Closing the Gap: Improving Access to Care in Rural Wisconsin by Training the Next Generation of Primary Care Practitioners

It’s a shortage that is hitting rural Wisconsin hard. With specialties that include family medicine, internal medicine, and pediatrics, primary care practitioners are often a patient’s first contact for diagnosing a health issue. In rural communities, they are relied on to treat a wider variety of health issues since specialists are often located in more densely populated areas. 

“With data from a number of sources it was clear to leaders at the Medical College of Wisconsin that there was a need to expand the pipeline for physicians in less well-served geographies in the state, including rural-serving doctors,” said Joseph E. Kerschner, MD, the Julia A. Uihlein, MA, Dean of the Medical College of Wisconsin School of Medicine, Provost and Executive Vice President. “We met with health systems all over the state and made it our mission to find new ways to train physicians for these areas of the state who will go on to improve health care access.”

Today, a $4.02 million AHW investment is making it possible for MCW to deliver on that mission. Awarded in 2012, the funding enabled medical education leaders to plan and develop innovative new curriculums that are training future health practitioners at MCW’s regional campuses in Wausau and Green Bay. 

The campuses provide a chance for students to study closer to home and start building relationships with the populations they plan to serve.

Since launching in 2015 and 2016 respectively, MCW-Green Bay and MCW-Central Wisconsin have trained 108 students. The class of 2021 will bring 44 more graduates into those ranks, and in June another 45 incoming medical students will begin their studies.

The programs have been designed to recruit and train these students to practice primary care in rural communities. It’s part of a “Grow Your Own” model that recognizes that students that come from rural areas are more likely to choose to practice in them. Data from the Wisconsin Hospital Association shows that 86% of Wisconsin students who attend a Wisconsin medical school and Wisconsin residency go on to stay in the state to practice.

So far, the model is showing promise. The programs are increasing the number of students from rural backgrounds who are entering medicine—an underrepresented population with declining numbers over the last 15 years, according to recent data. In 2017, rural students only made up five percent of all incoming medical students in the United States.

In 2021, 36 percent of MCW-Central Wisconsin’s graduates went on to begin residencies in Wisconsin, and in MCW-Green Bay that number was 45 percent. 

“If you have too few primary care doctors, health outcomes suffer.” – Lisa Grill Dodson, MD

Through their coursework, the programs are equipping tomorrow’s health care practitioners with the skills and perspective needed to address the needs of rural populations. The programs are modeled to enable students to enter the workforce sooner and incur less debt by accelerating the curriculum to allow motivated students the ability to graduate in three years.

“The cost savings can be significant for students from rural communities, many of whom come from economically disadvantaged backgrounds,” said Lisa Grill Dodson, MD, Sentry Dean and Founding Dean of MCW-Central Wisconsin.

The curriculum was also developed to prepare students for rural practice, with coursework and research designed to integrate their medical education with the needs of the community to prepare students to best serve a rural population. 

According to Dr. Dodson, the best health outcomes occur when at least 40 to 50 percent of physicians practice primary care. In Wisconsin, that number is 38%.

“If you have too few primary care doctors, health outcomes suffer,” said Dr. Dodson.

Campus partnerships with local universities and health systems provide students with experience in smaller health care settings, which often means students have increased opportunities to work directly with doctors.

“Students get a one-on-one, hands-on experience,” said Matthew L. Hunsaker, MD, FAAFP, Campus Dean of MCW-Green Bay. Dr. Hunsaker notes that this means medical students directly assist doctors with tasks a fellow or fourth-year medical student would typically do in a larger program.

“We find that when they get to residency, that pays real dividends in their confidence, skills, and their ability to integrate with physicians and others,” said Dr. Hunsaker.

While Dr. Hunsaker and Dr. Dodson are happy with the programs’ early success, they recognize it will take years to understand the impact on physician shortages in rural areas of the state.

Both campuses are in it for the long haul, continuing to work toward closing the gap between the health needs of rural communities and the workforce trained to serve them.