CHEYENNE — Wyoming’s two family practice residency centers were the result of a compromise after the Legislature gave up on the idea of a four-year medical school in the 1970s.

That decision, although heartbreaking to supporters, turned out to be wise, given the subsequent periodic drops in state revenues.

The state simply could not afford to create and support a traditional a medical school.

The Casper center was organized first, in 1976, followed in a few years by the Cheyenne clinic.

About the same time, the College of Human Medicine was established at the University of Wyoming.

The centers came about as part of the debate on how best to attract more physicians to Wyoming. At the time there was a dire shortage of family practitioners and the state was rolling in money from the coal boom.

Coupled with a their dislike of federal mandates, these factors convinced state leaders not to accept federal money for the medical education program. Wyoming is the only state to do so.

As a result the only revenue for the clinics was income from clinic operations and state appropriations.

And it has not been enough to pay the bills or to keep faculty spots filled.

Subsequent efforts to get the Medical Care Graduate Education reimbursement have failed.

So while the state leaders were wise to forgo the medical school, their dislike of all things federal wound up hurting the state and the clinics.

The idea of the residency program was to get physicians to live here long enough to get some roots and then decide to stay.

Results have been moderate. An estimated 106 graduates of the residency programs have remained to practice in Wyoming, according one study.

Now, a relatively new federal program is expected to help the clinics financially although it comes with plenty of strings.

Early last month the Joint Appropriations Committee (JAC) heard the details from Meredith Asay of the University of Wyoming.

For the first time in eight years, the Cheyenne program is not asking for state money, she said.

One of the requirements for the federal money is creation of a board separate from the UW board of trustees.

Plans also include consolidating the two programs under one administrative arm with a medical director and a chief fiscal officer.

The federal money will come from a generous increase in Medicaid reimbursements and other special payments.

The Casper clinic currently has 24 residents and a faculty of 7 or 8 while Cheyenne’s program has 18 residents and a faculty of about 7.

The Wyoming graduates who attend medical school at the University of Washington at state expense (20 per year) have to pay back the cost or practice for three years in Wyoming.

The graduates first must get residency training before they can practice.

During the JAC meeting, most of the questions were whether the clinics, particularly Cheyenne, can ever support themselves.

The co-chairman, Rep. Bob Nicholas, R-Cheyenne, noted that there was serious talk two years ago about closing the Cheyenne clinic.

If the clinics don’t get enough money to become self-sustaining there will continue to be questions about whether they should be continued, particularly the Cheyenne program, he said.

A couple of the JAC members spoke up in support of the centers.

Sen. Bill Landen, R-Casper, said the Casper clinic is serving a population of people who cannot get care from an urgent care clinic.

Both residency clinics accept “self-pay” patients who are charged on a sliding scale.

Rep. Sue Wilson, R-Cheyenne, traced the history of the education programs and the resulting 100 or so physicians practicing here who went through them.

“We’re educating providers for our citizens,” Wilson said. ‘It’s not a retail program. It’s to educate doctors.”

Wilson is right on.

The lawmakers may fuss and fume at the costs but, as a rural state, Wyoming has to pay to get good medical providers to come here and stay here and practice.

And the bill is high as are all things medical these days.

Contact Joan Barron at 307-632-2534 or jmbarron@bresnan.net.