We can’t leave medical training up to WWAMI

To be sure, it is a thing of beauty when a senior physician spends time with a newly-minted one.  Two scientists learning and re-learning, debunking previously held dispositions and passing on what experience has found really works along side the so-called state-of-the-art book-learning.  Each goes their way — better for the exchange.  The rest of the team and the surrounding community benefits from the chemistry, too.

Dr. Meyers’ contention is there is no capacity for more of this when it’s needed.  Yet, the road to Seattle and the University of Washington never seems to reverse to rural Montana!  Yes, a trickle to Western hot spots.  Some specialists that wouldn’t thrive without critical mass, of course.  But we don’t really need more specialists, do we?  There was a point when Missoula had an orthopedists ratio similar to Boston’s.

We can expect the “Ivory Tower,” not-get-our-hands-dirty stuff from UW, of course. But these clinical rotations are not so much training sites but observation and assistance transactions.  With the right individual/candidate (and clinical advisor) pretty much a wash.  The good practicioner gets some support and assistance in return for allowing a med student to shadow his work, ask questions, professionally discuss the latest literature and observe day-to-day work style.  Hopefully, that’s the beginning good start of becoming a diagnostician.  After all, our practitioner is the one who answers the phone in the middle of the night.  Prioritizing care, triaging, managing his or her 24 hours the best they can.

Later, down the line (Year Four?) follows more of the specialty dimension — that treats what other physicians have referred.  Is it more of a career-exploration? Sure. And, it’s often a recruitment tool for some larger practices.

Yes, we’re proud to have two years of medical school available in Bozeman.  WWAMI has been the way for us to matriculate some docs.  But it, too, bears some scrutiny.  Twenty to 30 (at the most) per year is a long way from the 400 expected to retire here in the coming years. Many institutions do become unresponsive;  WWAMI is not the first nor will it be the last.  Likewise, we certainly have had some world-class physicians in Montana.  To be sure, most never saw a WWAMI proctor.  I venture more have come by way of National Health Service Corps assignments at tribal facilities — then moved to Western Montana.

Residency training, like those in Billings and Missoula, are an even more important piece of this situation.  More for another day.  But suffice it to ask, why hasn’t WWAMI helped its co-sponsor, State of Montana/Higher Ed, get more residencies in Internal Medicine and the like?  Without a medical education navigator, it’s no wonder the free enterprise folks have stepped forward.  Now it falls to all of us to make these entities more productive than status quo.  We just can’t go on doing the same old, same old.