HELENA (AP)-Montana lawmakers have rejected a $400,000 request to expand a state program to train doctors.

The Joint Appropriations Subcommittee on Education did not approve an expansion request from Montana’s Graduate Medical Education program, The Helena Independent Record reports.

Doctors said the money would be used to expand training in rural areas and establish a psychiatry residency.

Montana has three residency programs and just 686 practicing primary-care doctors. Seventeen Montana counties have zero primary-care physicians.

The budget proposal now moves on to House Appropriations and eventually to Senate Finance and Claims, where it could see additions or reductions.

Republican Sen. Llew Jones of Conrad tells the newspaper that lawmakers want to ensure existing programs continue before funding an expansion like the one proposed.

Jones said the residency program was important in addressing Montana’s doctor shortage, and said there’s a good chance the program could be funded later in the session with a special revenue account. But in executive action, he said the committee struggled to do the least harm with limited resources.

“There’s a short-term hole that’s enormous,” Jones said. “None of the subcommittees are having a better time.”

Dr. Ned Vasquez, program director for the Family Medicine Residency of Western Montana, said residents are likely to stay in the community they complete their residency in.

“One of the most important mechanisms to ensure you have more doctors in your state is to train them in your state,” he said.

Vasquez said the shortage of doctors can be attributed to a rapidly aging population, doctors who are preparing to retire, an increase in the state population and people accessing care with the expansion of Medicaid.

The Graduate Medical Education program receives $519,336 in state funds each year, which is allocated to Montana’s three residency programs: Montana Family Residency, Western Montana Family Medicine Residency and Billings Clinic Internal Medicine Residency.

In total, there are 78 residents in the program, with each doctor costing $250,000 to $300,000 a year to teach. The actual cost of the program is $20.8 million per year with $10.3 million paid in multiple matching federal grants from Medicare.

The state’s teaching hospitals foot the rest of the bill.

Dr. Eric Arzubi, a psychiatrist at the Billings Clinic, told the committee some of the funds would go toward establishing a psychiatry residency in the state. According to the American Foundation for Suicide Prevention, Montana had the nation’s highest rate of suicide in 2016 with 23.8 deaths per 100,000 people.

“When there are suicide attempts we need well-trained psychiatrists,” Arzubi said.

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