How old will you be in 2030? Will you have a big family? Will you be taking care of your parents?
Know who your doctor will be?
The Wisconsin Hospital Association says that the state may be short 2,000 physicians by then – largely affecting rural areas, including the already underserved New North region.
But the solution also may lie right here at home, where medical education officials hope to create more training opportunities for future physicians.
Possible? Sure. The Medical College of Wisconsin in Milwaukee is already communicating with universities such as the University of Wisconsin-Green Bay, St. Norbert College and UW-Oshkosh about the potential to partner up on what essentially would become satellite campuses. Such partnerships would allow medical students to complete their education in the area, and ultimately help address the need for primary care physicians in underserved rural communities.
“What we really want is for our students to be willing to settle in the communities they train in,” says Dr. John Raymond, CEO of the Medical College of Wisconsin.
Nearly half of physicians locate in the state where they complete a residency, according to the WHA. Nearly 70 percent of Wisconsin medical students who graduate from a Wisconsin medical college and also complete a residency in the state decide to stay.
Green Bay and the Fox Cities are two of eight such potential campus “nodes” in underserved areas of Wisconsin that the Medical College of Wisconsin hopes to establish within a 10-year time frame, says Raymond. While some might argue that there isn’t a physician shortage, there certainly is at least a distribution problem, as “pretty much every county” has some underserved populations or areas, he says.
The U.S. Department of Health and Human Services Administration has flagged 13 of the 18 New North counties as having medically underserved areas or populations (MUA/P). They include Brown, Door, Florence, Fond du Lac, Marinette, Marquette, Menominee, Oconto, Shawano, Sheboygan, Waupaca, Waushara and Winnebago counties.
The Green Bay and Fox Cities areas provide ideal expansion possibilities for the Medical College because they have several sophisticated universities and hospital systems, and they have local rural communities that would benefit from the primary care physicians that would be educated here, Raymond says.
“The beauty of that type of arrangement is the faculty of local colleges and universities have the reward and challenge of working with professional students, and for us, we get to partner with institutions that we haven’t typically partnered with,” he says. “We think it’s a win-win situation.”
The college is first studying the feasibility of locating the program in Green Bay, hoping to use it as a template for looking into other regions as well. “We’ve received a very enthusiastic response from the entire community,” Raymond says.
UW-Green Bay has more than 500 students enrolled as majors in human biology, making it one of the largest majors on campus, says Craig Hanke, UW-Green Bay associate professor of human biology. In fact, the program has doubled in the last 10 years and the university doesn’t anticipate interest waning anytime soon – and quite a few of those students end up going on to medical or dental school, or become physician’s assistants, physical therapists or chiropractors.
“So we’re already in that sense kind of working in a relationship with the medical college,” Hanke says.
The potential partnership could be highly beneficial on a number of levels, including that young undergraduates who may be thinking of pursuing a medical degree will see these graduate students in action, he says.
“I think it’s just an intriguing new idea for how you kind of spread out some of these critical kinds of educational services,” Hanke says.
Educating medical students alongside other students who are entering the medical field in other roles is in keeping with the changing nature of health care delivery, which is increasingly becoming a team sport, Raymond says. That will result in an expanded role for non-physicians and an interdisciplinary approach that focuses on outcomes, efficiency and cost.
November’s WHA report, “100 New Physicians a Year: An Imperative for Wisconsin,” calls for increasing medical school class size, increasing medical residencies in Wisconsin and considering forgiveness of medical school tuition expenses as an incentive to practice here.
Part of the barrier to becoming a primary care physician is the expense of medical school (and primary care physicians generally don’t make as much as specialists, so it’s harder to pay all that back). The Medical College is hoping to develop a three-year training model for primary care physicians to eliminate some student loans.
Other areas the Medical College hopes to reach include north central and northwest Wisconsin, and areas surrounding Eau Claire, La Crosse, Janesville/Beloit and Racine/Kenosha.
Causes for the impending physician shortage include an aging population and the implementation of health care reform in 2014 which will increase the number of people who have financial access to health care.
“I think the obvious danger is that we could get to a point where people can’t find a physician in a timely manner, and it may become difficult for someone to get an appointment with a doctor while they’re still in the early stages of needing treatment,” Hanke says. “And with an aging population – which we seem to be – what can we expect in the next 20 years? The number of contact hours with the elderly population will just increase. We’re certainly risking overtaxing our medical system.”
The key to expanding physician education is establishing residencies – but it’s also one of the challenges, since they cost about $100,000 per resident per year, and the federal government has capped the number of residencies it will support, Raymond says.
“There’s going to need to be some conversations, not only on governmental funding, but also on alternative funding,” says Dr. Charles Shabino, WHA senior medical advisor.
Students also need to have facilities in which to practice and faculty to instruct them – one of the reasons to establish programs where there are already strong hospital systems in place.
“I think we will see new collaboratives created, where health systems as well as communities and private sources are going to come together to put together these residency experiences,” Shabino says.
The WHA study reports that one primary care physician can add $2.5 million in revenue and wages to a community, including the employment of 23 full-time employees. “It supports community growth and community vitality, which I think is as important as the hard dollar economic growth,” Shabino says.