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Indentured

schmidt

The Idaho legislature wants to make Idaho medical students whose education is supported by taxpayer dollars serve some time in Idaho when they grow up and become practicing physicians. Seems like a win-win, doesn’t it? Idaho needs doctors, the students want to become doctors. Why not require them to spend some time helping out this beautiful state in return for the taxpayer support they receive?

You need to know I have some history here. I was supported in my medical education by Idaho taxpayers some 40 years ago. I was an Idaho WAMI. It had just one “W” back then, before Wyoming joined Washington, Alaska, Montana, and Idaho in the medical school collaboration.

It’s not the first time Idaho has tried to incentivize WWAMI students to return to our dear state. The first attempt was a carrot, not a stick. WWAMI students who returned to Idaho and practiced in an underserved area could be eligible for support to repay medical school loan debt. This was from a fund garnered from assessments on students in the program, and later, taxpayer funds were added.

But the current law is a stick. If you are a WWAMI student and don’t come back to Idaho to practice within a year of finishing your residency or getting a license, and then stay for four years, you owe the state of Idaho the full amount of what the taxpayers doled out to support you: about $160,000.

Alaska, Wyoming, and Montana have all instituted such requirements of their state supported students in the last few years. None of these states has seen a dramatic drop in applicants for their programs.

The University of Washington School of Medicine and the WWAMI multistate collaborative program are recognized for their excellence in training and preparation of medical students to serve both primary care and rural populations.

I’ve watched the UW/ University of Idaho WWAMI faculty try to avoid this for the last ten years and I really haven’t understood their reluctance.
Taxpayers deserve some return for their investment. But carrots and sticks? Why not make Idaho a place doctors want to work and where people want to be well?

One of the most critical decisions a young highly trained professional in any field faces is where to locate and put their services to use. Market forces often focus on the quantifiable salary, but for many, there are greater considerations.

Where can my spouse be happy?

Will my children thrive in this town?

Will I continue to learn and grow in my profession?

Can we find a place to live that will suit us?

Will our family feel welcome?

I know these are their questions because I had them myself, and I addressed them in the colleagues I recruited.

The best way to serve our state in its health care professional needs may not be with carrots or sticks but instead to look at the bigger picture. We need to make our state sustainably desirable to live in, to work in, to serve in.

I moved from Hells Canyon to Council, Idaho to McCall, to Moscow where I started my family. We walked the streets before the Farmers Market and looked at the big old homes. We fell in love with the Palouse.

Each of our little towns, and even the big ones need to be supported as they struggle to serve their needs. Carrots and sticks are the tools of petty tyrants. We need vision and wisdom in the leaders we elect.

I cannot oppose this requirement that medical students return to the state that supported their wonderful education. They should have a deep sense of service to the health of their community. Idaho leaders need to build strong communities for them to serve.
 

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