Description

The shortage of family physicians in rural areas is an ongoing problem. To address this shortage, rural healthcare organizations in Wisconsin came together to develop a solution that would provide rural training opportunities for physician residents, increasing their exposure to rural communities and their experience in rural practice. What began as the Wisconsin Rural Training Track Collaborative in 2012 was soon renamed the Wisconsin Collaborative for Rural Graduate Medical Education (WCRGME).

While WCRGME does not have a formal membership, they collaborate with many organizations from multiple communities. At the beginning of WCRGME, 9 healthcare organizations from Wisconsin towns like Ashland, Baraboo, and Monroe came together to promote the development of Rural Training Tracks (RTTs) in Wisconsin. Two consultants were hired to help assess GME opportunities at seven inaugural sites. They shared general information regarding the development of rural GME training experiences and next steps in the process of establishing these rural experiences.

Currently, 62 different organizations in communities around the state are working with WCRGME, all of which are at varying stages of rural graduate medical education (GME) development, from initial interest to fully functioning Rural Graduate Medical Education Training Sites. WCRGME provides new opportunities to establish more sustainable rural graduate medical education programs, thus more rural physicians.

WCRGME members meet regularly via teleconferencing in order to discuss needs and challenges, share ideas and resources, brainstorm collaborative solutions, and provide support for new initiatives. WCRGME also markets the state's rural training opportunities through national conferences, presentations and its website.

In 2012, the Rural Wisconsin Health Cooperative (RWHC) received a 3-year $150,000 start-up grant from the Wisconsin Rural Physician Residency Assistance Program (WRPRAP) that allowed for the development of WCRGME. WRPRAP is funded by the Wisconsin state legislature through the passage of Wisconsin Act 190 which became effective July 1, 2010. The initial grant has been renewed through 2021 with continued funding anticipated in the future through WRPRAP and other sources. Most of the organizations that worked with WCRGME at their launch also received separate grant funding from WRPRAP to either explore or develop their rural training opportunities.

Services offered

WCRGME's offers the following rural-focused programs:

• 2 residencies in a rural continuity clinic for an urban resident
• 5 Wisconsin rural fellowship programs
• 27 rural rotations
• 15 urban residencies with rural tracks
• 4 rural training track residency programs

Additional services provided:

• Initial assessments for sites
• Informational presentations
• Annual Medical Education Administrators and Coordinators Workshop
• Annual Rural and Community Medical Educators Faculty Development Conference featuring a pre-conference Rural Research Spotlight Poster Fair
• Assistance with GME funding questions
• Development of statewide rural GME directory and website
• Provide rural-sensitive education, certification, and mentoring for faculty, community preceptors, and administrators/coordinators
• Accreditation and administrative assistance
• Project management
• Best practice resources
• Promotion of rural rotation opportunities at national and regional conferences, including the Family Medicine Midwest Conference and the American Academy of Family Physicians (AAFP) National Conference
• Initiatives to recruit medical students into rural residency training, including promotional videos, and presentations
• Rural Graduate Medical Education
• Technical assistance

Results

• Rural GME slots increased to 35 slots with more under development.
• Developed integrated rural training tracks in general surgery, psychiatry, and OB/Gyn
• Increased interest from urban partners and hospitals wanting to offer rural experiences to their residents
• A faculty development conference aimed at rural and community preceptors is held annually
• Medical Education Administrators and Coordinators (MEAC) are now served by an annual workshop developed to train and provide networking opportunities
• Rural Coordinator Leadership Program in development

WCRGME received the Wisconsin Rural Partners award in 2015 in recognition of being one of Wisconsin's top rural development initiatives.

Publications:

Bruksch-Meck, K., Crouse, B., Quinn, G., McCart, L., & Traxler, K. (2018). Graduate Medical Initiatives to Develop the Physician Workforce in Rural Wisconsin. Wisconsin Medical Journal, 117(5), 201-207.

Challenges

• Even when a healthcare facility has the desire to start a GME program, there may not be anyone on staff who is familiar with starting or running a residency. Also, a rural hospital wanting to develop a GME program needs to find a partner willing to sponsor them.
• WCRGME quickly realized that each of its members was in a different place with regards to organizational capacity, interest, and expertise. This resulted in the need to tailor presentations and training for different experience and interest levels.
• Centers for Medicare & Medicaid Services (CMS) reimbursement for graduate medical education is complicated, but essential to learn.

Replication

A centralized organization that can meet the needs and provide technical assistance for rural sites is a great model. Rural healthcare facilities often have the desire and interest to become sites for rural graduate medical education, but not necessarily the experience or resources. A collaborative like WCRGME can provide those things.

WCRGME's Start a Rural GME Program section provides statistics, information, explanation of different versions of rural training tracks, and future steps.

Contact Information

Lori Rodefeld, Director of Rural GME Development & Support
Wisconsin Collaborative for Rural GME
lrodefeld@RWHC.com