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CHARLESTON — Of the students who graduated from West Virginia medical schools from 2011 to 2016 and have finished their residencies since then, only 1 in 5 are now practicing in the state.

But, specifically for primary care providers, those who completed their residencies in state are much more likely to remain in West Virginia than those who fulfilled that post-graduation requirement elsewhere.

This is all according to the annual West Virginia Health Sciences and Rural Health Report.

Cynthia Persily, health sciences senior director for the state’s higher education oversight agencies, said the most recent data is from the 2011 to 2016 group of graduating classes because it takes years after graduation for doctors to complete their residencies at hospitals and other areas.

The 20% in-state retention rate is the lowest on record going back to the group that graduated from 1995 to 2000. The rate was around 39% for that group and for several years afterward, before the still-continuing decline began.

The actual number of West Virginia medical school graduates retained in state after residency — 404 out of the 2011 to 2016 graduates group — is also the lowest on record.

It’s not far below the 407 for the 1995 to 2000 group, but the number retained was rising before peaking at 497 a few years ago and falling since.

“This is probably a multifactorial problem, including the number of out-of-state students who come to medical school here, then go back home to do their residency and practice,” Persily told state lawmakers last week.

Persily told the legislative committee that “we will be hosting a graduate medical education summit in the spring to address some of the potential causes of this drop-off in retention and policy solutions that we can recommend for this continuing decline in numbers of graduates who come back or stay in West Virginia to practice.”

She told the Charleston Gazette-Mail student debt could also possibly be driving students to practice in areas where they could make more money.

There were nearly 2,000 students who graduated from West Virginia’s three medical schools from 2011 to 2016 and have since finished their residencies, the report says. More than half, about 1,080, came out of the School of Osteopathic Medicine.

That freestanding graduate school in Lewisburg had the lowest in-state retention rate of the three medical schools: 15%, meaning just 160 of those 1,080 are practicing in West Virginia.

The retention rate was 23% for graduates of Marshall University’s Joan C. Edwards School of Medicine. Ninety of its 380 graduates from those years who have finished residencies are practicing in state. The rate was 30% for West Virginia University, which retained nearly 160 of its 530 graduates who finished residencies.

Like Persily, Dr. Bobby Miller, medical education vice dean at Marshall, said he thinks multiple issues are decreasing the retention rate.

Miller said it’s likely too financially difficult nowadays to start a solo practice in rural West Virginia. And even if graduates could, he suggested the younger generation seems less willing to be on call night after night, as a rural area might demand.

“If there’s not a job for them in one of the bigger cities, namely Charleston, Huntington or Morgantown, they don’t want to be out on their own, I think,” said Miller, who was previously a residency program director at Marshall.

“Residents tell me they don’t want to go two hours away, where there’s no one else around but them,” he said.

Dr. Linda Boyd, vice president for academic affairs and dean of the freestanding School of Osteopathic Medicine, wrote in an email that “we are limited by the low number of post-graduate residency training programs in West Virginia, which results in many of the students we train needing to leave the state.”

“Once they leave the state for residencies — and establish themselves in other states for several years — the likelihood of returning to West Virginia vastly diminishes,” Boyd wrote.

The report says that, of the 2015 graduates who completed residencies in primary care, 83% of those who completed in-state residencies are practicing in state, compared to just 10% of those who completed out-of-state residencies.

“So this is why we continue to work really hard through the Rural Health Initiative and other avenues to incentivize students to choose a West Virginia residency program,” Persily said.

The Rural Health Initiative provided $590,000 each to the three medical schools last fiscal year, the report says. State law says the initiative’s goals include increasing the in-state retention rate and other related aims.

Miller said he had to leave West Virginia for training and a fellowship that wasn’t offered here. But he said Marshall will this summer start offering a fellowship in the same field he had to go to Texas for.

“We’ve actually increased our number of residencies and the number of fellowships we offer,” he said.

Ryan Quinn covers education for HD Media. He can be reached at 304-348-1254 or ryan.quinn@hdmediallc.com. Follow @RyanEQuinn on Twitter.

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