Wisconsin grant takes aim at shortage of doctors

Health care leaders in western Wisconsin are providing doctors with on-the-job residency training in local hospitals in the hope it will entice them to stick around when they choose where to set up their practices.

With a $750,000 grant from the Wisconsin Department of Health Services, HealthPartners is launching a residency program that will rotate doctors-in-training through Methodist Hospital in St. Louis Park for one year, and then through smaller Wisconsin hospitals in Amery, New Richmond and Hudson over the following two years.

"One of the best predictors of where a physician will locate a practice is where he or she completes a medical residency," said Deb Rudquist, president and chief executive of Amery Medical Center, which will receive its first medical resident in 2019.

The program represents a novel solution to a national shortage of primary care doctors that is predicted to worsen in coming years as baby boomer physicians retire. All doctors must complete residencies in their chosen specialties after graduating medical school, but there has been little growth in residency slots nationwide because they can be costly for teaching hospitals, and the federal Medicare program caps how much financial support it provides to those hospitals.

The program in Wisconsin takes advantage of a loophole that permits Medicare to support new residency programs at "critical access" hospitals — generally small, rural hospitals with no more than 25 inpatient beds. So while HealthPartners can't gain Medicare support while the new residents train at Methodist, it will be reimbursed when the residents rotate through the Wisconsin hospitals.

"It's part of how this program is sustainable," said Shannon Kojasoy, a HealthPartners consultant who is overseeing the grant along with other efforts to retain doctors.

The doctor shortage already is a pressing concern in rural areas. Most northern Minnesota counties report shortages — either because primary care doctors aren't nearby or those on hand don't accept low-income patients covered by the state's Medicaid program. In 2015 the Legislature increased funding to address the shortage by expanding loan-forgiveness programs for doctors who practice in sections of Minnesota that are shorthanded.

Similar shortages exist in Wisconsin; the state's hospital association reported in 2011 that it will need to train an additional 100 doctors a year through 2030 to meet the expected need for care.

HealthPartners' new program, called the Methodist Hospital Family Medicine Residency Program Rural Training Track, will start with its first doctor rotating through Methodist in 2018. The hope is it will add one new physician to northwestern Wisconsin every year beginning in 2021, Kojasoy said.

Although doctors completing the residency program have no obligation to stay in that region, history shows that half of all doctors stay in the states or regions in which they completed their training. A condition of the state grant is that the residents in the program grew up in Wisconsin or had some other connection with the state.

"This program means that in coming years, more patients will not have to wait to see a doctor or have to drive longer distances to get care," said Dr. Andrew Dorwart, HealthPartners St. Croix Valley medical director.

Enticing critical access hospitals to band together to support new residencies is a strategy suggested in Minnesota as well. Business leaders proposing a new osteopathic medical school in Gaylord, Minn., hope to form new residencies at small hospitals in central Minnesota to support its graduating doctors.

Jeremy Olson • 612-673-7744