010808 Mt Wwami - Mus

010808 Mt Wwami - Mus

WWAMI in Montana WASHINGTON WYOMING ALASKA MONTANA IDAHO WWAMI Jay S. Erickson M.D. Assistant Dean-WWAMI Clinical Phase/Montana 010808 MT WWAMI [1] Physician Pipeline K-12 College (4 years) Medical School (4 years)

Residency/Fellowship (3-7 years) Practicing Physician 010808 MT WWAMI [2] WWAMI Non-metro percent of population by state 12% 34% 65% 70% 33% 010808 MT WWAMI [3] The WWAMI Program: Founding Goals (1971) 1) Access to Publicly Supported Medical Education 2) Avoid excessive capital costs by using existing educational infrastructure

3) Create Community-Based Medical Education 4) Expand GME and CME across WWAMI 5) Increase the number of primary care providers (MD) /address maldistribution of physicians 010808 MT WWAMI [4] 010808 MT WWAMI [5] 010808 MT WWAMI [6] UWSOM TRUST/WRITE 2015-2016 ~ 34 sites Lynden/Birch Bay Fernd Gran Newpo ale Port d Chela

rt Angeles Port Coul Libb Whitefis n Sandpo Spoka Townsend ee y h int ne Montesa Moses no Ellensb Orofin Lake urg

o Pullm Butte Washington an Hamilt W on Dillon McCal l Glasgo w Montana W Lewisto wn Miles Livingst City

Hardi on n Powe ll Idaho Alaska Wasilla Anchora ge Kodi ak Boise Wyoming Hailey

Namp a Jerom e Land er Dougl as Cheyen ne Junea u Ketchik an TRUST/WRITE Sites WWAMI Regional

Offices 010808 MT WWAMI [7] 010808 MT WWAMI [8] Montana Physician Workforce Data Per 100K population, Montana ranks: 29th in nation for total active patient care physicians 24th for active patient care primary care physicians 11th for active patient care general surgeons Montanas physicians are aging: 32.7% of Montana physicians are over age sixty (National average is 29.4%) 2015 AAMC State Physician Workforce Data Book 010808 MT WWAMI [9] The Pipeline

How many Montana students attend medical or osteopathic schools, past 7 years? 54 MT residents per year attend medical school in the US MT WWAMI-30 WICHE medical school-6 19 MT residents per year attend osteopathic school in the US WICHE osteopathic school-2 010808 MT WWAMI [10] Workforce Progress-Montana WWAMI since inception in 1973 Rate of return: 40% (MT WWAMI grads that practice in MT) Return on Investment for MT: 56% ( all WWAMI grads that practice in MT) National rate of return on instate medical education: 38.7%

010808 MT WWAMI [11] Specialty Choice of WWAMI Graduates 1973-2015 (top ten) 180 161 160 Medical Specialties of Montana WWAMI # of Graduates in Specialty 140 Graduates (Total: 731) 120 Years: 1973 - 2015

100 80 62 60 46 40 20 166 32 18 67 51

35 22 0 51% matched into a primary care specialty Medical Specialty 010808 MT WWAMI [12] WWAMI is cost-effective State support per student for medical education in Montana is $35,871 (Provides funding for 110 WWAMI, 24 WICHE medical students and 8 WICHE osteopathic students per year) Montana FY 16 state appropriation for UW/WWAMI is $4,124,480 60% of Montana state appropriations for WWAMI are spent in Montana

A 2010 study showed that for every state dollar invested in WWAMI , Montana gets back 5.14 dollars into our economy 010808 MT WWAMI [13] State supported medical students per 100,000 42.2 45 40 32.8 35 30 25 20 14.8

15 10 5 0 Montana South Dakota North Dakota 010808 MT WWAMI [14] Medical Education-cost per capita $37.11 $40.00 $35.00 $30.00 $25.95

$25.00 $20.00 $15.00 $10.00 $5.00 $- $4.91 Montana South Dakota North Dakota 010808 MT WWAMI [15] Medical Education-Cost per Student $100,000 $87,958

$90,000 $79,075 $80,000 $70,000 $60,000 $50,000 $40,000 $35,871 $30,000 $20,000 $10,000 $- Montana South Dakota

North Dakota 010808 MT WWAMI [16] UWSOM Curriculum Scientific Foundations Phase Patient Care Phase Integrated blocks medical science in clinical context Required clerkships Career exploration Integrated basic science Specialty-specific

preparation Specific rotations in Seattle Research/ scholarship Clinical experience longitudinal clerkship Bozeman Montana, Seattle or the region Career Explore & Focus Phase Montana, Seattle or the region 010808 MT WWAMI [17]

GME- Graduate Medical Education Residency College K-12 4 years Medical School (UME) 4 years Residen cy (GME) Practicing physician 3-7 years

010808 MT WWAMI [18] Montanas gme history Montana Family Medicine Residency Billings First class matriculated 1995 24 residents / 8 per class Family Medicine Residency of Western Montana Missoula and Kalispell First class matriculated 2013 30 residents / 10 per class Billings Clinic Internal Medicine Residency Billings First class matriculated 2014 18 residents / 6 per class (expanding to 8 with private funding) 010808 MT WWAMI [19]

333% increase in GME since 2011 PGY-1 (1st year residents) 26 30 25 20 15 10 6 5 0 2011 2012 2013

2014 2015 2016 Year 010808 MT WWAMI [20] Why dont we have more residencies in MT? Development costs Hospital support Physician leadership Program directors and faculty Limited clinical teaching resources Practicing physician teachers in our communities Accreditation obstacles and complexities

010808 MT WWAMI [21] State comparisons in GME residents per 100,000-2016 High 1st Massachusetts: 81.7 2nd New York: 81.5 Mean 36.9 (Median 27.4) Low 44th North Dakota 18 45th South Dakota 15.5 47th Montana 8.2 48th Wyoming: 7.2

49th Idaho: 6.4 50th Alaska 4.9 010808 MT WWAMI [22] Why is this important? Family Medicine February 2015 55% of FM graduates in U.S practice within 100 miles of their residency Reached 70% in a handful of states (including MT!) Thus, addressing the primary care shortage, particularly in underserved areas, will require an increase in the number of residency positions in those locations. 010808 MT WWAMI [23] What increases the likelihood of a resident practicing in the rural and underserved parts of Montana?

More exposure to rural medical communities Clear understanding of the unique cultures of rural communities Good quality and comprehensive training Opportunities for loan repayment / forgiveness Simply placing a larger number of physicians in MT will not solve the rural / underserved workforce issues. 010808 MT WWAMI [24] How are MT residencies funded? Montana state funding Federal GME funding through sponsoring

hospitals Sponsoring hospitals cover budget deficits MT residency programs 010808 MT WWAMI [25] Where does the state funding reside? Within the MUS budget Connected to DPHHS (state Medicaid contract) Allows 3:1 federal matching dollars to increase the total state funding from $519,336 to approximately $1.5M per year

010808 MT WWAMI [26] The economic impact of investment in GME Return on Investment for GME Annual economic impact of one new FM physician in a community. $1,958,600 MFMR- Billings has 70 graduates over 17 years that have remained in MT These 70 graduates have created over $ impact for MT and its communities 1 Billion of economic Source: Family Medicine Residency Return on Investment Study by Larry White 010808 MT WWAMI [27] Key Questions Do we have the appropriate physician workforce data?

What are our goals based on the best available data? How can we best meet those goals, attending to the entire medical education pipeline? Improve STEM efforts in K-12 education-grow pipeline Scalable medical student increase Focused residency increase How can we assist rural/underserved Montana in recruiting and retaining physicians beyond simply increasing the physician supply? How can we improve the diversity in our physician workforce especially for our Native American populations? 010808 MT WWAMI [28] Future Directions Additional state funding for GME is needed Consider support for new and additional partnership residencies within Montana (ex. Psychiatry, Surgery, Pediatrics, OB/GYN, additional Primary Care Need to improve diversity within the WWAMI

student population; create position of MT WWAMI Diversity Director Need to plan/advocate for a scalable increase to WWAMI slots 010808 MT WWAMI [29]

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