How Should Wisconsin Address Its Worsening Physician Shortage?

According to the Wisconsin Hospital Association (WHA), by the year 2030, the state will face a shortfall of at least 2,000 physicians, particularly primary care practitioners and those practicing in rural areas and inner-city Milwaukee. The WHA places part of the blame on federal health care reform initiatives, which will increase the number of insured persons, nationally, by an estimated 30 million people. An additional culprit is the state’s reliance on recruiting physicians from other states due to the failure to retain medical school graduates from the state’s two medical schools. Considering the rapidly aging population of Wisconsin, the resulting number of retiring physicians, and the growing number of insured persons, the WHA concludes that the state must produce at least 100 new physicians per year, in addition to the number currently produced, in order to meet the increasing demand.

Since federal health reform and the aging population will increase the demand for physicians in all states, Wisconsin will find it more difficult to rely on the recruitment of physicians from other states. The two Wisconsin medical schools currently graduate 340 new doctors per year; however, only 38 percent of those graduates remain in Wisconsin to practice medicine. Consequently, the state has been recruiting approximately 720 physicians per year from out-of-state.

The WHA maintains that the best solution to retain medical school graduates is to increase the number of “home-grown” physicians from Wisconsin. The state in which a graduate completes his or her residency is a strong predictor of where that doctor will ultimately practice, with 70 percent of in-state medical students who complete their residencies in Wisconsin electing to practice in Wisconsin. The WHA is currently investigating ways to increase the number of residency spots in the state, as well as the capacity of medical schools.

Major roadblocks to increasing residency positions have been state budget cuts affecting residency funding and a cap on the amount Medicare will contribute to funding such positions. Some residency spots have been entirely funded by the hospitals themselves, which are struggling with their own budgets. According to George Quinn, the senior policy advisor of WHA, a collaborative approach is necessary among various “stakeholders,” including providers, hospitals, communities and the state’s medical schools, in order to find a funding solution.

While both state medical schools have made attempts to increase enrollment, some advocate that a third medical school is necessary to produce the additional 100 graduates per year, particularly those who will practice in rural areas. Aspirus Health System, located in rural Wisconsin, is investigating the development of a new medical school in northern Wisconsin. If the results of a feasibility study, due in February 2012, are positive and Aspirus can attain enough financial support, it hopes to enroll 100 students per year with the first class graduating in 2017.

Other solutions suggested include the forgiveness of medical education debt for graduates who choose to practice in Wisconsin and a movement toward a multi-disciplinary team approach to health care delivery. One thing is for certain: action taken to address the shortage must be swift. Any time wasted will only deepen the crisis.