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Utah must find ways to train more doctors at U. medical school

Kudos to Don Gale for his timely alert to the citizens of Utah regarding the Utah legislative mandate to reduce the annual number of medical graduates from 102 to only 82. He is right to be concerned about this potential medical disaster.

This mindless, across-the-board funding reduction comes at a terrible cost! The University of Utah School of Medicine has been graduating annually 100 graduates for more than 40 years dating back to when Utah had a population about half its current size. In addition to a much greater population, the state is now facing a growing elderly population that will require much more medical care.

We hear a lot of platitudes and self-praise from the politicians about their reforming health-care delivery, but how can this be rationalized in the context of reducing the number of physicians? Obviously even to the layman this is a blatant contradiction of terms. If anything there will be a crying need for more physicians, particularly primary care doctors. This need will be even more acute in states such as Utah, which has a large rural population where it is very hard to recruit physicians.

As Mr. Gale points out, we must hope there will be a solid phalanx of concerned local leaders petitioning the Legislature to reverse this travesty of public planning.

I have taught medical students on a volunteer basis in my private office for more than 25 years. The high cost of medical training and the relatively low reimbursement to primary care physicians clearly influences their career decisions. That is one reason medical career polling indicates that only 6 percent of medical students go into primary care. Many of us are already frustrated by the outsourcing of repairs and complaints for our electronic gadgets. Those frustrations will seem minor when we see the outsourcing of primary care. That will be the scenario when we go for medical care in the future in which most of the primary care providers are midlevel, non-physician practitioners or graduates of foreign medical schools.

Let me clearly state that these practitioners will certainly play important and appropriate roles in future medical care delivery, but they should not constitute the majority of the primary care providers of the future, I emphasize that I have great respect for medical personnel trained in other nations, but they are surely needed in their own countries more than they are needed here. However, such practitioners will surely fill the vacuum created by the absence of locally trained physicians. Under this scenario there will definitely be a future rationing of physician care.

It seems to me that there may be creative ways for Utah to both finance a full 100-seat complement of medical students and at the same time financially induce medical students to go into primary care here. One suggestion would be to contract with beginning medical students. If they go into a non-primary care specialty or decide to leave the state after they complete their medical training, then they would have to pay back the approximately $50,000 per student per year costs of medical education, much of it subsidized by Utah taxpayers. Perhaps the payback would be only half the amount or some proportion thereof based on the difference between the actual cost and the amount of tuition paid by the student. The payback could be spread over 20 years. This would actually be a great deal for such students since the $50,000 figure is the upfront average tuition now being paid at private medical schools that do not receive state financial support.

Wake up, legislators! In a time of proposed health coverage reform and a widening of insurance coverage, the state needs creative leadership rather than unwanted reduction of support for medical training. It is vital to train more doctors in order to guarantee that the state's burgeoning elderly and rural population will have adequate primary medical care for generations to come.

King S. Udall M.D., of Salt Lake City is a family practice physician.