Persily: In-state medical residencies drive doctor retention | Politics

Keeping West Virginia medical students in-state once they graduate continues to be a struggle, according to a report given to lawmakers on Sunday.

Health Sciences Vice Chancellor Cynthia Persily of the West Virginia Higher Education Policy Commission provided lawmakers with an overview of the Health Sciences and Rural Health Report during an interim meeting of the Legislative Oversight Commission on Education Accountability.

The report is required by law each year and is produced by the Health Sciences Division, which is tasked with fostering innovation and collaboration to improve the health of West Virginians, particularly those in rural and under-served populations, Persily said.

The report provides an overview of outcomes in the three state-funded medical schools, including admissions, graduation, medical school debt, and retention in the state, including those in rural areas and primary care, Persily said.

The report also outlines outcomes in scholarships and loan-repayment programs administered by the Health Sciences Division, as well as outcomes of the Rural Health Initiative funded by the state through the three medical schools, she said.

Persily said the Division has expanded the report by including state-funded pharmacy programs, as well as the dentistry program at West Virginia University. Other disciplines, including nursing, will be added to the report starting next year, she said.

West Virginia’s three state-funded medical schools enrolled more students per-capita than any other state, Persily told lawmakers. Typically, there are enough seats at any given time for all qualified applicants to state programs, she said.

West Virginia’s in-state tuition is among the most affordable in the nation, but in the 2022 academic year, only 44% of the 392 medical students admitted in the first-year program were from West Virginia, Persily said.

Mean debt for medical school ranges from $150,000 to $252,000, depending on the school, Persily said.

“The highest debt is from the Osteopathic school, but not because their tuition is significantly different, but because of the high percentage of out-of-state students who enroll at the school of Osteopathic Medicine,” Persily said.

The commission also has the medical schools report on their licensure examination pass rates each year, she said. Over the last five years, those have ranged from 93% to 100%.

There is a good chance those numbers will continue to climb, Persily told lawmakers.

“Once we get to next year, if all pass rates remain in a trend that we’ve been seeing, we’ll be talking about a range of 98% to 100%,” she said.

Persily also discussed medical resident retention, something the commission keeps a close eye on.

Once they graduate, students go into a medical residency that can last from three to seven years, or longer depending on specialty, Persily said. Getting students to do their medical residency in West Virginia is the best way to encourage them to practice in the state once they are finished, she said.

“So we work — the schools, as well as the Rural Health Initiative, as well as the Higher Education Policy Commission — very hard to incentivize students who are especially interested in primary care and rural practice to complete their residency training in West Virginia,” Persily said.

The commission’s Health Sciences Division follows medical school graduates in five-year cohorts, Persily said. In order to be counted, graduates must have completed their residency and be entering into practice, she said.

The most recent cohort covers 2012 through 2017, Persily said. Numbers show a steady decline in students who choose to practice in West Virginia, she said.

Persily said 20% of graduates from the latest cohort are practicing in West Virginia, while 12% are practicing in primary care and 6% are practicing in rural areas. These numbers have “leveled off” from last year, she said.

“We hope to start to see these rates incline. We are working hard to identify those students who are most likely to come back to practice,” Persily said.

The task is made more difficult by lower reimbursement rates and salaries, Persily said.

“With high debt loads, the choice of practicing outside of West Virginia is often one that students make,” she said.

The commission administers three financial aid programs for students in health professions, all designed to keep practitioners in West Virginia by providing incentives, Persily said. Each of them also has a service obligation attached requiring students to work in an under-served, rural area in a shortage specialty in order to participate, she said.

Created in 1995, the Health Sciences Services Program Award is the largest of these, with 231 students completing, Persily said. The commission gives out 15 to 20 of these awards each year. In addition to medical students, those in dentistry, pharmacy, nurse practitioner, physician’s assistant, occupational therapy, physical therapy, public health and other programs can qualify.

The state also has a loan program, administered by each individual school of medicine, that allows medical students to borrow up to $10,000 each year over the course of four years of medical school, with the debt forgiven in exchange for four years of service in an under-served area of the state in a shortage speciality, Persily said.

“The student, when they graduate from their residency and they come back to practice in West Virginia, they’re able to defer their payments for each year. And then each year they practice, they have one year forgiven of their loan,” Persily said.

Persily said the program has a low default rate but there is concern over the number of students who do not practice in West Virginia and opt to simply pay back the loan.

“Its intended purpose is to keep those students serving in West Virginia. Some of the changes that you made during the legislative session last year will, hopefully, change that trend of students who are choosing to pay back the loan as opposed to serving in West Virginia. One of the most important changes, I think, is a relatively robust interest rate,” Persily said.

A program that began in 2019, Choose West Virginia, provides a tuition waiver for non-resident students who agree to remain in the state and practice in an under-served area, Persily said. Students receive a waiver for the difference between in-state and out-of-state tuition, she said.

“So they receive upwards of $30,000 for each year that they’re in the Choose West Virginia program, which of course is an incentive to stay once they have graduated and finished their residency,” she said.

Persily said 52% of new admissions to the WVU School of Pharmacy last year were in-state students. The school had 81 total graduates last year, with a 90% board passage rate and 56% of graduates practicing in West Virginia, excluding those who went on to residencies, she said.

Persily said 22% of the school’s graduates who are practicing in West Virginia are practicing in rural areas.

Persily said 50% of new admissions to the Marshall University School of Pharmacy were from West Virginia. The school graduated 59 students last year, with a 75% board passage rate. Persily said 34% of its students are practicing in West Virginia, with 88 percent of those working in rural practices.

As with medical school students, the state has a number of initiatives to keep pharmacy students in West Virginia after they graduate, she said.

The WVU School of Dentistry is the only school of dentistry in West Virginia, with 71% of last year’s admissions coming from in-state, Persily said. The school had 46 graduates, with an 88% board passage rate for the first part of the examination and 91% for the second part, she said. Persily said 21% of the school’s graduates are practicing in West Virginia. Of those practicing in the state, 43% are practicing in rural areas, she said.

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