The Wisconsin Hospital Association is calling for significant changes to the state’s medical education and training system in order to address a physician shortfall that’s expected to reach more than 2,000 by 2030. Recommendations from a report released this morning by the hospital association include building a third medical school, opening a satellite campus of one of the state’s existing schools, and increasing residency spots.
“The bottom line is access,” Dr. Chuck Shabino, the hospital association’s senior medical advisor, told Wisconsin Health News. “Going forward, are we going to have enough physicians to maintain the current level of care that we have all become accustomed to?”
The expected shortfall represents 20 percent of the state’s current workforce. Wisconsin will need to add an additional 100 physicians a year for the next 20 years to avoid the gap. The need is most urgent in primary care. General surgeons and psychiatrists are also in short supply.
The medical schools agree it’s important to increase the number of medical school graduates, along with residency positions. The immediate focus, however, should be on nationally recruiting fully-trained physicians, said Medical College of Wisconsin president and CEO Dr. John Raymond and University of Wisconsin School of Medicine and Public Health dean Dr. Robert Golden in a joint statement. “This strategy has the most immediate impact, and is the most cost-effective approach to increasing the physician workforce in Wisconsin.”
Shabino disagrees. A growing demand for services – led by an aging population and changes in the federal health reform law – means that competition from other states continues to increase, he said. The Association of American Medical Colleges forecasts a nationwide shortage of more than 130,000 physicians by 2025. “Every state in the country is going after the same strategy,” he said. “We cannot depend on our current success of importing physicians from other states to maintain us even at our current level going forward.”
Instead, Wisconsin needs to concentrate on growing more of its own, Shabino said. Now, 38 percent of students that graduate from a Wisconsin medical school end up practicing in the state, according to the report. Those that complete their residency in the state stay 47 percent of the time. When both occur, there is a 70 percent chance of retaining the physicians.
Medical schools and residency programs should increase communication with one another and do more to sell Wisconsin-based residencies, recommends the study. The state should also consider ways to increase the number of medical school graduates, including increasing class sizes; opening a satellite campus from an existing school that focuses on primary care; establishing a new community-based medical school that partners with existing schools and hospitals; or building a new independent medical school.
The medical schools are willing to help, but can’t do it alone, said Raymond and Golden.
“We are very interested in increasing our class sizes, but in order to do so, we need an expansion in the number of high quality clinical training sites for our students,” they said. “We hope that the member institutions of the WHA will work with us in creating new and expanded clinical training slots which meet accreditation standards and provide the high quality experience that current clinical training sites afford our students.”
Hospitals have too much at stake not to help, Shabino said. “Hospitals are certainly in agreement with the medical schools that these issues need to be resolved through partnerships,” he said. “No single entity is going to be able to do this alone.”
Increasing medical student graduates is important, but it’s not the only answer, said Dr. Tim Bartholow, chief medical officer for the Wisconsin Medical Society. “Other pieces of the solution include using our resources more efficiently and more appropriately.”
Additional report recommendations include restoring tuition assistance at the Medical College of Wisconsin, providing loan forgiveness for graduates who stay in Wisconsin, increasing the number of non-physician providers trained in Wisconsin, and incorporating team-based care delivery models into the medical education curriculum.
In order to carry out the recommendations and decide on next steps, Wisconsin should increase the scope of the Wisconsin Council on Medical Education and Workforce, or develop a similar collaborative organization, said George Quinn, the hospital association’s senior policy advisor. The council consists of the two medical schools, the hospital association, the Wisconsin Medical Society, the Wisconsin Academy of Family Physicians, and the Wisconsin Association of Physician Assistants.
“All of the stakeholders need to work together,” Quinn said. “The hospitals, the providers, the communities and the medical schools need to sit down and develop an action plan to make this happen.”
Read WHA’s Report: “100 New Physicians a Year: An Imperative for Wisconsin”
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