Starting next year, Montana medical students entering the WWAMI doctor-training program will have to either promise to work in the state for three years or else pay $31,000 in higher fees.

The new law, Senate Bill 341 passed by the 2017 Legislature, will require WWAMI medical students to promise they’ll return to work in Montana within a year after finishing their training, or else pay higher fees.

The new fee requirement will begin with the class entering in the fall of 2018.

Montana medical students already are required to pay $5,224 a year into the Montana Rural Physician Incentive Program, or MRPIP, often called “Mr. Pip.”

The MRPIP fund was created to offer financial incentives to new doctors so they will practice medicine in Montana’s rural and underserved communities. They can earn up to $100,000 over five years, which helps pay back often huge medical school loans — typically $180,000 for Montana medical grads.

Today Montana medical students pay the $5,224 a year fee, or $20,896 over four years of medical school, into the rural doctor incentive fund.

Under the new law, if medical students decide against promising to work in Montana, they must pay fees two and a half times greater — $13,060 a year. That adds up to $52,240 over four years.

And under the new law, if students commit to work in Montana, but later break that promise, they must repay full state support for their education. That would cost approximately $55,000 a year for three years, or a total of $165,000, the legislative fiscal analyst estimated.

No one knows yet if the new law will affect future student applications to Montana’s WWAMI program.

“It could have been a lot worse,” Martin Teintze, WWAMI program director at Montana State University, said of the student fee hike. “We’re not happy it happened this way, but we can’t say it’s unreasonable.”

WWAMI stands for the states – Washington, Wyoming, Alaska, Montana and Idaho – that work together to offer students from rural states, too small to support their own medical schools, to train under the leadership of the University of Washington’s highly regarded medical school.

Montana has been a partner since WWAMI began in 1971. The program, based at MSU and housed at Bozeman Health hospital, calls itself “Montana’s Medical School.” In 2011, the Legislature agreed after years of debate to expand the number of students accepted into WWAMI each year from 20 to 30.

The 2017 Legislature, faced with a state revenue shortage, cut budgets for most state programs, including the Montana University System.

“They threatened to cut the (WWAMI) program back to 20 students,” Teintze said. “That would have been much worse. It would have had a long-term impact on our ability” to train new doctors.

Instead of cutting back on WWAMI’s training slots, he said, legislators raided the rural doctor incentive fund.

The Legislature took money from the incentive fund to pay for inflation in WWAMI’s costs and medical residency training for new doctors.

As a result of that raid, there may not be enough money in the fund this year to offer MRPIP incentives to new doctors, Teintze said. However, there is expected to be enough to pay doctors who signed up in the past.

The shortage in the MRPIP fund should be temporary, he said, because every year medical students pay fees into the fund and replenish it. And with the new law, some students will pay more than before.

“This is a much better deal than students in Alaska and Wyoming have been living with quite some time,” Teintze said. Those states require all medical students to return to practice within the state, and if students don’t, they have to pay back large sums.

“Our students have an option,” Teintze said. And because Montana tuition for the first 18 months of med school is so low, he said, even with the higher MRPIP fee, students are likely to pay no more than average for medical school.

The new law also preserves Montana students’ eligibility for federal military, Indian Health Service or National Health Service scholarships.

“It’s unfortunate, but in the long term we can survive it,” Teintze said.

Historically 41 percent of Montana WWAMI students have returned to Montana to practice, he said. When students from Washington, Idaho and other states are added in, the return of WWAMI students to Montana grows to 57 percent.

“It makes students have to make a really hard choice,” said Tracy Ellig, MSU spokesman. “They have to be really confident they’re going to come back. To be honest, the speculation is that most students will not choose this (promise-to-return option) and will pay the higher fee (figuring that) ‘I’m still going to get a deal.’”

Montana WWAMI’s Class of 2013, the first to enroll 30 students, just graduated, Teintze said. He said the staff is excited because a large number are going into primary care, rather than medical specialties. Nine chose family medicine.

“These are the kind of physicians Montana needs most,” he said. “Three years from now, when they finish residency, I think we’ll see a lot return to Montana.”

Gail Schontzler can be reached at 406-582-2633 or gails@dailychronicle.com.

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