Desperate to persuade young doctors to settle in rural areas — or just keep them from leaving the state — medical schools, hospitals, and state legislators are getting creative. They’re forgiving tens of thousands of dollars in loans, setting up mentorships, and recruiting med school grads with local ties in an effort to hold on to providers.
Convince a 30-year-old doctor fresh out of her residency to stay put, after all, and she could easily wind up delivering four decades of care in a needy community.
But on this crucial metric, some states are faring far worse than others. California, with an abundance of space and jobs for doctors, retains 70 percent of residents and fellows trained in-state — compared to just 28 percent in tiny New Hampshire, where full-time physician jobs are few and leaving the state may only mean moving a short distance.
There are stark contrasts even between states with similar demographics: Montana has a retention rate of 62 percent, compared to Wyoming’s 30 percent.
Reversing physician shortages is a lot more complicated than simply “putting docs out in lonely frontiers,” said Dr. Janis Orlowski, a nephrologist who serves as the AAMC’s chief health care officer. States seeking to retain more of the young doctors who train there must focus on “making not only the environment a place where a physician wants to live, but also making the professional environment something that they are attracted to,” she said.
Here, some of the top strategies states are trying:
Wiping out student debt
One of the most popular tacks: agreeing to pay young doctors’ medical school debt or tuition costs if they agree to practice in underserved areas in the state.
Kansas’s program, funded by the state, draws about 30 students per class at the University of Kansas School of Medicine, according to university spokeswoman Natalie Lutz. For each year that they receive funding to cover tuition and living expenses, they agree to spend a year after their residency practicing primary care in Kansas, either in underserved areas, at a free clinic, or by serving veterans.
In Alaska, local governments foot the bill. Such programs often cover about $50,000 to $80,000 a year of debt on top of the young doctor’s salary, in exchange for three years of service in a region where physicians are scarce. The town of Valdez, which has four doctors for 4,000 people, is working to get the newest such program off the ground, according to Dr. John Cullen, a Valdez local who’s also president-elect of the American Academy of Family Physicians.
But these programs don’t always work: Lawmakers two years ago halted the state-funded program for students at the University of Mississippi Medical Center. It turned out that 40 percent of the 93 students who had signed up since 1999 didn’t end up practicing in Mississippi’s needy areas. Instead, they either paid back their loans, are still in the process of paying them back, or defaulted on them, according to Jennifer Rogers, the director of a state agency devoted to student financial aid.
Opening up new medical schools
One common obstacle to retention in underserved areas is the fact that there are often no medical schools pumping out doctors for hundreds of miles. So states are trying lure providers to these places at the very start of their medical training.
That’s why the Medical College of Wisconsin in 2015 opened a campus in northerly Green Bay and then last year opened another campus in the central part of the state.
And in Texas, similar efforts are underway far away from the metropolises of Houston, Dallas, and Austin. Texas Tech University in 2009 converted a satellite campus in El Paso to a full four-year medical school, while the University of Texas last year admitted its first students to a new medical school in Rio Grande Valley.
Giving students an early taste of life as an in-state doc
Medical school students get the summer off between their first and second year. In Ohio, that period becomes a chance to show off the charms of the Buckeye State.
Since 1990, nearly 1,000 Ohio medical students have participated in a program that allows them to spend four weeks shadowing a veteran doctor who practices family medicine in the state. They get a stipend and often get placed in rural areas. One of the goals: “Letting them know that those opportunities are available in Ohio,” said Ann Spicer, vice president of the Ohio Academy of Family Physicians, which funds the program through its foundation.
Funding more slots for medical residents
Another common barrier to retaining young doctors: too few residency slots — in some cases not even enough to accommodate many who went to medical school in-state.
In Texas, the legislature has tried to address that problem over the past few years by pumping millions of dollars into efforts to increase the number of residency slots in the state. In the most recent grant cycle, that meant creating or maintaining 680 slots for medical residents.
Recruiting doctors with local ties
It can be hard for states in flyover country to compete with places like California for doctors fresh out of their residency. But otherwise overlooked states can get an upper hand if a potential recruit has a personal connection to the state. Maybe they grew up there. Or got their undergraduate degree there. Or they might have family nearby.
The Iowa Medical Society is building a database of residents and doctors all over the country who have local ties to Iowa, in the hope that in the future it could aid in recruitment, said Dr. Joyce Vista-Wayne, a psychiatrist who serves as the group’s president.
Cullen — the family medicine doctor in Alaska — said that local ties can be a crucial factor in convincing young doctors to settle down.
“We’re all competing for the same physicians,” Cullen said. And, he predicted, “states and communities are going to be ending up competing even more.”