Lawmakers hear case to expand Idaho residency slots; analysts and program directors point to retention and local care benefits

Program directors and legislative analysts told the Joint Finance-Appropriations Committee that expanding graduate medical education (residency) slots is a high-return investment for Idaho’s physician workforce and for near-term clinical capacity in hospitals and clinics.

Kevin Campbell, a legislative budget analyst, summarized the state’s portfolio of residency programs and spending patterns, noting the programs consistently spend available appropriations and that the state is increasing the number of residents funded. "The American Medical Association noted in 2022 that 55 percent of graduates of Idaho residencies and fellowships stay in Idaho," Campbell told the committee, a retention statistic the analyst said places Idaho among the top 10 states for retaining newly trained physicians.

Program leaders from Eastern Idaho, Boise and Idaho State University described how slots translate into care during training and into long-term retention. "Even if no one stayed in the state afterwards, you still have 16 additional doctors practicing psychiatry in Idaho Falls and the surrounding areas just from my program," Dr. Matthew Larson, psychiatry program director at Eastern Idaho Medical Residency, said when committee members asked about immediate clinical benefits of residents in training.

Why it matters: Idaho ranks low in physicians per capita. Residency training both adds hands-on clinical capacity (residents see patients while supervised) and — when residents remain in-state after training — increases the permanent physician workforce.

Requests and context presented - Eastern Idaho Medical Residency: the program requested $240,000 ongoing for four additional psychiatric residents (to fund the 3rd year of a 4-year psychiatric residency) to bring psychiatry slots to 12; program has 56 residents currently and is structured as a partnership with the Eastern Idaho Regional Medical Center. - Boise Internal Medicine: the program asked for $60,000 ongoing for one additional internal medicine resident (state share); Boise Internal Medicine has 41 residents and 2 addiction-medicine fellows. - Family Medicine Residency (Full Circle Health, ISU, Kootenai and others): the family medicine cluster is a multi-site program with 130 residents across locations; FMR requested funding tied to new sites including St. Alphonsus Nampa (6 new residents) and additional ISU positions in Eastern Idaho (funding requests and FTP shown in the packet).

Funding model and return-on-investment discussion Program directors described a three-way funding partnership that underpins most Idaho residencies: the sponsoring institution (hospital or health system), the clinical partners and the state each cover portions of residency costs. Program directors told the committee that state investment is crucial to stand up and sustain residency slots. "Currently in Idaho, it is... a third, a third, and a third," said one program director during questioning; the state share per resident was described in the hearing as in the range of $60,000 to $70,000 (2018 baseline cited at ~$60,000; more recent per-resident costs cited near $210,000 total cost).

Retention and capacity metrics Analysts and directors said retention from Idaho residency programs has been strong for primary care tracks: some programs reported retention rates above 50% and as high as about 65% for family medicine in specific programs. Dr. Mo Hagman, Boise internal medicine program director, noted that the state’s 10-year expansion plan has doubled the number of residency programs and residents in recent years and has moved Idaho up several slots in primary-care physicians per capita in regional comparisons.

Committee questions and readiness to expand Committee members asked how many additional positions could start quickly; program directors said some slots are ready to begin pending funding. Dr. Brandon Mickelson (Idaho State University family medicine program) said a child psychiatry slot in Pocatello and a sports-medicine fellowship were prepared to proceed if funding were available. Directors and clinicians underscored that residents provide immediate clinical services during training in hospitals, clinics and rural facilities; Dr. Larson said psychiatrists-in-training currently provide daily clinics and inpatient coverage in eastern Idaho.

No roll-call votes or motions to appropriate were taken during the presentation. Analysts and program directors encouraged the committee to consider multiple approaches — loan repayment for rural placement, more residency slots and greater graduate medical education capacity — as complementary strategies to boost the physician workforce.

Ending Program directors asked the committee to sustain the multi-year expansion effort through the planned 10-year horizon so newly created programs complete their multi-year training cycles. Several directors said they view the state’s investment as paying dividends in both immediate patient care capacity and in long-term physician retention.