Rural health care in Utah has two urgent problems. There aren’t enough workers, and it’s a challenge to train, hire and retain more workers for the future.
Lawmakers discussed both issues when the interim Health and Human Services Committee met in St. George on Sept. 18. Toward the end of her presentation to the committee, Rocky Vista University Dean of Osteopathic Medicine Heather Ferrill pointed to two maps that illustrate the challenge.
The first showed that a vast majority of Utah counties have too few primary care doctors to meet their local needs. The second showed where graduates from the university’s med school — located in Ivins just west of St. George — are doing their residency training this year.
She directed the legislators’ attention to the clusters of graduates who ended up going to hospitals in Nevada, Arizona and Idaho.
“Most of those students wanted to stay in Utah,” Ferrill said. “And they couldn't, so they had to go out of state.”
She said House Bill 295 — signed into law in 2022 — created temporary funding for more residencies in Utah, but that’s just a start. For her, long-term, ongoing funding to create more opportunities for Utah med students to complete their training in the state should be the next step.
“The big ask for us as a university is to help us remove those obstacles to those pipelines,” Ferrill said to committee members. “Help us to create and maintain the funding to open up these slots here in the state of Utah.”
Second-year Rocky Vista med student Maysen Smith joined Ferrill. Many of her classmates have families, she said, and moving out of state to complete their training can disrupt their lives.
“Just the process of moving itself with children can be really frustrating,” she said. “And then if they want to come back, that's a whole other beast.”
National statistics show close to 70% of med students end up staying to practice medicine in the state where they complete their training. That means for every 10 residencies the Legislature funds at Utah hospitals, Ferrill said, the state could eventually get repaid with seven new doctors.
Rocky Vista is working to build up the local pipeline of future doctors, Ferrill said. She pointed to a program that brings roughly 100 med students into a local high school to answer questions about their experiences.
Eli Bermudez, dean of Utah Tech University’s College of Health Sciences, told lawmakers his school is also doing what it can. For example, the university has formed partnerships with high schools in the small towns of Kanab and Hilldale to prepare more rural students for a pathway to nursing.
But Utah Tech also ends up sending many students to do their practicum at hospitals in neighboring states.
“Hopefully we can grow more, but … we don’t have that many hospitals here in southern Utah,” Bermudez said. “That’s something that limits how many students we can have in the program.”
He said the fact that 100% of students from several of his school’s programs secure jobs after — or even before — graduation shows how big of a need there is for medical professionals across Utah.
In southwest Utah, he said, the health care worker shortage is fueled by the lingering impacts of the COVID pandemic — when many people decided to leave the workforce after months of strain — and the increasing cost of living in the St. George area, which makes it hard for salaries to stay competitive.
These challenges extend beyond hospitals, too.
In his comments to the legislative committee, Southwest Utah Public Health Department health officer David Blodgett said his team has trouble retaining the people it hires because it often can’t compete with other health care positions that offer bigger salaries or more flexible work schedules.
“We end up training a lot of people and then sending them off to other jobs,” Blodgett said. “It's hard when you don't have that kind of experience base.”
That’s especially critical because his department covers more than 15,000 square miles across five counties. He said it can take up to nine hours to drive from his office in St. George to some of the district’s remote corners, such as the town of Bullfrog on the shores of Lake Powell.
Ultimately, Blodgett said, it comes down to how much Utah wants to support local public health. Most well-balanced public health department budgets nationwide are split equally between federal, state and local sources, he said, with roughly one-third of a department’s funding coming from each source.
But in his department, state funding only counts for around 1% of the budget.
“What the Legislature could do is provide a minimum level [of funding],” he said. “What does it really take to be a health department and what funding level is a minimum level? That would create the base on which we could build everything else.”
