INSIGHT ON: Health Care – The rural connection

Posted on Jul 1, 2014 :: Health Care , Insight On
Posted by , Insight on Business Staff Writer


To Dr. John Raymond, the statistics in a 2011 Wisconsin Hospital Association study painted a bleak portrait of health care in Wisconsin.

The study projected a shortfall of more than 2,000 physicians – or about 20 percent of the current physician workforce – by 2030, with the shortage most acute in rural areas. Primary care physicians will be most in demand, with general surgeons and psychiatrists also in short supply.

“We (the medical colleges) were challenged to train more students, but our school is already large and I thought, ‘If we do an off-site campus in northern Wisconsin, it would help solve the issue,’” says Raymond, the president and CEO of the Medical College of Wisconsin in Milwaukee. “Studies have shown that doctors often put down roots in areas where they study and do their residencies.”

With that in mind, the Medical College will open a campus in Green Bay in 2015 and in central Wisconsin in 2016. In Green Bay, the Medical College will use classroom and administrative space at St. Norbert and Bellin colleges. The University of Wisconsin-Green Bay and Northeast Wisconsin Technical College also will provide space as needed. Initially 20 to 25 students will be enrolled in the program.

“It’s very collaborative and a community effort, taking advantage of the great education facilities in the Green Bay area as well as the medical staff at area hospitals and clinics,” Raymond says.

Research shows that 70 percent of medical students who complete both their medical education and medical residency in the same region decide to stay there to practice medicine, he says. The Green Bay and Central Wisconsin campuses will allow the Medical College of Wisconsin to try something new – an immersive teaching model in which students receive basic core science and clinical experience right in the community.

“Students will also complete their education in three years, rather than four with this model,” Raymond says. “That has the potential to knock thousands of dollars off their student debt, which we think will make the program attractive to medical students.”

In Green Bay, the Medical College is working with local health care providers to find placement of students for their clinical experience. After they complete medical school, students begin their three-year residencies. Raymond says finding local residency options for the medical students will be key to the program’s success. The Fox Valley Family Residency Program based in Appleton is an option and the Medical College is looking at other possibilities.

The Fox Valley Family Residency Program is also going through changes. Next summer, it will transition from working with the University of Wisconsin School of Medicine and Public Health to a consortium of local health care organizations, including ThedaCare, Ministry Health Care and the Medical College of Wisconsin. The consortium will assume responsibility for the program’s education mission and its clinic in downtown Appleton.

The restructuring gives local health care providers a bigger say in how the program will be run, says Dr. Lee Vogel, residency program director.

“There will be a lot more flexibility. Right now, there is a huge demand for primary care providers and we think the change will help us better meet those growing needs,” she says. “Partnership with our local health systems will commit us to focusing even more on the health of our community and our region in ways that will better serve our physician trainees and patients.”

For example, the number of residents in the program will slowly expand over the next few years. There are currently 18 residents in the program.

Dr. Greg Long, ThedaCare’s chief medical officer, says the changes will also allow residents to work in ThedaCare and Ministry’s facilities outside of the Fox Cities; currently they do rotations at Appleton Medical Center and St. Elizabeth Hospital.

“We’ll be able to expose them to what it’s like to work in a more rural setting, such as New London, Shawano or at Calumet Medical Center in Chilton,” he says. “With having more residents in the program, we will have more options. This is about the local health care providers being able to direct more of the program and the local needs. Our hope is to get the residents engaged in the local community so after their residency is over, they will consider staying here and practicing.”

Dental Demands

The number of dentists in Wisconsin is expected to remain relatively stable until 2020, according to the Wisconsin Dental Association. A 2010 study found that state residents who have private insurance will have the same or better access to dental care.

One segment of the population – those with Medicare and others who lack dental insurance – faces a bigger challenge when it comes to getting dental care since they can’t pay for it. Since state health programs don’t begin to cover the costs for routine or emergency care, many dentists limit the number of patients they accept – if they accept them at all.

“We are reimbursed for only about 30 percent of what it costs to provide the care,” says Dr. Paul Feit, a dentist with offices in Sturgeon Bay and Sister Bay. “You can’t take on too many of these patients without doing serious damage to your business.”

The WDA is working with the Wisconsin Legislature to change how the reimbursements work, but change is slow going, he says.

“Many dentists do volunteer for free care clinics, but it’s still not enough to help everyone who needs it,” Feit says.

As for getting dentists to set up practices in rural counties, like Door, Feit says recruiting them is not the issue.

“The problem is that many have very educated spouses so they might not have job options in the community. You really need to work with both the dentist and the spouse to make sure it’s a good fit,” he says.