State budget includes funds to train family doctors

It’s not often that the Wisconsin State Legislature’s Joint Finance Committee approves something unanimously these days. But the committee recently voted 16-0 to commit an additional $1.76 million in funding for 12 new family medicine residency positions within the Medical College of Wisconsin’s Family Medicine Residency Training Program.

The funds are still subject to the approval of the full Legislature and Gov. Scott Walker.

Currently, the Medical College program supports 52 family medicine residents at three locations in southeast Wisconsin. With this funding, another six per year will be added.

“We need more family physicians,” said Dr. Alan David, professor and chairman at the Department of Family and Community Medicine at the Medical College of Wisconsin (MCW). “The data from national publications and data sets show that, and we think it will help people and reduce costs at the same time. By expanding our programs that are already existing, we think that’s an economical way for the state of Wisconsin to address that need.”

The expansion of this program aims to combat a shortage of primary care and family medicine physicians that exists throughout medicine. David noted a 2012 study by The Annals of Family Medicine, which said that the United States will require nearly 52,000 additional primary care physicians by 2025.

“There’s a national need,” said David. “There’s a regional state need. And we haven’t increased the number of positions across the state at all in the last 10 years.”

This need is a big reason why the funds for the program received bipartisan support, said Rep. Jon Richards, D-Milwaukee, a member of the Joint Finance Committee, who worked on and voted for the expansion of the program.

“We allowed the motion that we passed on a bipartisan vote to create 12 new residency positions in southeast Wisconsin to deal with the looming cliff we’re going to fall off in terms of training primary care physicians in Wisconsin,” he said. “We are rapidly losing primary care physicians. That’s true everywhere, and especially in southeast Wisconsin.”

The need was apparent, but, in an effort to cut down on costs, the Medical College took the route of expanding the program as opposed to creating an entirely new residency program, which would be more costly. Instead, creating more residencies in locations where residency programs are already in effect – at locations in the Columbia St. Mary’s, Wheaton Franciscan and ProHealth Care systems – less overhead, space, staff support and faculty support is required.

“We can accomplish with this legislation the same output by expanding each of our residency programs by two residents per year. In three years, we will have the same output as a brand new program at one-third to one-quarter of the cost,” David said. “This appropriation will cover the first two years of getting this going. This will have to continue and have a modest increase to accomplish the full three-year training cycle. When it’s done, it’ll be about $2.7 million that it’ll take to do this.”

Starting a brand new program would cost roughly $8 million, said David, so the route they’ve taken is an economical one. Part of this expansion, as well, is an additional $500,000 to begin developing a new family medicine residency program in the Green Bay and Central Wisconsin regions, where the Medical College is looking to create two new campuses.
“We’re going to develop a plan here and work with people in Green Bay to develop and help plan a residency program, but it’ll also be a planning platform for other residencies in that area,” said David.

Placing more of an emphasis on family medicine and primary care also plays into much of the changes many say are needed in health care.

“For as contentious as the health care debates have been, we need to lower cost, focus on preventive care and focus on wellness,” said Richards. “The best way to do that is to have a large, growing group of primary care doctors. To do that, we have to address the severe and growing shortage of primary care doctors. We have to start turning that around.”

Turning that around is a challenge that involves many different components. Federal funding for these types of programs has not significantly increased in well over a decade, said David, and many medical students have opted to pursue higher-paying and more attractive positions as specialists.

“We have, amongst developed countries, the largest imbalance between primary care physicians and specialists in any place in the world,” said David. “It’s not specialists’ fault that we have high costs, but we sort of glamorize and pay specialists a lot more than we pay primary care, and we have a very cumbersome primary care system based on how many people you see per day face-to-face. When you have a system where there’s a large primary care base, and then it tapers up as a triangle toward fewer and fewer specialists, the system costs a lot less.”

Also a concern is the number of residency slots available for medical college graduates. While finding employment after residency is not an issue, said David, finding residency slots is.

“This year in March, on Match Day, the day they hand out the envelopes to senior students about where they’re going to go, there were 1,097 senior MD medical students that didn’t have a slot, no place to do their training,” he said.

Available residencies for medical students also helps keep talented physicians in the state, as 65 percent of those who enter MCW residency programs stay in the state of Wisconsin. But Wisconsin is behind other states in this regard.

“If you look at the available slots per population of our surrounding states for people interested in a family medicine residency or first-year position, Wisconsin is lower,” said David. “We have fewer positions per population for availability for training family physicians than surrounding states.”

Improving care while controlling costs has been a major topic while the nation has discussed health care reform, and according to David, making family medicine and primary care a priority and creating more residency slots is a way to do that.

“Altering or improving the primary care workforce in this country will improve health care outcomes and reduce costs,” he said.

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