I wasn’t all that opposed to the “payback” law imposed on Idaho state-sponsored medical students. House Majority Leader Mike Moyle proposed this law that had been rumored for years. It passed this last session. Now Idaho state sponsored medical school graduates (University of Utah and WWAMI) will need to work for four years within our borders to repay our state the investment taxpayers have made.
I remember my second year as a WAMI student in Seattle. Nowadays, Idaho WWAMIs (with the addition of Wyoming to the consortium we have an extra “W”) do almost all their training in Idaho. But back in my day we had to go to Seattle for our second year.
I asked the Medical School librarian to help me answer the question: What is the best way to train healthcare providers to serve a rural population? This was before Google. I thought I knew the answer. Move to a “mid-level” model, that is quickly train nurse practitioners and physician assistants. But her search responses came up with a lot of citations about Cuba. I read them. It was fascinating.
After Castro took power, he wanted to bring health care to “the masses”. With total state control, he could design any system he wanted. His advisors liked the “doctor” model. He instituted a system that cranked out physicians. Today, the communist Cuban health care system scores better than ours in many measurements of public health.
I got an opportunity in the late Clinton presidency to visit Cuba. I got to look at their issues. I spent a day with a young resident in a Havana suburb as he staffed a community clinic. He saw every patient on his list who wanted an appointment. He listened to their everyday complaints and offered what little he had to comfort their suffering.
If he found a problem that he could not comprehend from his four years of medical training, he scheduled an appointment with a consultant. He went with the patient to visit the consultant. He watched the consultant and learned how that specialist considered this problem.
At the end of the day, I asked the young man his aspirations. He told me he wanted to go into plastic surgery and hoped to have a lucrative practice someday, probably in Brazil.
So, Comrade Moyle may be onto something. Having medical school graduates come back to Idaho might motivate them to go out and make the most money they can. Trickle down tells us that will enrich us all, right? I can just see Mike and Fidel sharing a cigar. Except Fidel is dead, and I doubt Representative Moyle smokes cigars, though I don’t really know.
I learned something else on that Cuba trip. I heard the head of the Cuban medical education system asked just how he had accomplished the incredible turnaround in Cuban public health. How had the proliferation of doctors he had engineered in this still poor country made such strides? His answer was telling.
“You look at the doctors and think our medical training deserves credit. But you must look further. Back in the 1950’s when our infant mortality was worse than Africa, and our maternal mortality was horrible, the average education of an expectant mother was second grade. Most were illiterate. Now days, when our infant mortality and maternal mortality is better than the United States, the average level of education for expectant mothers is high school or better. None are illiterate. We have greatly improved our education, and that has improved our health.”
So, I don’t know if Comrade Moyle was actually thinking of the communist Cuban system when he proposed indentured servitude for medical graduates. But if what he wants is a healthier Idaho, he should be thinking about a better education system.