Growing up, when Matthew Burgstahler pictured a doctor, he thought of his grandfather who practiced in a small town.
“He would drive a snowmobile out and deliver a baby at the farmhouse,” he said. His grandfather would get eggs in return. Or he would suture a football player's wound at the kitchen counter.
Burgstahler is from Sandpoint and he’s a fourth-year medical student in the WWAMI program, Idaho’s medical school with the University of Washington. He wants to follow in his grandfather’s footsteps and practice family medicine.
He imagines delivering children, and if he’s in a community long enough, potentially even a few generations.
“That joy, I think, is unparalleled,” he said.
Burgstahler interned in Boise last summer at Full Circle Health, a federally funded nonprofit health center. He loved it and got experience in everything from colonoscopies to vasectomies – all skills a rural doctor might need.
On Friday, medical students around the country find out where they “match” for residency, the roughly three years of training after medical school. But Burgstahler didn’t send in an application to Full Circle Health or any other programs in Idaho.
A big reason was geography; his fiancé was based in the Midwest. But he said Idaho’s laws that criminalize abortion definitely factored in.
During his internship, he heard doctors deliberating about the care they could or could not provide to patients.
“That was an extra element of medicine that I'd never seen before, was the legal aspect,” he said. “Could we get sued for something that we're trying to do to care for a patient? And that kind of made my skin crawl.”
Abortion laws are on the minds of students around the country right now who are considering where to train, and later, where to practice medicine.
Dr. Angela Bangs, a third-year resident in Boise, attended the biggest family medicine conference in Kansas City last summer, where medical students can learn more about residency programs.
Her booth was set up in a big conference hall alongside other programs representing the WWAMI network. Students, clutching spiral notebooks, would walk up to her table, and without introducing themselves first, would ask, pointedly, “What’s the status of abortion and the ability to provide them in your state?”
Bangs was surprised at how often this process repeated itself; more than half the students who asked her questions asked about Idaho’s abortion laws.
Losing out on medical students who could come to Idaho concerns Dr. Ted Epperly, the President and CEO of Full Circle Health.
“We will not see as many people rank our program as we would have, and we will see probably some of our best applicants choose not to come,” Epperly said.
He expects about one in five applicants to his residency program this year won’t choose to train in Idaho. That’s based, in part, on interviews with over 400 students.
“That is potentially significant,” Epperly said.
Many students are worried about missing out on training in states like Idaho. The skills needed to perform abortions are the same as for dealing with miscarriages.
“Understanding the same procedural skill can be life-saving to women,” Epperly said.
Some family medicine residents could seek that learning out themselves in other states, through organizations such as the Midwest Access Project. It places residents at clinics willing to teach abortion. But Dr. Debra Stulberg, a co-founder, said competition in a post-Dobbs era for those training spots is only going up.
“It became really clear there was going to be an increasing mismatch between the interest among residents in getting this training and the availability of places to go because places have had to close down,” she said.
No Idaho state funds go to abortion education or training, Epperly said.
Burgstahler said he doesn’t want to have to travel to another state to get the training he thinks will be important to care for his patients.
He also said the abortion laws and potential limits to gender-affirming care have made it so he doesn’t see himself practicing in Idaho beyond residency. That’s despite an opportunity to recoup about $100,000 through loan repayment if he were to work in a rural area of the state.
However, students who enroll in Idaho’s WWAMI program this fall or after would be required to practice in Idaho for four years or would need to pay back the public dollars that funded their medical school education.
Still, Epperly said Idaho will be poorly affected as students make similar calculations as Burgstahler. More than half of physicians stay within 100 miles of where they’re trained.
“Idaho will suffer for this,” he said. “We'll suffer because we won't have the physician workforce that's needed as our state ages, as our state has new people moving to it and that's what's at play right now.”
Epperly also emphasized that many medical professionals have spouses or partners who are in healthcare, so when one decides not to practice here, it could also mean one less nurse or one less doctor.
This comes as the state is halfway through a 10-year plan to expand residency training spots in Idaho in an effort to build the physician pipeline.
Epperly is coordinating that plan under the State Board of Education and said it’s seeing good progress. The number of trainees has already doubled since 2017 and new programs have opened, or are on track to, in specialties like psychiatry and pediatrics.
Idaho now ranks 45th out of all states for primary care doctors per person, up from 49th when the plan kicked off.
But the abortion bans are a strong counterforce to those efforts, Epperly said, and he doesn’t think it’ll stop there.
“Today, it's around abortion care,” he said. “Tomorrow, it may be around gender-affirming care. The day after tomorrow, what could it potentially be about as well?”
He hopes to have a better understanding of the effects when medical students “match” with programs Friday and later down the line when the health center surveys students who didn’t choose Idaho.
Find reporter Rachel Cohen on Twitter @racheld_cohen
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