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We have addressed aspects of this subject in many threads. But we don't follow it far.
I believe there is more than one reason for this statistic. Because info is easily accessible and absolutely a factor that should be reviewed, I want to start with Education. Specifically, what happened to WWAMI and WICHE.
I'm looking forward to your thoughts, observations and media info you can post.
And please ask questions. This is a safe place to ask what may be confusing or unclear.
The intermountain west has always had a hard time attracting doctors. Idaho might be last, but our neighbors aren't far behind.
This is also true in Canada. The British Columbia Rocky Mtn. region and westward has always had the same problem, even though Canadian doctors are paid by the government, and despite financial incentives offered by B.C. as a province.
Doctors seem to prefer more highly populated cities and areas. Here, those mean more patients, and up there, there are fewer social amenities. I'm sure climate and other factors also play a large part, too.
The need for a medical school in Idaho has been debated for a very long time. I don't think it will happen in my lifetime, but a med school would keep a lot of our best students here, rather than seeing them move to greener pastures once they have a degree. I also think BSU would the the natural for a med school, as Boise has some of our best and largest hospitals.
Down here, I watched several of my classmates go down to the U of Utah in Salt Lake to get their medical degrees, and few ever moved back. Once they were down there, it was easier for them to simply stay and establish a practice.
The only young doctors i know who did return were the sons and daughters of established local doctors, and they usually took over the family's practice.
That is not happening with their kids. Medicine as a livelihood runs in families, but the kids that were born to my generation have not returned nearly as often.
Here's a link to an interesting paper on this subject put out by the ID Dept. of Labor: Physicians in Idaho
I general, I'd guess that the proportion of doctors that would place a high value on living in a more rural environment would roughly mirror that of the population at large. If you buy that somewhat bodacious assertion, then you would think there would be enough doctors who would want to enjoy the lifestyle, natural beauty and other benefits of living in a rural state like Idaho to provide the state with a roughly equivalent number of doctors per capita as found in more urban areas.
I think what works against that notion is that they all pay more or less the same for their education, both in time and money, but the earning opportunity is likely much greater in a more urban setting. Earning sufficient income both to pay for that education, and then over the course of their career to earn a decent return on that investment, is probably a critical driver of where they decide to locate their practice.
If this is the case, the ID state program to subsidize school loans for doctors that locate in the state might be a good way to directly address the issue that drives doctors to more urban locations.
That said, the numbers are one thing, but what does this mean in terms of the real world experience getting access to medical care in Idaho? I'd be interested in hearing about that from those of you that have lived in the area for a while.
Here's a link to an interesting paper on this subject put out by the ID Dept. of Labor: Physicians in Idaho
I general, I'd guess that the proportion of doctors that would place a high value on living in a more rural environment would roughly mirror that of the population at large. If you buy that somewhat bodacious assertion, then you would think there would be enough doctors who would want to enjoy the lifestyle, natural beauty and other benefits of living in a rural state like Idaho to provide the state with a roughly equivalent number of doctors per capita as found in more urban areas.
..., but the earning opportunity is likely much greater in a more urban setting.
That said, the numbers are one thing, but what does this mean in terms of the real world experience getting access to medical care in Idaho?
You might be surprised; physicians actually tend to be paid more in more rural environments. In my specialty, physicians earn most in the upper midwest and the rural south. Most physicians, however, tend to flock to urban areas. For one, many of us have been attending urban universities for a number of years and then even more urban medical centers. They get used to the idea of having multiple entertainment options and their fingertips. Then you have recruiting agencies attempting to bring you into more urban centers. If you want a rural job in a partiuclar location, you have to knock on doors on your own, as smaller facilities don't have the cash to recruit nationally. There's also the fact that Obamacare and the like are attempting to push patients into medical homes, which frankly won't work that well with many rural areas that don't have the networks in place, and things are less settled in a rural setting v. an urban one. I don't think it's a major factor, but it's also worth noting that Idaho's tax structure is pretty brutal to physicians--particularly when compared to states like Wyoming, Colorado, or most southern states.
I, for one, am a physician who attempted to work in Idaho, but I ran into several administrations that sent me very mixed messages as to what they were looking for. I'd dreamed of living in Idaho for years, and well, I'm close by but will be calling Montana home after having job offers all over the place, including many of those urban locations.
One thing that makes it tough is that particularly for more specialized fields, you're literally a pioneer and going it on your own in more rural locations. You don't have colleagues to bounce ideas off of or mentors by which to start to structure your practice. You also don't have people to back you up, and you can really get slammed with call duty if you're not careful. Compare that to major urban centers where you can effectively eliminate a massive proportion of your call duties if you play your cards right.
Also, for some specialties, you almost have to be part of a major university or hospital system, as you're not going to make money on your own and will need more lucrative fields to effectively subsidize your practice.
You might be surprised; physicians actually tend to be paid more in more rural environments. In my specialty, physicians earn most in the upper midwest and the rural south. Most physicians, however, tend to flock to urban areas. For one, many of us have been attending urban universities for a number of years and then even more urban medical centers. They get used to the idea of having multiple entertainment options and their fingertips. Then you have recruiting agencies attempting to bring you into more urban centers. If you want a rural job in a partiuclar location, you have to knock on doors on your own, as smaller facilities don't have the cash to recruit nationally. There's also the fact that Obamacare and the like are attempting to push patients into medical homes, which frankly won't work that well with many rural areas that don't have the networks in place, and things are less settled in a rural setting v. an urban one. I don't think it's a major factor, but it's also worth noting that Idaho's tax structure is pretty brutal to physicians--particularly when compared to states like Wyoming, Colorado, or most southern states.
I, for one, am a physician who attempted to work in Idaho, but I ran into several administrations that sent me very mixed messages as to what they were looking for. I'd dreamed of living in Idaho for years, and well, I'm close by but will be calling Montana home after having job offers all over the place, including many of those urban locations.
One thing that makes it tough is that particularly for more specialized fields, you're literally a pioneer and going it on your own in more rural locations. You don't have colleagues to bounce ideas off of or mentors by which to start to structure your practice. You also don't have people to back you up, and you can really get slammed with call duty if you're not careful. Compare that to major urban centers where you can effectively eliminate a massive proportion of your call duties if you play your cards right.
Also, for some specialties, you almost have to be part of a major university or hospital system, as you're not going to make money on your own and will need more lucrative fields to effectively subsidize your practice.
Thanks for that perspective - it's very interesting.
I'd be interested in your thoughts about distance medicine, and whether that does or will provide specialists with opportunities to do the sort of networking and collaboration that you note can be difficult in a rural environment where you might be the only specialist of your type in a given area.
It's interesting that you mention Idaho's tax structure. I assume you are talking about the income tax, which does tend to punish high incomes with an effective tax rate of 7% or so. This happens to be comparable to what we pay in California, commonly thought of as one of the worst of the worst high tax states.
I am a physician assistant student from New York, ready to graduate in 2 months. I am considering Coeur d'Alene area to move to for several reasons: politics, weather, outdoor activities. I am tired of the liberal-minded and frigid northeast. Are there many opportunities for a new grad in northern Idaho? My interest is in family practice/internal med. Thanks
I am a physician assistant student from New York, ready to graduate in 2 months. I am considering Coeur d'Alene area to move to for several reasons: politics, weather, outdoor activities. I am tired of the liberal-minded and frigid northeast. Are there many opportunities for a new grad in northern Idaho? My interest is in family practice/internal med. Thanks
ADKsman,
Check ads in professional journals. Or a placement firm. Then you'll have real time info.
Thanks for that perspective - it's very interesting.
I'd be interested in your thoughts about distance medicine, and whether that does or will provide specialists with opportunities to do the sort of networking and collaboration that you note can be difficult in a rural environment where you might be the only specialist of your type in a given area.
It's interesting that you mention Idaho's tax structure. I assume you are talking about the income tax, which does tend to punish high incomes with an effective tax rate of 7% or so. This happens to be comparable to what we pay in California, commonly thought of as one of the worst of the worst high tax states.
As in telemedicine? Really, I think it's almost too difficult to be practically useful to address a patient's needs in a truly collaborative model unless you were to go with a Mayo Clinic system wherein everyone chimes in and discusses the care of a complicated patient. That's not the way medicine reimburses, and you really need to be a part of a clinical sytem that has adopted that model. The other side to that is that patients may not share intimate details that they might share in an individual setting. There's nothing quite like knowing the other physicians treating your patient with whom you would like to consult with and building a trusth with them over time, and that happens best either face-to-face or through very frequent interactions. Or talking face-to-face with someone in your own line of work and bounching ideas off one another after the patient is long-gone for next time.
As for Idaho's taxes, if you look at Idaho compared to other states in the mountain west, I'd put it as less conservative than any other surrounding mountain state: Colorado (4.63% income tax, 2.9% sales tax), Wyoming (0% income tax, 4% sales tax), Montana (6.9% income tax, 0% sales tax), and Utah (5% income tax, 5.95% sales tax) are all more tax friendly than is Idaho (7.4% income, 6% sales tax).
I'm from a state that I'd consider more tax friendly than most of these states, as well.
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Where Has the WWAMI Money Gone?
