Influx of medical students could stretch Montana resources

Opening two new medical schools in Montana would stretch and possibly overwhelm the state's physicians who provide the clinical training that students need to become doctors, according to leaders of a University of Washington medical school program that relies on those teaching physicians.

The UW School of Medicine's WWAMI program in Montana requires its students who have finished their academic work to complete clerkships and clinical rotations to graduate, and then those graduates must be matched with residencies. WWAMI — an acronym of the five states participating in the program: Washington, Wyoming, Alaska, Montana and Idaho — uses hundreds of Montana physicians for that hands-on training, in addition to physicians in the other four states.

That's why plans by the for-profit Rocky Vista University College of Osteopathic Medicine to build a campus in Billings and the nonprofit Touro College and University System to build an osteopathic medical school in Great Falls have WWAMI officials worried.

"The biggest concern that everyone has is around clinical resources," said Dr. Suzanne Allen, vice dean of academic, rural and regional affairs for UW's School of Medicine. "At some point, there's not enough of those clinical resources to go around for everyone to have a good learning experience."

The UW is an allopathic medical school, whose graduates are doctors of medicine, while the proposed Montana schools would train doctors of osteopathic medicine. Both kinds of doctors are fully licensed physicians. The students study the same curriculum and participate in the same clinical training, but they take different licensing exams, and the schools are accredited by different panels: the Liaison Committee on Medical Education for allopathic schools, and the Commission on Osteopathic College Accreditation for osteopathic schools.

Dr. Jay Erickson, assistant dean for regional affairs and rural health and assistant clinical dean for Montana WWAMI, criticized lax osteopathic school accreditation standards for creating a potential Montana medical student logjam that could affect his program.

"The LCME which accredits allopathic medical schools would never approve two new medical schools in a state of 1 million people with limited clinical teaching opportunities that are largely utilized by Montana WWAMI and the existing residencies," Erickson said in an email.

ROCKY VISTA, which has schools in Colorado and Utah, announced in May that the Commission on Osteopathic College Accreditation had approved its plan to build a Billings campus. The application by Touro, which has campuses across the country, for a facility in Great Falls is set to be taken up at the commission's August meeting.

Opening new medical schools would provide more slots to in-state students who might otherwise be rejected because of WWAMI's thresholds. Montana WWAMI accepts only 30 students a year. In Alaska and Wyoming, it's 20 students a year. In Idaho, it's 40, and in Washington, it's 160 divided between Seattle and Spokane. All WWAMI students must be residents of the state in which they apply.

Those classroom slots don't necessarily guarantee more training opportunities in the field. Such work accounts for about half of a medical student's education.

For the first two years, students in the WWAMI program receive classroom instruction at affiliated universities, such as Montana State University in Bozeman. Then in their third and fourth years, WWAMI students are required to complete clerkships and clinical rotations with doctors whom the program uses as clinical faculty, or teaching doctors, across the state.

About 230 WWAMI students from all five states participate in Montana clerkships as well as clerkships in the other four states. Other medical schools, including Idaho's College of Osteopathic Medicine and the Pacific Northwest University's College of Osteopathic Medicine, also use Montana for their students' clinical training.

The worry of school officials and some of those teaching doctors is that the flood of students the two new medical schools would bring could lead to increased competition and be harmful to the hands-on education that clinical rotations are designed to provide.

Dr. KayCee Gardner, a 36-year-old WWAMI graduate, practices family medicine in Miles City and trains WWAMI students.

"I just hope with more medical schools being built that there will be enough teachers and enough places for them to get a good rotation and not just be standing in the back observing," Gardner said.

Another point of concern is how the new Montana schools will affect residencies, which all medical school students must complete after graduating to become certified doctors. Residency placements are already very competitive, depending on the hospital and the specialty. WWAMI students are encouraged to seek residencies in the five-state region.

SINCE MANY doctors end up staying in the area where they do their residency, it is important to the goal of training doctors for rural and underserved communities, such as Montana and Idaho, for schools to encourage students to complete in-state residencies.

Four years ago, Idaho went through the uncertainty that Montana is going through now. That's when the for-profit Idaho College of Osteopathic Medicine was founded, leading to worries that the school would hamper WWAMI students' clinical training opportunities there.

Dr. Tracy Farnsworth, ICOM's president, said the school created more than 50 clinical affiliations and hundreds of affiliations with private physicians to avoid conflicts.

Now, both Farnsworth and WWAMI's Idaho director, Dr. Jeff Seegmiller, say their schools are united by the goal of boosting Idaho's number of physicians per capita, the second-worst ratio in the nation.

"In our view, we need WWAMI, but we also needed Idaho College of Osteopathic Medicine. To become something other than last in the nation for physicians, you need more resources, more ability to generate physicians," Farnsworth said.

ICOM has 486 students compared with WWAMI Idaho's 160, and about three-quarters of the for-profit school's students are from states outside of Idaho and the region.

Of the more than 800 physicians who have been trained by the Idaho WWAMI program, 51% of graduates return to practice in Idaho, according to Seegmiller.

ICOM's first class will graduate in May 2022, so it is unknown how many of its students will return to the state.

Touro University College of Osteopathic Medicine, which is awaiting approval from accreditation agencies, plans to accept 125 students each year and to educate them with affiliates in Montana as well as sending some students out of state for their clerkships and rotations, according to Dr. Alan Kadish, president of the Touro College and University System.

He said Touro plans to give preference to Montana residents but does not have a quota on how many in-state vs. out-of-state students it will accept.

"With our [osteopathic] model and increased primary care residencies, we believe that we will encourage students to enter primary care and remain in the state," Kadish said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.