By Trista Stankowski-Drengler
Student in the Wisconsin Academy for Rural Medicine blows the whistle on myths that research and innovation are not happening in rural areas or in primary care.
Many advocates of primary care have speculated as to why so few medical students choose primary care. Some argue it’s the reimbursement discrepancy; others say it’s the care delivery model. Still others say students don’t know that exciting research and innovation are taking place in primary care just as in other specialties. These argue that to address this issue, medical schools must expose students to these innovations, to modern (and more attractive) models of care.
The same can be said of rural medicine. Many students don’t consider practicing in rural areas because they don’t know what these areas have to offer. They don’t know, for example, that one can practice in a rural area and still be involved in clinical research or practice in modern, state-of-the-art facilities. Likewise, to address this knowledge gap, medical schools must expose students to the reality of rural practice.
Just as we are seeing a nationwide shortage of primary care physicians, we are seeing a shortage of all types of physicians in rural America. In my state, Wisconsin, 28 percent of the population is found in rural areas while only 11 percent of physicians practice there. This discrepancy is seen in primary care as well as many sub-specialties throughout the state, and many rural hospitals and clinics are searching for ways to increase their workforce.
The Wisconsin Academy for Rural Medicine (WARM), already covered at length here on Progress Notes
, was created to address the shortage of physicians in rural areas. Requiring students to complete third- and fourth-year rotations in rural communities across the state, WARM shows students the reality of rural practice and dispels detrimental stereotypes – for example that one cannot be a physician/researcher in a rural area.
I grew up in a small town in central Wisconsin, and even I once believed that my desire to raise a family and practice medicine in rural central Wisconsin precluded my interest in specializing in hematology/oncology and particularly in performing research as part of my future practice. I am fortunate the WARM program has shown me that I can “have my cake and eat it, too.” I’ll complete my clinical rotations in and around Marshfield, Wisconsin (population ~20,000 people). Between my third and fourth year, I plan to take a year to conduct research at the Marshfield Clinic. Although rural, the Marshfield Clinic has a large research facility in which approximately 450 clinical trials and other research projects are being conducted at any one time. The Marshfield clinic also employs hematology/oncologists who see patients in Marshfield as well as hold outreach clinics in even more rural areas such as Minocqua (population ~5,000 people).
So has this program made a difference in rural Wisconsin? It may be too early to tell but so far two years worth of WARM students have matched for residencies with approximately 62% of students matching in primary care and 69% matching in residency programs within Wisconsin. These percentages are in line with WARM’s goals and are promising for increasing rural Wisconsin’s future physician workforce. These numbers may also demonstrate that indeed the way to address critical physician shortages, whether in a particular specialty, such as primary care or in a geographic area, like rural Wisconsin, is to expose students to the reality of the practice, and let the practice speak for itself.
Trista Stankowski-Drengler is in her 3rd year of medical school at the University of Wisconsin School of Medicine and Public Health. She has just begun rotations in rural Marshfield, WI, as a student in the WARM program. She is considering a career in hematology/oncology and hopes to incorporate research into her future practice.