A major limiting factor in Idaho’s effort to expand medical education is the lack of available physicians willing to take on medical students in addition to their patient workload. The solution to this problem may likely require more money and designated time for those providers doing the training.
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The Idaho Medical Education Working Group — a committee of lawmakers and stakeholders looking into expanding medical education in the state — on Tuesday heard from some of these physicians who train medical students, and the themes of doctors needing more time, space and money to be motivated or able to take on the education role arose again and again.
“My challenge is, as an ER doctor, when I have students, is that I can’t control what’s going on in the emergency department,” said Kanan Silvas, an emergency room doctor in Coeur d’Alene. “It’s obviously very chaotic. I can’t decide that I’m going to see less people today or I’m going to take care of less people. So oftentimes, I have to slow down.”
More than 30% of surveyed Idaho hospitals don’t provide any medical undergraduate training
Brian Whitlock, president and CEO of the Idaho Hospital Association, told working group members Tuesday that in a survey of 34 hospital systems in the state — many of which have several hospitals and clinics within them — around two-thirds said they provided some sort of undergraduate medical education. Around 36% of those surveyed do not provide any of this training, he said.
“I was pleased that two thirds of our folks are seeing the value and the importance of being part of the education system for these students,” Whitlock said.
Within medical training, undergraduate education includes when students are still in medical school and must complete what are called “clerkships,” where they rotate among practitioners to receive real-world training in different fields of medicine. Graduate medical education refers to training provided once students graduate medical school and must complete a residency.
The physicians who oversee the undergraduate training are called “preceptors.”
Many of the hospital and clinic leaders and physicians who serve as preceptors had a similar message: It takes a lot of time to provide training to a medical student, and time away from patients can often mean the physician is not getting paid as much. For many providers, their pay is tied to their caseload, and there are not many programs to offset that time lost for teaching.
When Idaho is last in the nation in doctors per capita, many physicians may also not see it as an option to take fewer patients anyway, because the needs are so high, speakers said.
“We’ve built a system that relies on volunteerism and altruism, and I think we’re seeing some of those limits,” said Lisa Nelson, a physician and director of graduate medical education at Saint Alphonsus.
Nelson said training a medical student can sometimes mean it doubles the provider’s time to see a patient.
“If you see fewer patients, to really do a good job of teaching, your bottom line is affected,” she said, “and some people just don’t want to do more work for less money.”
Other challenges include a lack of space for students to see patients or use a computer without displacing a practitioner or housing constraints that prevent students from being able to live near the clinics where training might be provided.
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Another reason physicians may not want to take on students, according to several speakers on Tuesday, is they were trained to be doctors, not teachers. Many don’t feel comfortable or feel as if they have the skills to teach.
Multiple preceptors suggested a collaborative virtual training program that could be offered to preceptors that includes multiple medical schools that offer medical education in Idaho, such as the University of Washington medical school, the private Idaho College of Osteopathic Medicine, and the University of Utah.
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Idaho does not have a public medical school, although Idaho State University is researching the potential purchase of the Idaho College of Osteopathic Medicine, known as ICOM, Idaho Education News reported. Idaho medical students have access to 40 state-supported seats at the UW through the WWAMI partnership, which stands for Washington, Wyoming, Alaska, Montana and Idaho; and 10 state-supported seats at the University of Utah.
Several preceptors and hospital leaders also mentioned financial incentives, such as additional loan repayment support or tax credits, to those who take on medical students.
Andrea Christopher, a medical educator at the Boise Veterans Affairs Medical Center, suggested tying potential incentives to metrics, to ensure the quality of education is better.
Several preceptors also highlighted the support of residencies — the graduate medical education — as helping all levels of medical education and keeping more doctors in the state.
“I think for keeping physicians in Idaho, that residency spots are going to be key,” said Alex Tanabe, a doctor at St. Luke’s Medicine in Boise.
The desire to not prioritize quantity of preceptors over quality of care or education was echoed by Maureen Ferguson, a doctor at St. Luke’s in McCall.
“I still really believe that this is going to be a slow roll, because the most important thing for me in all of this is maintaining the quality that we have had thus far in terms of preceptors, educators, students,” Ferguson said, “and so I continue to just want to slow it down a little bit so we can maintain quality, rather than get a quantity of providers out there.”
Idaho Capital Sun is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christina Lords for questions: info@idahocapitalsun.com.