Small-town medicine

When Dr. LeeAnna Muzquiz was growing up on the Flathead Indian Reservation in northwestern Montana, doctors seemed to come and go.

She saw her dad die in his 40s of a heart attack and other family members deal with chronic health problems without the benefit of consistent, quality medical care. A member of the Salish and Kootenai tribes, Muzquiz decided she wanted to do something to help her people.

"That was my plan: to go to medical school and then try to make health care better for the people here on the reservation," said Muzquiz, 35, who lives in Polson and practices in Ronan, Mont.

A 2003 graduate of the regional medical-school program of Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) based at the University of Washington, Muzquiz now works for the tribes as a primary-care physician.

The program's goal is to train primary-care doctors and send them back to work in small towns and rural areas in the five states. Students are offered incentives to participate, such as in-state tuition for the University of Washington.

In Wyoming and Alaska, students must return to the state for a few years after their residency or repay some of the money the state invested in their education.

Jonathan Olson, 25, a fourth-year medical student from Green River, Wyo., said he has every intention of returning to the state when he finishes his residency but wishes he could go to Montana instead.

"The place I really fell in love with was Whitefish, Mont.," said Olson, who made sure he worked in every state in the region during medical rotations in his third year.

"A combination of really good medicine, I love the doctors and the area is just spectacular," Olson said. "It's kind of a small town, but it's a cosmopolitan small town."

The program accepts up to 120 medical students each year from Washington, 20 from Montana, 18 from Idaho, 10 from Alaska and 10 from Wyoming, though each of the states has been offered a chance to underwrite more students within the next few years.

Since it began in 1972, the program has graduated more than 6,500 doctors. About 750 to 775 WWAMI medical students are enrolled in the four-year program at any one time.

Many students in the program choose not to return to their home states.

Wyoming's insistence that students return — referred to as "indentured servitude" by some former students — prompts 83 percent of graduates to return, said Dr. Doug Schaad, an administrator who has tracked program statistics since its inception.

Medical schools nationally return about 40 to 42 percent of their students to their home states to practice, said Dr. Tom Norris, head of the program.

"It's provided a really cost-effective medical program for five states, and very high quality education for students across the Northwest," he said.

In Alaska, 50 percent return. Graduates from other WWAMI states, equivalent to 17 percent of the number of Alaska graduates, choose to practice in Alaska, offsetting some of the Alaska graduates who go elsewhere.

In Idaho, the return rate is 46 percent, or 64 percent when students from other states in the region are included.

In Montana, 39 percent of residents return, but the number jumps to 52 percent when other states are included.

Fifty-two percent of Washington medical students stay in their home state to practice. When students from the other states are added, Washington gets a 61 percent return.

Muzquiz did her residency in Seattle at the Indian Health Board because she wanted to better prepare for her work on the reservation and that was the only residency in the country that focused on American Indians.

"I didn't stay in Seattle primarily because my goal from the get-go was to come home and practice and try to make a difference here," she said. "Although I had some offers to stay in Seattle, I felt obligated to myself."

Dr. Jeff Ward, an oncologist and hematologist in Edmonds, came to the WWAMI program from Idaho, and had significant changes of heart during his years of medical school.

"My original plan when I headed to medical school was to be a medical scientist and never see a patient," Ward said. Then he fell in love with the "instantaneous gratification" he got from taking care of people.

Despite his decision to leave his home state, Ward said he views the program as a success, especially because doctors from other parts of the region stepped in to take his place.

But the students who go off to Seattle and never return fuel efforts in Idaho, Montana and Eastern Washington to advocate for their own medical schools — even though the cost of opening a new medical school is many times the cost of paying out-of-state tuition at the UW.

Idaho sends its medical students both to the UW and the University of Utah, but competition is fierce for those slots, said Ronald McCune, Idaho State University's vice president of medical education.

"We have the issue of access to doctors, but we also have 160 students vying for 26 seats," he said. "This state really needs to address these shortages at both ends of the spectrum."

Washington has offered to enroll more students from other states if the states have the money to pay for them.

Associated Press writer Jesse Harlan Alderman in Pocatello, Idaho, contributed to this story.