rural wisconsin health cooperative “a rural perspective on physician workforce planning” tim...

Rural WisconsinRural WisconsinHealth CooperativeHealth Cooperative

““A Rural Perspective onA Rural Perspective onPhysician Workforce Planning”Physician Workforce Planning”

Tim SizeTim SizeExecutive DirectorExecutive Director


for thefor theWHA Board WHA Board

Planning SessionPlanning SessionJuly 23rd, 2009July 23rd, 2009


Crisis Now Unavoidable–Not Just PhysiciansCrisis Now Unavoidable–Not Just PhysiciansCrisis Now Unavoidable–Not Just PhysiciansCrisis Now Unavoidable–Not Just Physicians

““The United States faces a looming shortage of many The United States faces a looming shortage of many types of health-care professionals, including nurses, types of health-care professionals, including nurses,

physicians, dentists, pharmacists, and allied-health and physicians, dentists, pharmacists, and allied-health and public-health workers. The results will be felt acutely public-health workers. The results will be felt acutely within the next ten years. Colleges and health science within the next ten years. Colleges and health science

programs will all be affected by demographic, programs will all be affected by demographic, technological, and bureaucratic trends driving the pending technological, and bureaucratic trends driving the pending crisis… crisis… The final crucial factor precipitating the health The final crucial factor precipitating the health

care workforce crisis is a lack of comprehensive care workforce crisis is a lack of comprehensive workforce planning on the parts of academe, workforce planning on the parts of academe, government, and the health care professions.government, and the health care professions.””

““The United States faces a looming shortage of many The United States faces a looming shortage of many types of health-care professionals, including nurses, types of health-care professionals, including nurses,

physicians, dentists, pharmacists, and allied-health and physicians, dentists, pharmacists, and allied-health and public-health workers. The results will be felt acutely public-health workers. The results will be felt acutely within the next ten years. Colleges and health science within the next ten years. Colleges and health science

programs will all be affected by demographic, programs will all be affected by demographic, technological, and bureaucratic trends driving the pending technological, and bureaucratic trends driving the pending crisis… crisis… The final crucial factor precipitating the health The final crucial factor precipitating the health

care workforce crisis is a lack of comprehensive care workforce crisis is a lack of comprehensive workforce planning on the parts of academe, workforce planning on the parts of academe, government, and the health care professions.government, and the health care professions.””

Chronicle of Higher EducationChronicle of Higher Education, 11/07, 11/07

Rural WisconsinRural WisconsinHealth CooperativeHealth CooperativeDennis Winters, Chief, Office of Economic Advisors, WI Department of Workforce Development 9/07Dennis Winters, Chief, Office of Economic Advisors, WI Department of Workforce Development 9/07


Rural* Most Vulnerable to Poor PlanningRural* Most Vulnerable to Poor PlanningRural* Most Vulnerable to Poor PlanningRural* Most Vulnerable to Poor Planning

• Across all healthcare professions, we have Across all healthcare professions, we have limited limited statewide supply/demand forecasts statewide supply/demand forecasts to adequately to adequately inform decisions regarding the preparation, retention, and inform decisions regarding the preparation, retention, and distribution of a sufficient workforce. distribution of a sufficient workforce.

• ConsequentlyConsequently, educational programs have , educational programs have greater greater challenge to attract state resources challenge to attract state resources needed needed to to significantly expand the number of graduatessignificantly expand the number of graduates..

• Efforts to gather and analyze data on labor markets and Efforts to gather and analyze data on labor markets and distribution of health professionals are uneven across the distribution of health professionals are uneven across the state and state and we particularly lack good forecasts for we particularly lack good forecasts for supply and demand at regions within the statesupply and demand at regions within the state..

• Across all healthcare professions, we have Across all healthcare professions, we have limited limited statewide supply/demand forecasts statewide supply/demand forecasts to adequately to adequately inform decisions regarding the preparation, retention, and inform decisions regarding the preparation, retention, and distribution of a sufficient workforce. distribution of a sufficient workforce.

• ConsequentlyConsequently, educational programs have , educational programs have greater greater challenge to attract state resources challenge to attract state resources needed needed to to significantly expand the number of graduatessignificantly expand the number of graduates..

• Efforts to gather and analyze data on labor markets and Efforts to gather and analyze data on labor markets and distribution of health professionals are uneven across the distribution of health professionals are uneven across the state and state and we particularly lack good forecasts for we particularly lack good forecasts for supply and demand at regions within the statesupply and demand at regions within the state..

* * and inner portions of large citiesand inner portions of large cities


Statewide Average Estimates InsufficientStatewide Average Estimates InsufficientStatewide Average Estimates InsufficientStatewide Average Estimates Insufficient

““When it rains in the When it rains in the suburbs, expect a suburbs, expect a tsunami in rural and tsunami in rural and the inner-citiesthe inner-cities.” .”

Wisconsin Academy Wisconsin Academy of Rural Medicine & of Rural Medicine & TRaining in Urban TRaining in Urban Medicine and Public Medicine and Public Health exist only due Health exist only due to focus on regional to focus on regional maldistributions. maldistributions.

““When it rains in the When it rains in the suburbs, expect a suburbs, expect a tsunami in rural and tsunami in rural and the inner-citiesthe inner-cities.” .”

Wisconsin Academy Wisconsin Academy of Rural Medicine & of Rural Medicine & TRaining in Urban TRaining in Urban Medicine and Public Medicine and Public Health exist only due Health exist only due to focus on regional to focus on regional maldistributions. maldistributions.


Stress re Rural Physician Shortages (1 of 3)Stress re Rural Physician Shortages (1 of 3)Stress re Rural Physician Shortages (1 of 3)Stress re Rural Physician Shortages (1 of 3)

While more than While more than 20% of Americans live in rural areas, only 20% of Americans live in rural areas, only 9% of physicians practice in rural 9% of physicians practice in rural locations. Rural America locations. Rural America has long struggled with a shortage of physicians and has long struggled with a shortage of physicians and as as shortages spreads into urban areas, the rural shortage is shortages spreads into urban areas, the rural shortage is becoming more intense. Wisconsin faces the same challenge becoming more intense. Wisconsin faces the same challenge and it is predicted to get a lot worse before it gets betterand it is predicted to get a lot worse before it gets better. .

Due to the numbers of jobs available, the shortages are Due to the numbers of jobs available, the shortages are mostly in Primary Care mostly in Primary Care (both Family Medicine and Internal (both Family Medicine and Internal Medicine). Medicine). However, the growing shortage in General However, the growing shortage in General Surgery is particularly troubling given their critical role Surgery is particularly troubling given their critical role with patients needing emergency interventions. with patients needing emergency interventions. Specialists Specialists in Orthopedic Surgery and Obstetrics/Gynecology are also in Orthopedic Surgery and Obstetrics/Gynecology are also already extremely difficult to recruit successfully. already extremely difficult to recruit successfully.

While more than While more than 20% of Americans live in rural areas, only 20% of Americans live in rural areas, only 9% of physicians practice in rural 9% of physicians practice in rural locations. Rural America locations. Rural America has long struggled with a shortage of physicians and has long struggled with a shortage of physicians and as as shortages spreads into urban areas, the rural shortage is shortages spreads into urban areas, the rural shortage is becoming more intense. Wisconsin faces the same challenge becoming more intense. Wisconsin faces the same challenge and it is predicted to get a lot worse before it gets betterand it is predicted to get a lot worse before it gets better. .

Due to the numbers of jobs available, the shortages are Due to the numbers of jobs available, the shortages are mostly in Primary Care mostly in Primary Care (both Family Medicine and Internal (both Family Medicine and Internal Medicine). Medicine). However, the growing shortage in General However, the growing shortage in General Surgery is particularly troubling given their critical role Surgery is particularly troubling given their critical role with patients needing emergency interventions. with patients needing emergency interventions. Specialists Specialists in Orthopedic Surgery and Obstetrics/Gynecology are also in Orthopedic Surgery and Obstetrics/Gynecology are also already extremely difficult to recruit successfully. already extremely difficult to recruit successfully.

RWHC Survey Presented to Injured Patients & Families RWHC Survey Presented to Injured Patients & Families Compensation Fund Advisory Committee, 1/20/09Compensation Fund Advisory Committee, 1/20/09


Stress re Rural Physician Shortages (2 of 3)Stress re Rural Physician Shortages (2 of 3)Stress re Rural Physician Shortages (2 of 3)Stress re Rural Physician Shortages (2 of 3)• The trend to sub-specialization means that The trend to sub-specialization means that most physicians are most physicians are

being trained for careers that are most often only sustainable being trained for careers that are most often only sustainable in urban centersin urban centers. General Internists are about as scarce of a . General Internists are about as scarce of a commodity as there is as the vast majority are sub-specializing.commodity as there is as the vast majority are sub-specializing.

• For general surgery in a rural setting, you are For general surgery in a rural setting, you are often recruiting not often recruiting not only basic general surgical coverage but also seeking a only basic general surgical coverage but also seeking a candidate that will assume C-Section call responsibilitiescandidate that will assume C-Section call responsibilities. .

• When some rural hospitals recruit a When some rural hospitals recruit a Family Practice physicianFamily Practice physician, , they prefer one that includes OB in his / her practice. This means they prefer one that includes OB in his / her practice. This means that the newly recruited practitioner will need to be willing to that the newly recruited practitioner will need to be willing to both both assume the risk of OB without access to an on-site OB/GYN assume the risk of OB without access to an on-site OB/GYN and to assume a call rotation that will require an average call and to assume a call rotation that will require an average call ratio of 1 in 4 shifts ratio of 1 in 4 shifts on top of other practice call responsibilities.on top of other practice call responsibilities.

• The trend to sub-specialization means that The trend to sub-specialization means that most physicians are most physicians are being trained for careers that are most often only sustainable being trained for careers that are most often only sustainable in urban centersin urban centers. General Internists are about as scarce of a . General Internists are about as scarce of a commodity as there is as the vast majority are sub-specializing.commodity as there is as the vast majority are sub-specializing.

• For general surgery in a rural setting, you are For general surgery in a rural setting, you are often recruiting not often recruiting not only basic general surgical coverage but also seeking a only basic general surgical coverage but also seeking a candidate that will assume C-Section call responsibilitiescandidate that will assume C-Section call responsibilities . .

• When some rural hospitals recruit a When some rural hospitals recruit a Family Practice physicianFamily Practice physician, , they prefer one that includes OB in his / her practice. This means they prefer one that includes OB in his / her practice. This means that the newly recruited practitioner will need to be willing to that the newly recruited practitioner will need to be willing to both both assume the risk of OB without access to an on-site OB/GYN assume the risk of OB without access to an on-site OB/GYN and to assume a call rotation that will require an average call and to assume a call rotation that will require an average call ratio of 1 in 4 shifts ratio of 1 in 4 shifts on top of other practice call responsibilities.on top of other practice call responsibilities.

RWHC Survey Presented to Injured Patients & Families RWHC Survey Presented to Injured Patients & Families Compensation Fund Advisory Committee, 1/20/09Compensation Fund Advisory Committee, 1/20/09


Stress re Rural Physician Shortages (3 of 3)Stress re Rural Physician Shortages (3 of 3)Stress re Rural Physician Shortages (3 of 3)Stress re Rural Physician Shortages (3 of 3)

• A complicating factor for primary care is the A complicating factor for primary care is the unrealistic unrealistic expectations that recent graduates have of rural hospitals. expectations that recent graduates have of rural hospitals.

• The The ability for rural hospitals to adopt a hospitalist model ability for rural hospitals to adopt a hospitalist model varies greatly varies greatly and is a and is a significant challenge to recruitment significant challenge to recruitment for for those who don’t have it, as it automatically excludes a those who don’t have it, as it automatically excludes a substantial number of recent grads. substantial number of recent grads.

• Urban-based clinics, which also serve rural areas with Urban-based clinics, which also serve rural areas with visiting specialists, staff the city needs first visiting specialists, staff the city needs first and the rural areas and the rural areas literally “do without” until someone can be found to travel. literally “do without” until someone can be found to travel.

• Waiting time in rural areas for specialty appointments with Waiting time in rural areas for specialty appointments with visiting specialists is increasing; this is true even for visiting specialists is increasing; this is true even for appointments provided via telehealthappointments provided via telehealth..

• A complicating factor for primary care is the A complicating factor for primary care is the unrealistic unrealistic expectations that recent graduates have of rural hospitals. expectations that recent graduates have of rural hospitals.

• The The ability for rural hospitals to adopt a hospitalist model ability for rural hospitals to adopt a hospitalist model varies greatly varies greatly and is a and is a significant challenge to recruitment significant challenge to recruitment for for those who don’t have it, as it automatically excludes a those who don’t have it, as it automatically excludes a substantial number of recent grads. substantial number of recent grads.

• Urban-based clinics, which also serve rural areas with Urban-based clinics, which also serve rural areas with visiting specialists, staff the city needs first visiting specialists, staff the city needs first and the rural areas and the rural areas literally “do without” until someone can be found to travel. literally “do without” until someone can be found to travel.

• Waiting time in rural areas for specialty appointments with Waiting time in rural areas for specialty appointments with visiting specialists is increasing; this is true even for visiting specialists is increasing; this is true even for appointments provided via telehealthappointments provided via telehealth..

RWHC Survey Results Presented to Injured Patients & Families RWHC Survey Results Presented to Injured Patients & Families Compensation Fund Advisory Committee, 1/20/09Compensation Fund Advisory Committee, 1/20/09


Rural Use of AHPs MixedRural Use of AHPs MixedRural Use of AHPs MixedRural Use of AHPs Mixed• Some reported a dramatic shift Some reported a dramatic shift to the use of Advanced Health to the use of Advanced Health

Practitioners (AHPs) Practitioners (AHPs) but in other sites use is limited. but in other sites use is limited. • Some Some older often more complicated older often more complicated patients retain a marked patients retain a marked

preference and possibly need to see a physician.preference and possibly need to see a physician.• Increasingly PAs are being hired into subspecialty practices Increasingly PAs are being hired into subspecialty practices

and not entering primary care or underserved regions.and not entering primary care or underserved regions.• CRNA coverage is very difficultCRNA coverage is very difficult..• The The increasing number of AHPs does not help with call increasing number of AHPs does not help with call

coverage in most casescoverage in most cases, placing additional pressure on the fewer , placing additional pressure on the fewer physicians in the mix.physicians in the mix.

• CurrentlyCurrently one physician can only supervise two PAs at a time one physician can only supervise two PAs at a time and with fewer doctors and a higher dependence on PAs, this may and with fewer doctors and a higher dependence on PAs, this may become an additional problem.become an additional problem.

• Some reported a dramatic shift Some reported a dramatic shift to the use of Advanced Health to the use of Advanced Health Practitioners (AHPs) Practitioners (AHPs) but in other sites use is limited. but in other sites use is limited.

• Some Some older often more complicated older often more complicated patients retain a marked patients retain a marked preference and possibly need to see a physician.preference and possibly need to see a physician.

• Increasingly PAs are being hired into subspecialty practices Increasingly PAs are being hired into subspecialty practices and not entering primary care or underserved regions.and not entering primary care or underserved regions.

• CRNA coverage is very difficultCRNA coverage is very difficult..• The The increasing number of AHPs does not help with call increasing number of AHPs does not help with call

coverage in most casescoverage in most cases, placing additional pressure on the fewer , placing additional pressure on the fewer physicians in the mix.physicians in the mix.

• CurrentlyCurrently one physician can only supervise two PAs at a time one physician can only supervise two PAs at a time and with fewer doctors and a higher dependence on PAs, this may and with fewer doctors and a higher dependence on PAs, this may become an additional problem.become an additional problem.

RWHC Survey Results Presented to Injured Patients & Families RWHC Survey Results Presented to Injured Patients & Families Compensation Fund Advisory Committee, 1/20/09Compensation Fund Advisory Committee, 1/20/09


Can’t Wait for Better Forecasts to ActCan’t Wait for Better Forecasts to ActCan’t Wait for Better Forecasts to ActCan’t Wait for Better Forecasts to Act

• Act on the urgency forAct on the urgency for health workforce health workforce data analysis data analysis (including collection) (including collection) and forecasting and forecasting to maximize to maximize downstream the use of limited development funds. downstream the use of limited development funds.

• Plan collaboratively across schools & disciplinesPlan collaboratively across schools & disciplines . . Multiple key stakeholders bring different perspectives on Multiple key stakeholders bring different perspectives on workforce needs and different resources critical to workforce needs and different resources critical to defining the problems and developing strategies to defining the problems and developing strategies to address them.address them.

• The The crisis is now unavoidable crisis is now unavoidable given the late start of our given the late start of our national and state interventions–national and state interventions–our opportunity is to our opportunity is to limit is depth, destruction and duration. limit is depth, destruction and duration.

• Act on the urgency forAct on the urgency for health workforce health workforce data analysis data analysis (including collection) (including collection) and forecasting and forecasting to maximize to maximize downstream the use of limited development funds. downstream the use of limited development funds.

• Plan collaboratively across schools & disciplinesPlan collaboratively across schools & disciplines . . Multiple key stakeholders bring different perspectives on Multiple key stakeholders bring different perspectives on workforce needs and different resources critical to workforce needs and different resources critical to defining the problems and developing strategies to defining the problems and developing strategies to address them.address them.

• The The crisis is now unavoidable crisis is now unavoidable given the late start of our given the late start of our national and state interventions–national and state interventions–our opportunity is to our opportunity is to limit is depth, destruction and duration. limit is depth, destruction and duration.


The Great Lie: Education is Value FreeThe Great Lie: Education is Value FreeThe Great Lie: Education is Value FreeThe Great Lie: Education is Value Free

Schools need Schools need to recruit, to recruit, admit, educate admit, educate and mentor to and mentor to help increase help increase (and not (and not decrease) the decrease) the odds for odds for recruitment and recruitment and retention in retention in underserved underserved communities.communities.

Schools need Schools need to recruit, to recruit, admit, educate admit, educate and mentor to and mentor to help increase help increase (and not (and not decrease) the decrease) the odds for odds for recruitment and recruitment and retention in retention in underserved underserved communities.communities.


WARM Enough? 25 MDs/Yr by 2015WARM Enough? 25 MDs/Yr by 2015WARM Enough? 25 MDs/Yr by 2015WARM Enough? 25 MDs/Yr by 2015

• Applicants limited to Wisconsin residents.Applicants limited to Wisconsin residents.• Bright, accomplished and rural community focused.Bright, accomplished and rural community focused.• A rural core curriculum is integrated into all four years A rural core curriculum is integrated into all four years

of medical school: Yr 1 Clinical experiences can be of medical school: Yr 1 Clinical experiences can be done in smaller communities near Madison.done in smaller communities near Madison.

• WARM students participate in the Rural Health Interest WARM students participate in the Rural Health Interest Group to learn about topics relevant to rural medicine.Group to learn about topics relevant to rural medicine.

• An “Overview of Rural Health” offered during the An “Overview of Rural Health” offered during the second year introduces key concepts of rural medicine second year introduces key concepts of rural medicine and prepares students for clinical work in rural and prepares students for clinical work in rural Wisconsin.Wisconsin.

• Applicants limited to Wisconsin residents.Applicants limited to Wisconsin residents.• Bright, accomplished and rural community focused.Bright, accomplished and rural community focused.• A rural core curriculum is integrated into all four years A rural core curriculum is integrated into all four years

of medical school: Yr 1 Clinical experiences can be of medical school: Yr 1 Clinical experiences can be done in smaller communities near Madison.done in smaller communities near Madison.

• WARM students participate in the Rural Health Interest WARM students participate in the Rural Health Interest Group to learn about topics relevant to rural medicine.Group to learn about topics relevant to rural medicine.

• An “Overview of Rural Health” offered during the An “Overview of Rural Health” offered during the second year introduces key concepts of rural medicine second year introduces key concepts of rural medicine and prepares students for clinical work in rural and prepares students for clinical work in rural Wisconsin.Wisconsin.


Warm Students “Outstate” Yrs 3 & 4 Warm Students “Outstate” Yrs 3 & 4 Warm Students “Outstate” Yrs 3 & 4 Warm Students “Outstate” Yrs 3 & 4 • Regional and Rural Learning CommunitiesRegional and Rural Learning Communities: “Marshfield : “Marshfield

Clinic and its clinic in Rice Lake begins hosting the first group Clinic and its clinic in Rice Lake begins hosting the first group of WARM students beginning in July 2009. Gundersen Lutheran of WARM students beginning in July 2009. Gundersen Lutheran in La Crosse will host students beginning in July 2010 and in La Crosse will host students beginning in July 2010 and Aurora BayCare in Green Bay will host WARM students Aurora BayCare in Green Bay will host WARM students beginning in July 2011. Sites are affiliates of UWSMPH and are beginning in July 2011. Sites are affiliates of UWSMPH and are a part of the school’s ‘statewide clinical campus.’ ”a part of the school’s ‘statewide clinical campus.’ ”

• Student-Centered CurriculumStudent-Centered Curriculum: “The WARM program will : “The WARM program will ensure that its students are meeting the same goals and ensure that its students are meeting the same goals and objectives and competencies that the traditional program objectives and competencies that the traditional program requires. This will be done while tailoring students’ experiences requires. This will be done while tailoring students’ experiences to meet their career interests. WARM curriculum is structured to to meet their career interests. WARM curriculum is structured to provide hands-on learning and students will learn a variety of provide hands-on learning and students will learn a variety of clinical skills relevant to rural practice.”clinical skills relevant to rural practice.”

• Regional and Rural Learning CommunitiesRegional and Rural Learning Communities: “Marshfield : “Marshfield Clinic and its clinic in Rice Lake begins hosting the first group Clinic and its clinic in Rice Lake begins hosting the first group of WARM students beginning in July 2009. Gundersen Lutheran of WARM students beginning in July 2009. Gundersen Lutheran in La Crosse will host students beginning in July 2010 and in La Crosse will host students beginning in July 2010 and Aurora BayCare in Green Bay will host WARM students Aurora BayCare in Green Bay will host WARM students beginning in July 2011. Sites are affiliates of UWSMPH and are beginning in July 2011. Sites are affiliates of UWSMPH and are a part of the school’s ‘statewide clinical campus.’ ”a part of the school’s ‘statewide clinical campus.’ ”

• Student-Centered CurriculumStudent-Centered Curriculum: “The WARM program will : “The WARM program will ensure that its students are meeting the same goals and ensure that its students are meeting the same goals and objectives and competencies that the traditional program objectives and competencies that the traditional program requires. This will be done while tailoring students’ experiences requires. This will be done while tailoring students’ experiences to meet their career interests. WARM curriculum is structured to to meet their career interests. WARM curriculum is structured to provide hands-on learning and students will learn a variety of provide hands-on learning and students will learn a variety of clinical skills relevant to rural practice.”clinical skills relevant to rural practice.”

WARM Brochure, 2008WARM Brochure, 2008


But WARM Fails Without Rural ResidenciesBut WARM Fails Without Rural ResidenciesBut WARM Fails Without Rural ResidenciesBut WARM Fails Without Rural Residencies• Create Incentives for Rural Residency ProgramsCreate Incentives for Rural Residency Programs in Primary in Primary

Care and General Surgery in rural area. Increase cap on rural Care and General Surgery in rural area. Increase cap on rural residency training programs in primary care and general surgery by residency training programs in primary care and general surgery by 30%. (To qualify, training must occur at least 6 months in a rural 30%. (To qualify, training must occur at least 6 months in a rural location.). Provide appropriate funding for faculty to train location.). Provide appropriate funding for faculty to train additional residents. Create an incentives for primary care: additional residents. Create an incentives for primary care: Interest-free loans if residency is in primary care or general Interest-free loans if residency is in primary care or general

surgery and residency is in a rural underserved location; surgery and residency is in a rural underserved location; Tax credit on income if residency is in primary care or general Tax credit on income if residency is in primary care or general

surgery and residency is in a rural underserved location. surgery and residency is in a rural underserved location. • Fully implement Rural Training TrackFully implement Rural Training Track established by Congress established by Congress

in BBRA 1999. CMS has never approved utilization of RTT in BBRA 1999. CMS has never approved utilization of RTT claiming that it did not have proper authority because it did not claiming that it did not have proper authority because it did not have a definition of "rural training track.” SEE AAFP HANDOUT have a definition of "rural training track.” SEE AAFP HANDOUT

• Create Incentives for Rural Residency ProgramsCreate Incentives for Rural Residency Programs in Primary in Primary Care and General Surgery in rural area. Increase cap on rural Care and General Surgery in rural area. Increase cap on rural residency training programs in primary care and general surgery by residency training programs in primary care and general surgery by 30%. (To qualify, training must occur at least 6 months in a rural 30%. (To qualify, training must occur at least 6 months in a rural location.). Provide appropriate funding for faculty to train location.). Provide appropriate funding for faculty to train additional residents. Create an incentives for primary care: additional residents. Create an incentives for primary care: Interest-free loans if residency is in primary care or general Interest-free loans if residency is in primary care or general

surgery and residency is in a rural underserved location; surgery and residency is in a rural underserved location; Tax credit on income if residency is in primary care or general Tax credit on income if residency is in primary care or general

surgery and residency is in a rural underserved location. surgery and residency is in a rural underserved location. • Fully implement Rural Training TrackFully implement Rural Training Track established by Congress established by Congress

in BBRA 1999. CMS has never approved utilization of RTT in BBRA 1999. CMS has never approved utilization of RTT claiming that it did not have proper authority because it did not claiming that it did not have proper authority because it did not have a definition of "rural training track.” SEE AAFP HANDOUT have a definition of "rural training track.” SEE AAFP HANDOUT

NRHA Grass Roots National Health Reform Message, 7/8/09NRHA Grass Roots National Health Reform Message, 7/8/09


The Obvious–We Get What We In$entThe Obvious–We Get What We In$entThe Obvious–We Get What We In$entThe Obvious–We Get What We In$ent

““Growing physician income disparities are a major driver Growing physician income disparities are a major driver of student behavior. It does so directly, but also indirectly of student behavior. It does so directly, but also indirectly through messages about prestige, intellectual rigor, need through messages about prestige, intellectual rigor, need to increase ‘productivity,’ and status. In many academic to increase ‘productivity,’ and status. In many academic health centers, primary care is labeled as the revenue ‘loss health centers, primary care is labeled as the revenue ‘loss leader’ rather than as a core function or even producer of leader’ rather than as a core function or even producer of downstream revenue. downstream revenue. This income disparity explains This income disparity explains much of the difficulty in achieving the balance in much of the difficulty in achieving the balance in specialty and geographic physician distribution and specialty and geographic physician distribution and will continue to inhibit achieving the workforce will continue to inhibit achieving the workforce needed for better quality, efficiency and equityneeded for better quality, efficiency and equity.”.”

““Growing physician income disparities are a major driver Growing physician income disparities are a major driver of student behavior. It does so directly, but also indirectly of student behavior. It does so directly, but also indirectly through messages about prestige, intellectual rigor, need through messages about prestige, intellectual rigor, need to increase ‘productivity,’ and status. In many academic to increase ‘productivity,’ and status. In many academic health centers, primary care is labeled as the revenue ‘loss health centers, primary care is labeled as the revenue ‘loss leader’ rather than as a core function or even producer of leader’ rather than as a core function or even producer of downstream revenue. downstream revenue. This income disparity explains This income disparity explains much of the difficulty in achieving the balance in much of the difficulty in achieving the balance in specialty and geographic physician distribution and specialty and geographic physician distribution and will continue to inhibit achieving the workforce will continue to inhibit achieving the workforce needed for better quality, efficiency and equityneeded for better quality, efficiency and equity.”.”

““Specialty and Geographic Distribution: What Influences Specialty and Geographic Distribution: What Influences Medical Student & Resident Choices?” from The Robert Medical Student & Resident Choices?” from The Robert Graham Center, Washington, DC, (AAFP Policy Center), Graham Center, Washington, DC, (AAFP Policy Center), 3/093/09


Editorial Comment (With No Disrespect)Editorial Comment (With No Disrespect)Editorial Comment (With No Disrespect)Editorial Comment (With No Disrespect)

rural wisconsin health cooperative “a rural perspective on physician workforce planning” tim...

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