With Idaho's first medical school set to open in less than two years, some doctors are wondering if the state has enough resources to train new graduates.
“I worry about adding more students,” said Dr. Thomas Patterson, who runs his own practice and teaches medical school graduates in Boise. “I know I can't add anything else on my plate, but yet I have an obligation to give back the education I received.”
The proposed Idaho College of Osteopathic Medicine, commonly called ICOM, plans to open in Meridian in 2018 with a class of 150 students. The private school, which is still seeking national accreditation, will serve Idaho and four other states in the region.
Doctors aren't ready to practice medicine on their own after medical school. They must first be accepted into a residency program, which coordinates with hospitals and clinics to supervise and train the new graduates for three to seven years, depending on the specialty.
Idaho's residency programs have 42 openings each year, which, per capita, is the second lowest residency offering in the country. Doctors have expressed concern that adding 150 more graduates from ICOM will strain the training resources.
The medical college is a good idea, but the class size seems too big for the region to handle, said Dr. Ted Epperly, president and CEO of Family Medicine Residency of Idaho. He said that 40 to 50 graduates would be better.
“In a small state with limited resources, you must be careful about flooding the potential resources with too many student learners, so that becomes the biggest issue,” Epperly said.
Not all of those 150 students will seek training in Idaho after they graduate, as ICOM's efforts are spread across five states. Training doctors in Idaho, however, increases the doctors' chances of staying in Idaho to practice medicine, Epperly said. Nationwide, more than half of physicians work in the state where they did their residency training, according to the Association of American Medical Colleges.
ICOM is offering seed money to encourage health organizations in the five-state region of Idaho, Montana, Wyoming, North Dakota and South Dakota to create new residency programs. The offer is $250,000 per program.
Robert Hasty, the founding dean and CEO of the proposed medical school, said he's confident the region will be able to create more residency positions, especially with the seed money from the college.
“We're in talks with hospital systems throughout the area,” he said. Benefis Health System in Montana has pledged to create 78 more residency positions by 2020, he added.
Hasty has visited hospitals throughout the state to share his vision and excitement, Idaho Hospital Association President and CEO Brian Whitlock said. The college is working diligently, he said, to make sure there are enough training opportunities for its graduates.
St. Luke's Health System is already “bursting at the seams” in its teaching efforts, but the hospital is committed to working with ICOM to increase training opportunities, said Dr. W. Mark Roberts, St. Luke's medical director for research and medical education.
“This will challenge us,” he said. “But we're up to the task, because it's critical to our mission and our state that we train more doctors.”
Idaho's doctor shortage is a growing concern as the population increases and the physician workforce ages.
“Twenty-five percent of our doctors in Idaho are over 60. That means in the next few years, we've got a lot of doctors that are retiring. We have no way to replace them,” said Sen. Marv Hagedorn, R-Meridian. “And I'm 60, so I'm kind of getting concerned about that. Who am I going to go to? Who are my kids going to go to? This is something we all need to be concerned about.”
Hagedorn and Gov. Butch Otter were part of a team that negotiated with investors to bring the medical school to Idaho. The investors were originally looking at Montana. Doctors there raised similar concerns as some doctors in Idaho have raised.
“Physicians are feeling overwhelmed by, how could they possibly do this amount of medical education?” said Suzanne Allen, a family doctor in Boise and a vice dean at the University of Washington School of Medicine.
Part of the deal with investors was that Idaho leaders could not include the Idaho Medical Association in the discussion because of the resistance investors faced in Montana, Hagedorn said. The Idaho Medical Association represents more than 2,000 active physicians and residents, yet its leadership only heard about ICOM the day before it was announced to the public.
The secret dealings troubled doctors around the state, Allen said.
“It was a tough deal," Hagedorn said. “I felt really badly about it. ... But that was a request of the company, and we had to honor that."
The main investors in ICOM are The Burrell Group from New Mexico and The Rice Company, part of Rice University in Houston.
"We were dismayed that we weren't included in that process," Idaho Medical Association CEO Susie Pouliot said. "However, I do have to tell you that that was a while ago, and we're trying to move forward in a productive manner now.”
Idaho's medical community has been working for years to bolster the state's medical education and improve our low doctor-patio ratio. Idaho ranks 49th nationwide in the number of physicians per resident, according to the Association of American Medical Colleges.
Though Idaho doesn't have its own medical school, the state state buys medical school seats for Idaho students in the University of Washington WWAMI Regional Medical Education Program and at the University of Utah School of Medicine.
Earlier this year, Idaho lawmakers approved seven new medical school seats and six new residency positions, bringing the total up to 50 medical school seats per grade level and 42 first-year residency positions.
Even before Idaho's new medical school was announced, Idaho State University and the Family Medicine Residency of Idaho were looking at expanding their residency programs.
Because Idaho is second to last in the country for the number of residency positions per capita, it's at a disadvantage in attracting and retaining doctors, Whitlock said.
“Now more than ever, we really need to address this issue that existed even before the medical school was announced,” he said. “It's time to stop talking about it and put our words into action now, and part of that is a financial commitment."
Sen. Hagedorn said he and other state leaders see the need for a greater investment in residency programs, and he expects the issue to come up during the 2017 legislative session.
“Our biggest opportunity now as a state is to set up a program where we can help fund residencies,” he said.
Hagedorn, along with Whitlock and Roberts from St. Luke's, is optimistic that the new medical school will strengthen Idaho's efforts to expand medical training.
“It's been a catalyst to move us in a very positive direction,” Whitlock said.
HOW IT STARTED
In early 2016, the Idaho Osteopathic Physicians Association learned that The Burrell Group, an investor group in New Mexico, was seeking to build a private, for-profit osteopathic medical school in the Intermountain West, according to the Idaho State Board of Education's Feb. 25 meeting agenda.
The Idaho Department of Commerce in turn contacted The Burrell Group to explore the possibility of building the school in Idaho. Idaho and investors reached a deal within 30 days, and on Feb. 25, Otter announced that the Idaho College of Osteopathic Medicine, or ICOM, was coming to Meridian.
The same investor group also started the Burrell College of Osteopathic Medicine at New Mexico State University, which opened in the fall.
- Type of institution: Private, for-profit medical school, largely funded by The Burrell Group and the Rice Management Company with Rice University
- Status: Working toward pre-accreditation, with plans to gain provisional accreditation in 2017 and full accreditation when the first class graduates in 2022
- Projected open date: Fall 2018
- Class size: 150 students
- Program length: Four years
- Location: Future three-story, 90,000-square-foot facility just east of the Idaho State University Meridian Health Science Center. The college has reached a 40-year land lease agreement with ISU.
- Capital investment: More than $30 million
- Service area: Idaho, Montana, Wyoming, North Dakota and South Dakota
- Tuition: ICOM can't publish its tuition until it reaches provisional accreditation, but the college has pledged to keep tuition lower than the national average for private osteopathic medical schools. That average is projected to be about $50,200 when ICOM opens in 2018, according to the school's founding dean and CEO, Robert Hasty
- Staffing and training: At least 438 preceptors in the five-state region have committed to help train students, Hasty said, and ICOM has hired six associate and assistant deans, as well as a board chairman and a president. The college is affiliated with 10 health care systems.