Doctors have always been hard to find and keep in a rural state like Wyoming. So the state created incentives like WWAMI (which stands for the states served by the UW School of Medicine: Washington, Wyoming, Alaska, Montana and Idaho) to try to get Wyomingites to come back and practice in their home state after medical school. The program has been successful but recent bills going through the legislature are causing some of those in the program to decide not to come back and help fill the physician gap.
Natalie Meadows Eggleston was born and raised in Jackson.
“I would say I have kind of the cliche story of genuinely wanting to be a doctor for as long as I can remember,” she said.
In high school, some of her teachers told her about WWAMI, so she met with a current WWAMI student who talked to her about the program and said that if she was a part of it, she wouldn’t have to pay back her medical school debt plus other benefits.
“Just all the benefits of the state sponsored loan repayment, the University of Washington, how amazing that medical school was,” said Eggleston. “It became the shining star for me. After I heard about that, I was like, ‘This is amazing. This is absolutely what I want to do.’”
She did get into WWAMI. She ultimately chose to become an OB-GYN and is currently completing her last year of residency. During medical school, she represented her class for the Wyoming Medical Society. She kept tabs on Wyoming healthcare issues and brainstormed how she'd handle those when she came back.
But last year, she started seeing bills coming through the legislature like the Roe v. Wade trigger law and this year's chemical abortion bill that would potentially put doctors in jail and take away their license for doing what people like Eggleston have been trained to do: care for their patients.
“They create a wall where I have to make decisions for my own self preservation as opposed to decisions that would help my patients with whatever it is that they're needing help with,” said Eggleston. “That presented an unacceptable level of risk and conflict.”
After months of agonizing over whether to come back to Wyoming or not, she decided against it. She will now have to pay back over $300,000 in student loans unless she reverses her decision and comes back in two to three years.
“It's been one of the harder things that I've honestly had to go through. It feels [like] betrayal. And that's so hard, it is so hard to have these conflicting emotions of gratitude and betrayal,” she said of her decision not to come back and practice in Wyoming.
Rachael Piver’s family homesteaded outside of Douglas and a family mantra was passed down: help your neighbors because we’re all part of this community. She sees these potential laws stopping her from doing that.
“I have seen horrible things happen to women because of pregnancy and we're being effectively hav(ing) our hands tied behind our back by this kind of legislation,” said Piver.
Piver, like Eggleston, is a WWAMI graduate and will not be returning to Wyoming this spring when she finishes her residency.
“The first thing that we're asked to do as medical students, and Natalie [Eggleston], and I stood up next to each other on this stage, and we swore to do no harm,” said Piver. “And the legislature making laws like this is actively harming patients.”
Caroline Hickerson sees Eggleston and Piver’s decisions first hand. She’s the executive director of the Wyoming Health Resources Network. Its primary mission is to recruit and retain physicians who are from Wyoming and who did their training in state programs like WWAMI.
“We have WWAMI physicians who I think initially upon joining the WWAMI program [had] a plan to come back to Wyoming. But with the overturning of Roe vs. Wade and the continuing restrictions that we're seeing coming through with the legislature, they will not be returning,” she said.
She said this exacerbates a problem they already have. There are about 11 OBs per 100,000 people in the state. The national average is 27 OBs per 100,000 people. OBs are considered primary care, Hickerson said, so it’s essential for any community to have one.
“I have clinics across the state who have been recruiting for over a year for an OB-GYN,” said Hickerson. “There's one community in Wyoming that I believe all three OB-GYNs have left. And they've been trying for over a year to recruit them.”
Plus, just last year two communities shut down their labor and delivery departments because of this. Ultimately, Hickerson is worried about five years from now, because there’s nobody in the pipeline to replace physicians who retire or move out of communities.
“We're going to be competing for a smaller pool of potential doctors to come into our state,” said Eric Boley, president of the Wyoming Hospital Association. “And I think they are going to take a look at the political environment and what's going on within our state when they make the decision on whether they want to set up practice.”
No lawmakers sponsoring the chemical abortion bill responded to requests for audio comment. But Rep. Abby Angelos (R-Gillette) did write back, “No healthcare provider will have to worry about being criminalized or losing their license if they do not ‘dispensed (sic) for purposes of causing an abortion.’”
In response to the question of deterring doctors from coming back to the state, she wrote, “I would like to see them reconsider, there are plenty of good Wyoming people who need quality healthcare providers in this state who are not seeking abortions.”
But Boley said some of the bills that have been proposed are so restrictive that physicians can’t use the medicine they know will save lives because those drugs are also used for abortions.
“They're drugs [that] have been used for years and years and years effectively in our hospitals to protect life and to give the doctors the tools that they need to preserve life and to treat expectant mothers,” said Boley. “And some of these bills have unintended consequences because they're removing the ability for the doctors to prescribe those or use those to actually save the mother's life.”
The bill that would ban chemical abortions passed the Senate and will now be considered by the House.
