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Tim Size: State faces looming physician shortage

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Wisconsin’s rural communities have faced a shortage of physicians for decades. Without changing how we train and retain our next generation of physicians, it is about to get a lot worse.

New predictions show future shortages statewide, rural and urban. Urban shortages will only make it even harder to recruit to rural communities.

You can blame people my age — the fabled baby boomers. According to a new report by the Wisconsin Hospital Association, “100 New Physicians a Year: An Imperative for Wisconsin,” we will be 2,200 doctors short by the time baby boomer retirees finally slow down around the year 2030.

For the next 20 years, large numbers of older physicians and other health care professionals will retire and become major “consumers” of health care.

WHA projects an increase in the number of physicians but not enough to make up for increased demand, increased retirements and the large number of medical school students in Wisconsin that end up practicing elsewhere.

It would be fine to do nothing if this were just about waiting longer for a hot new iPhone or iPad. But this shortage is a bit more serious. It means many, particularly in rural communities, will wait months to be seen by a doctor. None of us want that wait when we are anxious, have a deteriorating condition or untreated pain.

There will also be a significant hit on the rural economy. A retiring rural physician not replaced means a loss of income and jobs throughout the community. Studies at the National Center for Rural Health Works at Oklahoma State University have found that one full-time rural primary care physician generates about $1.5 million in revenue for the community, and creates, or helps create, 23 jobs.

There are those who say that hospitals and clinics must start doing a better job recruiting physicians into our state. But this is something we are already unusually good at. For every graduate of a Wisconsin medical school, five other physicians are now being recruited from outside Wisconsin. Compared with other states, we are very dependent on “importing” physicians.

Other states face the same affect of aging baby boomers, and many will face an even greater increase in demand due to health reform. With that greater competition, we will be very fortunate to maintain our current level of “imports.”

This brings us to the imperative of growing our own. The possibility of our two existing schools expanding the number of students they graduate is encouraging. So is the possibility of the long rumored addition of a new school of osteopathic medicine. But at best, this is only half of the solution.

Overall, only 38 percent of the graduates from Wisconsin’s two medical schools remain and practice in Wisconsin. We must not only graduate more but also retain them. This requires that we substantially increase the number of instate and rural residencies — the additional formal training that physicians need after medical school.

If you look at those students who are from Wisconsin, go to medical school here and do their residency here, 86 percent stay and practice in Wisconsin. Bottom line for retaining doctors once they are fully trained: it makes a huge difference where medical schools draw their students from and what they do to encourage their graduates to choose residency training in Wisconsin after graduation.

Our medical schools need to encourage physicians to have their residency experience in rural Wisconsin. This requires rural residencies to be available. We are fortunate to have a nationally recognized Rural Training Track in Baraboo, but they can only take two new medical school graduates a year.

The Baraboo residency has now placed more than 75 percent of its graduates in rural practice, with more than 70 percent providing rural maternity care and over half of whom have stayed in Wisconsin. These statistics are similar to the other 22 Rural Training Tracks that exist nationally. However, each individual program is small. This model of education will not make a big impact on the rural access problem without collaborative approaches to expanding the number of these sites.

Expanding the number of Rural Training Tracks in Wisconsin must become a top priority.

Tim Size is executive director of the Rural Wisconsin Health Cooperative.

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