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http://www.jsonline.com/story/money...in-addresses-shortage-rural-doctors/92064220/
Wisconsin addresses shortage of rural doctors
Guy Boulton , Milwaukee Journal Sentinel10:10 p.m. CDT October 26, 2016
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Jessica Lemke grew up in Chippewa Falls, is married to a cheese maker and is looking forward to returning to the western Wisconsin community when she completes her training as a doctor.
The problem is, there aren’t enough Jessica Lemkes to go around.
As the state's rural population ages, increasing its need for health care, Wisconsin is facing a shortage of physicians in rural areas that is projected to get much worse in coming decades.
To address it, the University of Wisconsin School of Medicine and Public Health, the Medical College of Wisconsin and the state’s health systems are developing residency programs in rural areas — knowing that doctors are more likely to practice where they do their training.
Residencies are the typically three to five years of training that follow medical school.
“There is a movement here to really try to help with the rural physician shortage,” said Ellen Hartenbach, a professor of obstetrics and gynecology at the UW School of Medicine.
The school announced last month that it was expanding its residency program to train an OB/GYN physician interested in practicing in rural areas.
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But the UW program also is an example of the challenges ahead.
They include accreditation standards that can require some residency programs to be close to larger cities, recruiting physicians willing to volunteer their time as adjunct faculty and, not the least, finding the money to pay for the programs.
For example, the cost of training just one more OB/GYN a year — over the four years of a residency program — is conservatively estimated at $400,000.
Still, the state is expanding its residency programs outside of the Milwaukee and Madison areas for family medicine, general surgery and psychiatry, according to a report released in August by the Wisconsin Council on Medical Education and Workforce, which includes the Wisconsin Hospital Association, the state’s two medical schools and other organizations.
The new or expanded programs eventually will result in 28 more physicians each year completing their training in Wisconsin. The hope is that many of them will choose to practice in lesser-served rural areas.
Future gains, however, could be harder.
“The low-hanging fruit has been picked,” said Byron Crouse , a professor of family medicine and associate dean for rural and community health at the UW School of Medicine and Public Health.
His concern: The state is running out of potential training sites.
“There is a finite number of training opportunities,” said Crouse, who once practiced in Spooner, a city of roughly 2,700 people in northwestern Wisconsin.
The problem is nationwide.
Currently, less than 5% of physicians completing their training opt to practice in rural areas, according to a 2015 blog on the website of Health Affairs, a policy journal. Its authors included Crouse and Richard Rieselbach, professor emeritus at the UW School of Medicine.
By comparison, 11% of the country’s physicians now practice in rural areas — and they provide a significant amount of the care for 20% of the U.S. population.
Changing that won’t be easy.
Starting a residency program can take six years or more. And residency programs are expensive.
The federal government spends an estimated $15.5 billion a year on what is known as graduate medical education. The largest share comes from Medicare. And states, including Wisconsin, that support residency programs through their Medicaid programs, spend more than $1 billion.
Doctors in residency programs also generate revenue by seeing patients.
The number of positions in residency programs funded by the federal government was capped in 1997. Hospitals with new programs can receive payments through the Medicare program. But hospitals with existing programs must fund new positions on their own or rely on state and federal grants.
Yet increasing the number of residency programs is the only way to increase the number of physicians, particularly in rural areas.
The Medical College has opened campuses in Green Bay and in Wausau and central Wisconsin — with a combined total of about 50 students in each class — that are designed to attract students interested in practicing in northern Wisconsin.
The UW School of Medicine and Public Health also started the Wisconsin Academy for Rural Medicine in 2007 to recruit students with an interest in practicing in smaller cities and rural areas. The program has 26 students in each class.
Without more new residency programs, the additional graduates of the state’s medical schools will just take positions now filled by other students, including those trained in foreign medical schools.
“We have a bottleneck at the graduate medical level,” Hartenbach said.
Some policy experts have questioned whether the current system is training the physicians most in need — those who specialize in family medicine, internal medicine, pediatrics and other specialties in short supply.
“To me, it’s unbelievable that we can spend billions of dollars and no one is measuring whether we are getting the outcomes we want,” said Crouse, who is director of the Wisconsin Academy for Rural Medicine and the Wisconsin Rural Physician Residency Assistance Program.
In addition to state and federal grants, Wisconsin health systems spend $177 million a year on graduate medical education, according to the Wisconsin Hospital Association.
Despite the challenges, health systems throughout the state have started and expanded residency programs, including several designed for rural areas.
Part of this stems from self-interest. The programs help them recruit physicians.
“The majority of residents are going to practice in the same place and same type of venue they did their training,” Hartenbach said.
That is particularly true of physicians who grew up in small or mid-size towns in Wisconsin.
Lemke, who is in the third year of her residency at Mosaic Family Health in Appleton, is an example.
For her, family back in Chippewa Falls is a draw. So, too, is practicing in an area where she will get to know her patients and the community. And since her husband is a cheese maker, he probably can find work just about anywhere in Wisconsin.
“A lot of where you end up is dependent on making sure your spouses will be happy, too,” she said.
She is interviewing for jobs now and is unlikely to lack for options. “There definitely is a strong need for family medicine doctors,” Lemke said.
She's in a program supported by ThedaCare and St. Elizabeth Hospital, part of Ascension Wisconsin, which drew on a state grant to add three more positions to the three-year residency program and now has 21. It eventually would like to add three more.
That would enable a total of eight physicians a year to complete their training in the program.
“Every position you have makes a difference, especially over the long haul,” said Allen Last, a physician and director of the Fox Valley Family Medicine Residency Program.
Some other programs aiming to address the shortage of rural-area doctors:
The expansions still will not meet the need for physicians in rural areas, Crouse said. But despite the challenges the state's medical schools and health systems are trying to lessen the problem.
Crouse likens their efforts to a barn-raising.
“No one of us,” he said, “can do it all ourselves.”
Wisconsin addresses shortage of rural doctors
Guy Boulton , Milwaukee Journal Sentinel10:10 p.m. CDT October 26, 2016
TWEET 1LINKEDIN 2COMMENTEMAILMORE
Jessica Lemke grew up in Chippewa Falls, is married to a cheese maker and is looking forward to returning to the western Wisconsin community when she completes her training as a doctor.
The problem is, there aren’t enough Jessica Lemkes to go around.
As the state's rural population ages, increasing its need for health care, Wisconsin is facing a shortage of physicians in rural areas that is projected to get much worse in coming decades.
To address it, the University of Wisconsin School of Medicine and Public Health, the Medical College of Wisconsin and the state’s health systems are developing residency programs in rural areas — knowing that doctors are more likely to practice where they do their training.
Residencies are the typically three to five years of training that follow medical school.
“There is a movement here to really try to help with the rural physician shortage,” said Ellen Hartenbach, a professor of obstetrics and gynecology at the UW School of Medicine.
The school announced last month that it was expanding its residency program to train an OB/GYN physician interested in practicing in rural areas.
ADVERTISING
inRead invented by Teads
But the UW program also is an example of the challenges ahead.
They include accreditation standards that can require some residency programs to be close to larger cities, recruiting physicians willing to volunteer their time as adjunct faculty and, not the least, finding the money to pay for the programs.
For example, the cost of training just one more OB/GYN a year — over the four years of a residency program — is conservatively estimated at $400,000.
Still, the state is expanding its residency programs outside of the Milwaukee and Madison areas for family medicine, general surgery and psychiatry, according to a report released in August by the Wisconsin Council on Medical Education and Workforce, which includes the Wisconsin Hospital Association, the state’s two medical schools and other organizations.
The new or expanded programs eventually will result in 28 more physicians each year completing their training in Wisconsin. The hope is that many of them will choose to practice in lesser-served rural areas.
Future gains, however, could be harder.
“The low-hanging fruit has been picked,” said Byron Crouse , a professor of family medicine and associate dean for rural and community health at the UW School of Medicine and Public Health.
His concern: The state is running out of potential training sites.
“There is a finite number of training opportunities,” said Crouse, who once practiced in Spooner, a city of roughly 2,700 people in northwestern Wisconsin.
The problem is nationwide.
Currently, less than 5% of physicians completing their training opt to practice in rural areas, according to a 2015 blog on the website of Health Affairs, a policy journal. Its authors included Crouse and Richard Rieselbach, professor emeritus at the UW School of Medicine.
By comparison, 11% of the country’s physicians now practice in rural areas — and they provide a significant amount of the care for 20% of the U.S. population.
Changing that won’t be easy.
Starting a residency program can take six years or more. And residency programs are expensive.
The federal government spends an estimated $15.5 billion a year on what is known as graduate medical education. The largest share comes from Medicare. And states, including Wisconsin, that support residency programs through their Medicaid programs, spend more than $1 billion.
Doctors in residency programs also generate revenue by seeing patients.
The number of positions in residency programs funded by the federal government was capped in 1997. Hospitals with new programs can receive payments through the Medicare program. But hospitals with existing programs must fund new positions on their own or rely on state and federal grants.
Yet increasing the number of residency programs is the only way to increase the number of physicians, particularly in rural areas.
The Medical College has opened campuses in Green Bay and in Wausau and central Wisconsin — with a combined total of about 50 students in each class — that are designed to attract students interested in practicing in northern Wisconsin.
The UW School of Medicine and Public Health also started the Wisconsin Academy for Rural Medicine in 2007 to recruit students with an interest in practicing in smaller cities and rural areas. The program has 26 students in each class.
Without more new residency programs, the additional graduates of the state’s medical schools will just take positions now filled by other students, including those trained in foreign medical schools.
“We have a bottleneck at the graduate medical level,” Hartenbach said.
Some policy experts have questioned whether the current system is training the physicians most in need — those who specialize in family medicine, internal medicine, pediatrics and other specialties in short supply.
“To me, it’s unbelievable that we can spend billions of dollars and no one is measuring whether we are getting the outcomes we want,” said Crouse, who is director of the Wisconsin Academy for Rural Medicine and the Wisconsin Rural Physician Residency Assistance Program.
In addition to state and federal grants, Wisconsin health systems spend $177 million a year on graduate medical education, according to the Wisconsin Hospital Association.
Despite the challenges, health systems throughout the state have started and expanded residency programs, including several designed for rural areas.
Part of this stems from self-interest. The programs help them recruit physicians.
“The majority of residents are going to practice in the same place and same type of venue they did their training,” Hartenbach said.
That is particularly true of physicians who grew up in small or mid-size towns in Wisconsin.
Lemke, who is in the third year of her residency at Mosaic Family Health in Appleton, is an example.
For her, family back in Chippewa Falls is a draw. So, too, is practicing in an area where she will get to know her patients and the community. And since her husband is a cheese maker, he probably can find work just about anywhere in Wisconsin.
“A lot of where you end up is dependent on making sure your spouses will be happy, too,” she said.
She is interviewing for jobs now and is unlikely to lack for options. “There definitely is a strong need for family medicine doctors,” Lemke said.
She's in a program supported by ThedaCare and St. Elizabeth Hospital, part of Ascension Wisconsin, which drew on a state grant to add three more positions to the three-year residency program and now has 21. It eventually would like to add three more.
That would enable a total of eight physicians a year to complete their training in the program.
“Every position you have makes a difference, especially over the long haul,” said Allen Last, a physician and director of the Fox Valley Family Medicine Residency Program.
Some other programs aiming to address the shortage of rural-area doctors:
- Aurora Health Care is starting a rural family medicine program for four residents a year who will train in Milwaukee and Elkhorn.
- Monroe Clinic, west of Janesville, has started a family medicine residency program.
- Gundersen Health in La Crosse has done the same.
- The Medical College of Wisconsin has announced a new residency program that will train psychiatrists in northern Wisconsin.
The expansions still will not meet the need for physicians in rural areas, Crouse said. But despite the challenges the state's medical schools and health systems are trying to lessen the problem.
Crouse likens their efforts to a barn-raising.
“No one of us,” he said, “can do it all ourselves.”
