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The Right Fit
In the course of one week nearly three and a half years ago, the future of medical providers in Utah may have been changed for decades. That was in September 2008, when the federal government cut $10 million in Medicaid funding to the University of Utah’s hospital. Days later, the state legislature’s mandated budget cuts to the university resulted in a further loss of $2.5 million in funding for the U’s School of Medicine.
The net result—a 40 percent loss of its education budget almost overnight, and with it, an eventual loss of “slots” available for students wanting to enter the program. Even a 15 percent raise in tuition for med school students couldn’t offset the inevitable loss of that funding, and available openings for new students dropped about 20 percent.
The cuts have prompted university officials to plead with this year’s state legislature for more money—not just to restore it’s lost slots, but to add 20 more over the next school academic years. Those 40 student openings are estimated to cost $12.2 million, with the university proposing a cost-sharing of $9.6 from the state. Over four years, that would mean an additional 160 students being trained as physicians.
Short of changes, a potential crisis awaits Utah—a shortage of medical providers going forward. A study by the Association of American Medical Colleges estimated that the United States could face a shortage of 85,000 to 96,000 physicians by 2020 unless med schools can increase the numbers of their graduates. The AAMC said five years ago that enrollment would need to increase by 15 percent in med schools over a 10-year period running through 2015. Instead, many schools around the country, like the U, are now enrollment-capped or actually admitting fewer numbers of first-year students.
A Boom in Demand
Locally, the long-term effects of those lost openings could be widespread and painful, particularly for the state’s rural communities.
“We are already facing a shortage,” says Michele McOmber, CEO of the Utah Medical Association. “The [U] medical school has had the same amount of students for the past 100 years, and the year of the cuts, they had planned on increasing that number by about 30 percent, rather than see a decrease. We have a continued growth in the population in this state—lots of children, and that increases the need for providers. Yet, we have decreased numbers of physicians.”
In 2011, Utah ranked 43rd in the United States in terms of the number of physicians per population. Neighboring Idaho was 50th. (Washington, D.C. ranked first.) As Utah’s population continues to increase without adding physicians, its ranking could drop even lower.
It’s not just about med school admittance, however. It’s also about medical student residency.
“Look at the baby boom generation,” says Dave Gessel, vice president of government relations and legal affairs for Utah Hospitals and Health Systems. “That generation is getting older, and clearly there is going to be a need for more physicians and allied professionals. Losing 20 [percent] of homegrown doctors, who might have to either go to a medical school or do their residencies elsewhere other than here in Utah, will impact us both in the short term and long term. If you were to call an office right now for many non-emergencies, it might be several weeks before you can actually get an appointment to see a physician.”
Gessel’s point about residency is significant, McOmber says.
“If you have a tie to a state, or are in grad school in a certain state, you will tend to try to stay there in your career to practice,” she says. “We have a decreasing number of slots both for education and residency in Utah. That could well mean physicians who would have been likely to practice here will end up somewhere else.”
The hardest-hit segment in a practitioner shortage would be rural areas, roughly 21 percent of the U.S. population, and perhaps higher in Utah. Rural regions are particularly at-risk for shortages in certain specialty practices.