Wisconsin Faces Doctor Shortages

The Wisconsin Council on Medical Education and Workforce said the greatest need is for doctors specializing in family practice, internal medicine, and hospitalists. In other words, doctors serving as primary-care physicians. The report also predicts that demand for primary-care doctors will increase by 33 percent by the year 2020 and as much as 65 percent by the year 2030.

However, the increase in the number of actual physicians lags far behind, and that's creating a huge gap in the chain of supply and demand.

Dr. Charles Shabino, senior medical advisor for the Wisconsin Hospital Association, said the need for physicians will create serious problems in the future.

"We estimate that in Wisconsin today we are someplace 400 short in doctors of primary care and probably equal numbers in specialties. We estimate this shortage will grow for a number of reasons and to get to the point that within that training cycle of 10 to 15 years from now, that number may increase to the thousands here in Wisconsin," he said.

That gap is of serious concern to some Wisconsin medical experts, and should be to all Wisconsin residents. Chances are it will eventually affect everyone's medical care in the state of Wisconsin, officials said. They said residents are on the brink of a crisis in health care -- not just in Wisconsin but across the country, WISC-TV reported.

Those same experts said the problem will be felt most acutely in rural areas.

However, one doctor is taking on this challenge head-on. By day, Dr. Aaron Dunn is a family practice physician in Iowa County. Many evenings, however, he sees patients at the Community Connections free clinic that he co-founded in Dodgeville.

"From an intelligence standpoint, I like doing lots of different things, and I really thrive on the breadth of skills that a family medical training brings," said Dr. Dunn. "From delivering babies to doing hospital work to seeing patients in clinic, pediatrics, sports medicine, geriatrics, the whole gamut."

Dr. Dunn's role as a primary-care physician in an underserved area like Iowa County means regular workdays of 10 hours or more.

"When you're in a rural area or in an underserved community, the need dictates your hours," said Dr. Dunn.

According to the latest report from the Wisconsin Council on Medical Education and Workforce, one of the reasons driving potential doctors away from family medicine is too many hours combined with too little monetary compensation.

"I think all medical students who go into medicine choose that profession because they want to help people, but then a certain amount of reality confronts them," said Dr. Shabino. "One of those is that the average medical student now, after he finishes medical school, is nearly $200,000 in debt."

Dr. Dunn concurs.

"This is a hard sell. The cost of medical education is way higher than even when I was in medical school and that wasn't that long ago," he said.

Studies show primary-care physicians make four to five times less than their specialist counterparts.

"We need to either generate some more funds to support our primary care physicians or address the issue of this huge debt that all the primary physicians have at the time they're making this choice of what to do in terms of specialty," said Shabino.

"I'll be paying off my debt for a long time," said Dunn. "For a long time. But with that said, I still live comfortably and have a happy family and we have no complaints financially."

Some individual practices are starting to offer incentives like signing bonuses and loan repayment programs. Medical organizations are lobbying the state to extend tuition reimbursement for primary care providers who stay in Wisconsin.

This brings up the next obstacle facing Wisconsin: Getting doctors to stay here. Currently more than 60 percent of Wisconsin medical students leave the state for residency, WISC-TV reported.

"We know that the highest predictor of where physicians will practice is location -- where they do their residencies," said Shabino.

"We do know that about half end up back in Wisconsin eventually practicing, but again we know that if they're gone for their first three, five, or seven years of practice before they return, that's lost opportunity for us in Wisconsin to be meeting the needs of residents," said Dr. Bryon Crouse, director of the Wisconsin Academy for Rural Medicine.

That's a need growing faster than doctors are being trained.

"It currently takes between 8 to 12 years to educate a physician from the time they graduate college to the time they're actually ready to go out and practice. That means that if we're going to address this problem, we need to address it today knowing we won't see the benefit of that for a dozen years or so," said Crouse.

For Dunn, though, if he had to do it all over again, he said he wouldn't do anything different.

"You can do primary care and not be burned out and have a family and have a social life and be happy," said Dunn. "You can make a good living and you can really thrive in a health care system."

Speaking of wage discrepancies among doctors, an anesthesiologist makes more than $320,000 a year.

An OB/GYN with more than one year's experience makes around $247,000, while a psychiatrist makes $180,000.

Family practice doctors make an average of $156,000.

There has been a national call for all medical colleges to increase class size by 30 percent, which the University of Wisconsin School of Medicine is gradually doing.

But to address the shortage more specifically, the school developed the Wisconsin Academy for Rural Medicine program.

Through WARM, the UW tries to identify students that may be a good candidate to work in a more rural setting.

"Some of that is coming from rural communities, some of that is students that really engage in community life and community support. Even back in their junior high and high school eras, we find that who really engages in the community, things like that will help predict who returns to rural practice," said Dr. Crouse.

Crouse also points out that they really want to focus on students who will stay in a rural area long term and really become part of the community.

Another part of this solution is to fund more residencies in the state, WISC-TV reported.

Residencies are paid by Medicare, and statewide medical groups are lobbying Congress for more money to pay for more medical residents.

Baby Boomers also are playing into the doctor shortage: In the early 1970s there was an expansionary movement when the federal government grew the number of physicians by 30 percent.

Now, those doctors are retiring by the droves. And at the same time the aging baby boomer population needs more medical services.