Addressing Physician Shortages in Underserved Communities: An Immersive Longitudinal Approach
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1 1 Addressing Physician Shortages in Underserved Communities: An Immersive Longitudinal Approach Elizabeth M. Petty, MD Senior Associate Dean for Academic Affairs School of Medicine and Public Health University of Wisconsin-Madison
2 Individuals in underserved areas experience worse health outcomes and higher rates of hospitalizations for common conditions, especially in rural communities. 2
3 Most underserved counties in Wisconsin are rural. Predicted demographic changes and physician shortages will further impact health outcomes in these regions.
4 At the UW-Madison SMPH we are deeply committed to addressing health disparities and diminishing the growing gap between the number of health care providers and need for providers in underserved rural and urban areas
5 Longitudinal Community Immersive Integration Along the UW-Madison SMPH Education and Training Continuum PRE-MED MED SCHOOL RESIDENCY PRACTICE AHEC programs Undergraduate public health and global health curriculum Rural and Urban Scholars in Community Health (RUSCH) pipeline program Integrated Community Engagement and Public Health Curriculum Statewide medical campus Unique educational programs in Public Health, Rural Medicine (WARM), and Urban Underserved Medicine (TRIUMPH) Family Medicine throughout state Rural Residency Training Sites New Preventive Medicine Residency Loan Forgiveness Office of Rural Health and Hospital Association Physician Recruitment Continuing community health education for health care professionals
6 Longitudinal Community Immersive Integration Along the UW-Madison SMPH Education and Training Continuum PRE-MED MED SCHOOL RESIDENCY PRACTICE AHEC programs Undergraduate public health and global health curriculum Rural and Urban Scholars in Community Health (RUSCH) pipeline program Integrated Community Engagement and Public Health Curriculum Statewide medical campus Unique educational programs in Public Health, Rural Medicine (WARM), and Urban Underserved Medicine (TRIUMPH) Family Medicine throughout state Rural Residency Training Sites New Preventive Medicine Residency Loan Forgiveness Office of Rural Health and Hospital Association Physician Recruitment Continuing community health education for health care professionals
7 Wisconsin Area Health Education Center (WiAHEC) Health Career Camp - high school students Global Health Institute Training Workshop high school students Wisconsin Express - week-long immersion experience for college students Community Health Internship Program (CHIP) community projects for undergraduate and first year graduate/professional students Interprofessional Health Care Case Competition interprofessional student teams
8 Rural and Urban Scholars in Community Health (RUSCH) Program Two year academic enrichment and community engagement program for pre-medical students interested in rural and urban health Public health and clinical internships in own community MCAT review support and admissions counseling Research and scholarly enrichment internship at SMPH Health equity seminars Rural and urban field trips Career mentoring
9 Longitudinal Community Immersive Integration Along the UW-Madison SMPH Education and Training Continuum PRE-MED MED SCHOOL RESIDENCY PRACTICE AHEC programs Undergraduate public health and global health curriculum Rural and Urban Scholars in Community Health (RUSCH) pipeline program Integrated Community Engagement and Public Health Curriculum Statewide medical campus Unique educational programs in Public Health, Rural Medicine (WARM), and Urban Underserved Medicine (TRIUMPH) Family Medicine throughout state Rural Residency Training Sites New Preventive Medicine Residency Loan Forgiveness Office of Rural Health and Hospital Association Physician Recruitment Continuing community health education for health care professionals
10 New physicians more likely to practice in state if they have lived and trained in Wisconsin Medical school in WI 37.8 % stay in WI (public 42.8%, private %) Residency in WI 46.8 % stay in WI Medical school and residency in WI 70% stay in WI From WI, medical school and residency in WI - 86% stay in WI
11 Community Engagement and Public Health is Integrated into Curriculum Starting 1 st year Population Health and Epidemiology Integrative Cases: Cross Disciplinary and Interprofessional Experiences (Poverty, Drunk Driving, Health Policy Advocacy, Tuberculosis, Upstream from the ER)
12 Statewide Communities in Diverse Learning Environments
13 M3 and M4 Years Include Statewide Interprofessional Community Immersion and Public Health Curriculum M3 - Primary Care Community Projects & Core Clerkship Days M4 - Community Health Assessments & Public Health Electives Immersion Tracks in Rural (WARM) and Urban Medicine (TRIUMPH)
14 Public Health/Primary Care Innovations in Medical Education (PRIME) (HRSA funded)
15 The Training in Urban Medicine and Public Health (TRIUMPH) Program First cohort (7) graduated May 2011 Doubled class size to 16 M3 students in 2014 TRIUMPH graduates were more likely to select: primary care specialties urban residency programs with underserved populations Haq C, Stearns M, Brill J, Crouse B, Foertsch J, Knox K, Stearns J, Skochelak S, Golden RN. Training in Urban Medicine and Public Health: TRIUMPH. Acad Med Mar;88(3):
16 WARM: Wisconsin Academy of Rural Medicine Interprofessional/Interdisciplinary Rural Health Electives public health issues, telemedicine, rural/farm zoonosis, rural healthcare policy and economics, agrochemical hazards, physical injury hazards, agricultural environment Summer Externships in Rural Communities Clinical training in rural clinics Immersive Community Health Projects Rural Health Interest Group 16
17 Wisconsin Academy of Rural Medicine (WARM) Timeline Milestones 1 st Cohort Graduates 1 st WARM Graduates Begin Practice WI Rural Medical Education Planning Committee University Committee Approval 1 st Cohort Admitted n=5 Marshfield and Rice Lake Clinical Training Sites Open La Crosse Clinical Training Sites Open Green Bay Clinical Training Sites Open PRIME Pathway of Distinction begins 8 th Cohort Admitted n= Collaboration Planning Grant Strategic Initiatives Grant Funding Streams Wisconsin Partnership Grant Tuition Support Begins HRSA Grant for Pathway of Distinction in Public Health and Primary Care (PRIME) State Fund Bolus
18 University of Wisconsin Affiliated Rural Medicine Pipeline Elementary and high school College Medical school Residency program Rural practice Prepare students in basic sciences and expose them to health care systems and providers Enhance pre-medical experiences and strengthen medical school application portfolio Recruit students with rural backgrounds and career goals Ideal Student Enhance traditional curriculum with relevant rural medicine content Ideal Preparation Locate education and training programs within rural communities in Wisconsin Ideal Environment Promote development of rural GME rotations, residencies, and fellowships Facilitate recruitment and retention of graduates for employment in rural Wisconsin Enhance the rural health care environment through support of rural hospitals and clinics WiAHEC RUSCH WARM WRPRAP WiORH WiAHEC RUSCH WARM WRPRAP WiORH Wisconsin Area Health Education Centers Rural and Urban Scholars in Community Health pipeline program Wisconsin Academy of Rural Medicine Wisconsin Rural Physician Residency Assistance Program Wisconsin Office of Rural Health All of the above offices report to the SMPH Associate Dean for Rural and Community Health, Dr. Byron Crouse
19 WARM and TRIUMPH Outcomes through 2014 \ 2015: 86% TRIUMPH and 48% WARM students matched into Primary Care compared to 37% of other students
20 Practicing WARM graduates
21 Longitudinal Community Immersive Integration Along the UW-Madison SMPH Education and Training Continuum PRE-MED MED SCHOOL RESIDENCY PRACTICE AHEC programs Undergraduate public health and global health curriculum Rural and Urban Scholars in Community Health (RUSCH) pipeline program Integrated Community Engagement and Public Health Curriculum Statewide medical campus Unique educational programs in Public Health, Rural Medicine (WARM), and Urban Underserved Medicine (TRIUMPH) Family Medicine throughout state Rural Residency Training Sites New Preventive Medicine Residency Loan Forgiveness Office of Rural Health and Hospital Association Physician Recruitment Continuing community health education for health care professionals
22 Family Medicine Residencies
23 Wisconsin Rural Physician Residency Assistance Program (WRPRAP) Wisconsin Act 190 July 1, 2010 Grant funding to launch rural programs in family medicine, internal medicine, obstetrics/gynecology, general surgery, psychiatry Technical assistance to grantees and organizations through funding of the Wisconsin Collaborative for Rural GME of the Rural Wisconsin Health Cooperative Outreach to a broader spectrum of medical specialities Collaboration with GME stakeholders (i.e. Wisconsin Council on Medical Education and Workforce, Wisconsin Hospital Association, Wisconsin Department of Health Services)
24 Growth of WI Collaborative for Rural GME Rotations 7/1/2010 6/30/2014
25 Growing number of rural residency positions funded in past fiscal year under Act 190 Monroe Clinic RTT : 2 Brodhead family medicine 12 Rural Surgery 4 Emergency Medicine 1 hospitalist Divine Savior Hospital, Portage: 5 Emergency Medicine rotations for UW Family Medicine residents 12 General Surgery rotations for UW Surgery residents UW Department of Pediatrics: 3 Pediatric rotations in Beaver Dam, Baraboo and Sauk City Marshfield Clinic: 2 Internal Medicine rotations in Rice Lake, Minocqua, and/or Park Falls UW-Fox Valley: 1 Family Medicine rotation in Waupaca
26 Preventive Medicine Residency Accredited March 2014 First 2 residents began July 2014 Seeking HRSA funds May 2015
27 Longitudinal Community Immersive Integration Along the UW-Madison SMPH Education and Training Continuum PRE-MED MED SCHOOL RESIDENCY PRACTICE AHEC programs Undergraduate public health and global health curriculum Rural and Urban Scholars in Community Health (RUSCH) pipeline program Integrated Community Engagement and Public Health Curriculum Statewide medical campus Unique educational programs in Public Health, Rural Medicine (WARM), and Urban Underserved Medicine (TRIUMPH) Family Medicine throughout state Rural Residency Training Sites New Preventive Medicine Residency Loan Forgiveness Office of Rural Health and Hospital Association Physician Recruitment Continuing community health education for health care professionals
28 Wisconsin Office of Rural Health (WiORH)
29 WiORH Wisconsin Office of Rural Health, 2014
30 B O T T L E N E C K I N A D E Q U A T E R E S O U R C E S Longitudinal Community Immersive Integration Along the UW-Madison SMPH Education and Training Continuum PRE-MED MED SCHOOL RESIDENCY PRACTICE AHEC programs Undergraduate public health and global health curriculum Rural and Urban Scholars in Community Health (RUSCH) pipeline program Integrated Community Engagement and Public Health Curriculum Statewide medical campus Unique educational programs in Public Health, Rural Medicine (WARM), and Urban Underserved Medicine (TRIUMPH) Family Medicine throughout state Rural Residency Training Sites New Preventive Medicine Residency Loan Forgiveness Office of Rural Health and Hospital Association Physician Recruitment Continuing community health education for health care professionals
31 Challenges and Opportunities Increase Residency Training Capacity Adjust caps Create incentives for programs that address shortages Develop partnerships with community hospitals and academic institutions Increase flexibility in training requirements Build technology infrastructure Recruit and Retain Physicians to Address Shortages Increase supply Provide incentives Invest in health system partnerships Build technology infrastructure Create interprofessional cross coverage options
32 QUESTIONS AND DISCUSSION
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