Wisconsin may find in rural and inner-city grade schools the medical students it needs to alleviate its current and projected future shortage of physicians in underserved areas of the state.
A joint study by the Wisconsin Medial Society and the Wisconsin Hospital Association released today concludes a shortage of primary-care physicians in rural Wisconsin and in inner-city Milwaukee already exists. The state is a tough sell for recruiting nonprimary-care physicians and general surgeons and radiologists, who are in critically short supply in rural communities.
"The implications are that patients are increasingly waiting longer to receive care, traveling long distances for that care, or . . . are deciding not to seek necessary medical care," the report concluded. "Lack of access to physician services causes inappropriate emergency room utilization."
What to do?
One is to start early identifying and encouraging students who might want to practice medicine who are now attending school in rural areas, according to Paul Wertsch, M.D., president of the Wisconsin Medical Society. The idea is that people from rural areas are more likely to return to familiar surroundings and locate their practices near where they have undergone the residency training, Wertsch said.
"We really need to be looking at schools all the way down to kindergarten and grade three," said Wertsch, a family physician and founder, past president and board member of the 10-physician Wildwood Family Clinic in Madison. "Reading skills at age 8 correlate very highly with how well you do in medical school."
For all the stresses on the profession and the grumbling doctors have been doing about it, physicians have been doing a poor job of late selling the joys of their profession to the public, and particularly to young people, and that needs to be reversed as part of a state physician retention program, Wertsch said.
"They don't hear about things we really love about job," he said. "They only hear us complain."
While the demand for primary-care physician services is expected to grow 13.5% by 2015, the report says, the supply of physicians coming out of Wisconsin's two medical schools, flat in the 325 to 340 range for at least a decade, will not keep pace.
At 184 physicians per 100,000 Wisconsin residents, the ratio ranks 26th among the states, but the unequal distribution of doctors throughout the state and the age of the current physician population make shortages a reality today and more likely in the future. Wisconsin has 68 primary-care physicians per 100,000, well within the "reasonable" range, according to the report. Yet the median is 31, with one rural county having a primary-care physician ratio of 20 and several others with rates in the 20s.
For specialists, the statewide average ratio is 113 physicians per 100,000 people, but in some sparsely populated counties the ratio drops to 8, while in rural counties it falls to 49.
One stumbling block healthcare leaders will face in redirecting the flow of doctors to rural areas is maintaining the flow of trained physicians through the state?s residency programs, which face a massive cutback this year due to belt tightening at the state level.
Wertsch said Wisconsin has a $1 billion budget deficit and Medicaid funding for residency programs took a massive hit.
George Quinn, senior vice president of the Wisconsin Hospital Association and author of the joint report on the physician shortage, said just $2.6 million is left in the Medicaid budget to fund residency programs, while $28.6 million was slashed, compared with the budget for the fiscal year ending June 30, 2003.
Quinn said there have been no reported cuts of residency slots by his member hospitals -- not yet -- but the cuts were just a part of a larger reduction in the state contributes to the $400 million Wisconsin Medicaid program.
"It will result in more cost shifting," Quinn said.
An appendix to the report hails several states' efforts, including the 25-year-old program run at Jefferson Medical College of Thomas Jefferson University, that have achieved a measure of success routing medical school graduates into rural family practices.
"That program and others will be models we?ll take a look at," Quinn said. Before the end of the year, the medical society and the hospital association will put together a task force to address the physician shortage and distribution problems, he said.
A copy of the joint report is available on the Wisconsin Hospital Association Web site.