WWAMI graduates have practiced or are practicing in Idaho.
I hope you see that the challenge of educating, attracting and retaining Idaho’s 21st-century physician workforce is a complex one. The University of Idaho is pleased to have a world-class partner in the University of Washington to help us meet that challenge, and we are proud to have rapidly increased the number of students admitted to pursue physician training.
We have a long history and exciting future in training Idaho’s next generation of physicians. We need to work collaboratively to find solutions for access to medical education. Together, we can overcome our state’s healthcare challenges and lead Idaho to a healthier tomorrow.