Rural areas throughout the country often have a difficult time recruiting – and retaining – doctors there, and Wyoming is no exception. In 1997, Wyoming joined the WWAMI program. WWAMI stands for Washington, Wyoming, Alaska, Montana, and Idaho, rural states that collaborate to send students to the University of Washington Medical School. It’s part of a plan to produce more Wyoming doctors and keep them in the state. Wyoming Public Radio’s Rebecca Martinez checked back to see how it’s working.
REBECCA MARTINEZ: Dean Bartholomew owns the Platte Valley Medical Clinic in Saratoga, and he’s the only physician in town. People call him “doc,” and sometimes ask personal health questions when they run into him at the grocery store or at a restaurant. Sometimes, they ask him to perform stranger tasks.
DEAN BARTHOLOMEW: They couldn’t tell if their internal timing mechanism was working in the safe at the bank, so I was called down with my stethoscope to listen to it.
MARTINEZ: But that’s the fun stuff, and a small part of the job. Bartholomew or one of his two support staff are on-call 24-7. When he’s not seeing patients in his clinic – which is 40 miles from the nearest hospital – he’s treating people in a nearby nursing home, riding with a patient in an ambulance or balancing the books to keep his business running. Rural doctors have a high rate of burnout and turnover.
BARTHOLOMEW: It is a high-time and high-stress job, no doubt about it… being a physician in a small town, it’s not a job, it’s who you are.
MARTINEZ: And there’s a shortage of family doctors in rural Wyoming. In fact, the astronomical cost of going through medical school has contributed to a shortage of new doctors nationwide. Wyoming has used some visa sponsorship and loan repayment programs to entice doctors from other states and countries and work here for a few years. Some stay, some leave. Then Wyoming tried a more homegrown strategy. Almost 15 years ago, the Wyoming Legislature and the University of Wyoming sent its first class of medical students to the University of Washington Medical School as part of the WWAMI program.
MATTHEW MCECHRON: The WWAMI program is this highly collaborative activity that involves so many different people in the state and in Seattle.
MARTINEZ: Matthew McEchron directs the WWAMI program at the University of Wyoming. Seattle has the only medical school in the region, and Wyoming is the most recent state in the region to begin sending students there, who pay only a fraction of the cost. Wyoming’s is a competitive program, and the state legislature has allocated more funding to the program every few years, putting more future doctors on track to practice in the state.
MCECHRON: The state invests some money in those folks’ education, and then those folks can then either come back and practice medicine in the state of Wyoming, or repay that money with interest.
MARTINEZ: After completing their residencies in Wyoming, U-W’s WWAMI graduates are expected to practice in the Cowboy State for three years. As of 2011, 67-percent took that option. Only three of those doctors decided to leave the state after their required years of service were up. This is good news for Wyoming, but it’s not quite a panacea. Only about a quarter of the WWAMI doctors who have stayed in the state are practicing family medicine, which is a huge need here.
Neil Hilton, Vice President of the Wyoming Hospital Association, says this follows a broader trend of doctors choosing instead to become surgeons, anesthesiologists or other specialists.
NEIL HILTON: From a financial perspective, there’s a lot more incentive for a student to take that extra step, a couple of extra years of school to become a specialist.
MARTINEZ: Hilton adds that a family doctor might see upwards of 20 patients a day, whereas a specialist might perform a few procedures, for example, surgeries – so can be more intense, but less of a grind.
However, the WWAMI graduates might be helping fix another problem Wyoming has with medical access… Traditionally doctors recruited from other states have gravitated to Cheyenne and Casper because of the access to medical, social and cultural amenities. Sharla Allen manages the Office of Rural Health for the Wyoming Department of Health.
SHARLA ALLEN: By raw numbers, we may have as many providers a we need, but it could be an issue of maldistribution. So, for instance, Sweetwater County was unable to see some 36-thousand visits in a year because they didn’t have enough providers. You go then, like into Laramie County. They can take on an additional 52,000 visits, because they have more providers than the community needs.
MARTINEZ: Most WWAMI graduates still practicing in the state have chosen on their own to live outside Cheyenne and Casper.
Although Wyoming’s WWAMI program doesn’t press students to practice a certain type of medicine or live in a certain part of the state, 14 Wyoming students have signed up this summer to work in the Rural/Underserved Opportunity Program. That’s where each of them takes a four-week internship shadowing a doctor who practices in a rural area.
MARK WEFEL: The first day was kind of a whirlwind. I think we had two ambulances that day and a lot of patients, but ever since then, it’s just been great.
MARTINEZ: Mark Wefel just finished his first year of the WWAMI program and spent a month this summer working with Dr. Dean Bartholomew at his rural clinic in Saratoga. Wefel was a Wilderness First Responder and an EMT before starting med school. He likes living in remote areas, and loves the diversity of the work. So far, he’s helped expedite patents with chest pain to the hospital and Rawlins, and treated a patient who was injured by a firework. He likes the idea of a constant challenge, and sees rural medicine as a lifestyle.
WEFEL: You know, I’ve never been one to just go home and turn it off. You’re constantly there, and it’s just something you have to learn to integrate: your personal life and the business life. And I think that’s the biggest challenge, is trying to balance all that.
MARTINEZ: Dr. Bartholomew has only been running the clinic three years, but he’s already made a tongue-in-cheek offer to sell it Wefel when he finishes his residency a few years down the road. Wefel says he’ll think about it.
For Wyoming Public Radio, I’m Rebecca Martinez.