I want to applaud Emily Anderson Stern and the editors of The Salt Lake Tribune for publishing the June 4th article on the physician workforce in Utah. The 13.5% decrease in residency applications in Utah is alarming. While the laws on abortion and diversity are temporally related to the decline in applications, there may not be sufficient evidence to say that they caused the decrease. Scientifically, it is an association. Other scientific measures must determine causation.
Residency programs at U. of U. Health are Utah’s principal producers of physicians. Over half of our residency program graduates practice within 100 miles of the University Hospital. In some programs, that number is closer to 80%. We do not yet know if the above laws will be associated with graduating residents choosing to practice elsewhere.
A decrease in the number of those who decide to stay in Utah for employment will exacerbate the physician shortage. Utah is currently 47th in primary care physicians per capita and 50th in psychiatric physicians per capita.
Every residency program must interview a certain number of people to fill their positions each year. Many programs have increased the number of interviews for the same positions. In 2020, one program interviewed eight people for every position. Today, that number is more than 10. This phenomenon is happening across the country in states with similar laws. Interviewing potential residents takes time, and increasing the number of interviews ensures that faculty interviewers spend less time seeing patients or doing other duties. The increase in interview duties incurs an additional cost to the health system, increases employee workload, and can negatively affect our rankings.
Rankings affect our ability to attract residents and can exacerbate the existing challenges.
However, there are solutions to this trend, and we should consider them in our state Legislature and educational institutions.
The first solution is straightforward: Use state surplus funding to pay for more primary care and psychiatry residency positions.
Lawmakers and educators can create these positions where the greatest needs are — rural and frontier counties. New positions are costly, but their creation can pay dividends for generations. It will also attract more residents to our beautiful state.
Second solution: Take advantage of our immigration-friendly policies. In our hospitals across the state, some physicians work as interpreters, medical assistants, radiology technicians, etc. They do this because they have been unable to get into a residency program, usually due to additional requirements for international medical graduates. A state-funded, training-based pathway into primary care or psychiatric residencies (or other advanced practice clinician professions) for international medical graduates could be a solution, and it has been successful in different states. This pathway could require a commitment to practicing in rural and frontier counties, community health centers, or other safety net practices. Finally, we can emphasize our welcoming nature as a state, the sanctity of the physician/patient relationship, and our support of academic freedom as we address the shortages in the physician workforce.
José E. Rodríguez, Salt Lake City
