This story was originally published by Daily Montanan: URL: https://dailymontanan.com This story has not been altered or edited. (C) Daily Montanan. Licensed for re-distribution through Creative Commons license CC BY-NC-ND 4.0. ------------ Tester's rural medical residency bill a 'game-changer' for states like Montana, experts say – Daily Montanan ['Darrell Ehrlick', 'More From Author', '- February'] Date: 2022-02-07 00:00:00 The problem sounds as simple as the solution: Montana needs more doctors, therefore just make more doctors. But the reality is complicated by two important factors – training and geography — something that new legislation championed by Sen. Jon Tester aims to overcome by tweaking federal law. What looks to be a bureaucratic addition to bulky federal law is really a change that rural doctors and healthcare systems have been requesting for years. Doctors must go through practical training during a four-year residency program, and those programs are supported in part through the Centers for Medicaid and Medicare Services, which reimburse healthcare centers and doctors’ offices for seeing patients in those programs. Because residencies are tied to CMS funding, the number of slots or positions available for doctors graduating from medical school has been limited by a Congressionally controlled cap, which hasn’t changed for decades. Essentially, this means the same number of slots for doctor training hasn’t increased in years, while the demand and population has increased and gotten older. However, Tester’s legislation, which was begun in 2019 with a bill called “Rural Physician Workforce Production Act,” was funded through the appropriations last year. It will create 1,000 new CMS-funded physician residency slots to qualifying rural hospitals, phasing in 200 slots per year for the next five years. Medical and education leaders throughout the state and beyond have told the public and media that producing more doctors means creating more residency capacity. By 2028, that capacity will have expanded by 1,000 slots nationwide. Montana has four established residency programs, three in Billings and one in Missoula. They cover family practice, psychiatry and recently, surgery. The programs say this new legislation has changed the equation – almost overnight. While the residency programs can take money and time to establish, the programs in Montana stand ready to take advantage of the expanded slots and hope other healthcare organizations in the state can use it. One of the most encouraging signs, say officials from both residency areas, is that many of the doctors-in-training who come to Montana want to live and practice in a rural area. Nationally, around 60 percent of doctors wind up living with 50 miles of where they train. By opening more residency slots to rural hospitals, officials said it will increase the chances of recruiting doctors to more rural places in the state. Dr. Virginia Mohl leads Billings Clinic’s Family Residency. She is from Montana and did part of her training in rural settings. “When people would call up and want to talk to the emergency room, I would say, ‘I am the ER, labor and delivery and the ICU – what part of me do you want,” Mohl said. She said that recruiting in larger places like Billings or Missoula is hard because even though those places are big by Montana standards, they’re still looked at as “rural” to others. For smaller, rural critical-access hospitals, the challenge is even more severe. But as the residencies in Montana have become more established, it’s also helped with recruitment. For example, when doctors-in-training rotate into clinics like Lewistown or Sheridan, Wyoming, it establishes a familiarity. For example, one central Montana healthcare center had been looking for an internal medicine doctor for more than seven years, and discovered a resident who wanted to come back to the area after training. Part of the challenge is matching prospective doctors to the right area. Some programs, like the Western Montana Family Residency program of the University of Montana, intentionally try to recruit physicians who want the rural practice. “We tell folks we are looking for people who like cows, hunting and fishing,” Mohl said. Dr. Robert Stenger in Missoula said they’re very specific about the language they use attracting physicians to residencies. “We say our program focuses on rural underserved Montana. We’re marketing to an interest in that,” Stenger said. Stenger said that many hospitals and communities were open to the idea of starting a residency training, but didn’t want to spend the precious staff time and money on slots that simply didn’t exist before Tester’s legislation. “But now there’s the certainty that if you start the program, the funding will be there to sustain it,” Stenger said. Jim Duncan, President of the Billings Clinic Foundation, which helped establish residencies with the help of the Helmsley Foundation, said that he’s not surprised doctors who train in Montana are staying here for their careers. The challenge has always been getting enough of critical mass to show it works. “What’s always been top of the mind is the long-term benefits of investing here,” Duncan said. “It was complicated because there were always barriers at the forefront, but this is going to pay off in perpetuity and we won’t know the full benefit for decades.” As the programs phase in during the next five years, the healthcare officials say it should be easier to tell the direct impacts the legislation will have. Part of the challenge will be to help smaller communities find the resources to start and support the residents. Mohl said it takes a village of healthcare educators to train a doctor, and that can be a culture shift for many organizations. “The federal government can provide the funding but that won’t build the medical community,” Stenger said. In other words, the doctors and hospitals have to work together to commit to training. “The more we can do to build residency, the more that will bring meaningful numbers of physicians to rural Montana,” Stenger said. “This gets us a long way down the road, especially in states like Montana.” [END] [1] Url: https://dailymontanan.com/2022/02/07/testers-rural-medical-residency-bill-a-game-changer-for-states-like-montana-experts-say/ Content is licensed through Creative Commons license CC BY-NC-ND 4.0. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/montanan/