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Lawmakers review residency funding, three‑way cost model and calls to expand psychiatry and family medicine slots
Summary
Joint Finance members heard multiple residency program directors and analysts on requests to expand residency slots across Idaho and discussed the state's three‑way funding model, costs per resident and retention rates as a strategy to address physician shortages in rural areas.
Committee members and analysts heard detailed briefings on Idaho's graduate medical education (GME) programs and requests to add residency slots in family medicine, internal medicine and psychiatry. Legislative analyst Kevin Campbell presented enrollment and funding data; program directors described workforce impacts.
Kevin Campbell, Legislative Services Office analyst, summarized the state's GME landscape and residency funding mechanics: many Idaho residency programs operate as three‑way partnerships among the sponsoring institution, local health systems and the state. Campbell said the state's portion of support is typically the third of program costs and that recent per‑resident costs are about $210,000 per year.
"The fund support the resident's salary, training costs, liability insurance, and payments to the doctors who oversee the resident's work," Campbell explained in the presentation of Eastern Idaho Medical Residency (EIMR). He noted EIMR had 56 residents and that the program spends nearly all appropriations each year to pay sponsoring hospitals.
Why it matters: Idaho ranks near the bottom nationally for physicians per capita; legislators repeatedly pressed that training more residents and keeping them in‑state is a long-term strategy to expand access, especially in rural health professional shortage areas.
Key details
- Program sizes and recent requests: Eastern Idaho Medical Residency (EIMR) reported 56 residents; Boise Internal Medicine reported 41 residents; Family Medicine Residency (FMR) programs collectively reported about 130 residents across multiple sites (Full Circle Health, Idaho State University programs, Kootenai Clinic and others). Several FY2026 requests seek additional residents and fellowships (examples: EIMR requested four psychiatry slots as part of a multi-year increase; Boise Internal Medicine requested one additional resident; FMR requested six new residents at a new Nampa program and other additions).
- Cost and funding model: Campbell and program directors explained the roughly $210,000 annual cost per resident; historically the state's share has been about one third (approximately $60,000 per resident in earlier years), though presenters noted inflationary pressures have increased total per‑resident costs and that state contributions would need adjustment.
- Retention and impact: Presenter Elke Shaw Tullock (Division Administrator, Public Health) said loan repayment and rural incentive programs have high retention: "Almost 91% of the providers that receive these loan repayments stay in the state and practice in the state." Campbell cited a 55% retention figure for graduates of Idaho residencies overall, based on American Medical Association data. Program directors described immediate service benefits: Dr. Matt Larson (psychiatry) said, "It takes 3 and a half months to get into me," illustrating long waits for specialty care that residency growth aims to reduce.
Questions and committee concerns
- Bottleneck at residency training: Several legislators, including Vice Chair Miller and Senator Wintrow, asked whether medical school output or residency slots are the binding constraint; presenters uniformly said the bottleneck is the residency end—many medical students apply but residency slots are limited by training infrastructure and operating costs.
- Where to focus expansion: Directors urged continued investment in primary care and psychiatry; Dr. Larson urged continued support for the multi‑year expansion plan and warned that psychiatry in particular remains scarce. Directors identified near‑ready expansions that could begin quickly if funding is available (for example, a child psychiatry program option and a sports‑medicine fellowship referenced for Pocatello).
- Return on investment and evaluation: Vice Chair Miller and others asked how to measure program success against alternatives (loan repayment, rural incentives, scholarships, residencies). Presenters said the programs target different lifecycle stages (scholarships and loan repayment target recruitment; residency slots convert students into practicing clinicians under supervision) and recommended a combined, multi-pronged approach.
Context and background
- Ten‑year plan and progress: Program directors described a statewide 10‑year expansion that began in 2018. One director said Idaho increased residency programs from nine to 16 and residents from about 134 to 262 in recent years, moving Idaho up from the very bottom among states in training capacity.
- Immediate clinical value: Directors emphasized that residents provide direct patient care during training (in hospitals, clinics and FQHCs), easing access even before retention is measured—an argument offered repeatedly to justify funding increases.
No formal committee votes were recorded on residency items during this session. Presenters asked the committee to continue multi-year support to complete planned expansions; members asked analysts for further cost and retention data to inform appropriation decisions.
