Joseph E. Kerschner, MD
WMJ. 2023;122(3):233-234
The United States is facing an ever-worsening shortage of primary care physicians – about 40% of whom are family medicine practitioners, according to the American Academy of Family Physicians (AAFP). This shortfall of primary care physicians is expected to top 52,000 by 2025. To address this shortage, the AAFP and seven other national and international family medicine organizations have worked together to increase the number of family medicine physicians in the US and to enhance the likelihood that US medical students pursue family medicine as their specialty.1
In Wisconsin in particular, the shortage of primary care physicians is acute. A report published in 2018 by the Wisconsin Council on Medical Education and Workforce found that there would be a shortfall of 745 primary care doctors in the state by 2035, at which time about 40% of family doctors are expected to retire.2
More recently, a 2021 baseline scorecard that tracks support for high-quality primary care (funded in part by the Milbank Memorial Fund and The Physicians Foundation) noted that in 2020, there were only 39 primary care physicians in medically underserved areas in the state per every 100,000 population, and 78 primary care physicians per 100,000 population in areas not medically underserved. Also in 2020, there were only 36 primary care residents per 100,000 population and only 20% of new physicians entering the workforce in Wisconsin were primary care physicians.3 The scorecard further found that the US is systematically underinvesting in primary care; the primary care physician workforce is shrinking and gaps in access to care appear to be growing; and too few physicians are being trained in community settings.
The Medical College of Wisconsin (MCW) has long held that primary care improves population health and decreases health disparities, and that a robust family medicine workforce is critical to ensure that patients throughout the country have appropriate, effective and accessible care for generations to come.
In my “Dean’s Corner” in the July 2019 issue of the Wisconsin Medical Journal on “Helping to Alleviate the Projected Physician Shortage” (clearly a continuing problem!), I noted that among the most impactful ways to address this issue is through the creation of additional graduate medical education (GME) residencies.4 I shared a number of MCW’s successes in this area, including the creation of two new 4-year residency programs attached to our regional medical school campuses in central and northeastern Wisconsin, as well as new family residency programs in the Milwaukee area and Green Bay. I concluded the column with the promising words, “We look forward to providing additional data on these successes in the years to come.”
Fast forward to 2021, when, under the leadership of Joseph Gravel, MD, chair of MCW’s Department of Family and Community Medicine, the new Froedtert & MCW South Side Family Medicine Residency Program was accredited – offering bilingual and culturally competent care to Milwaukee’s Hispanic and Latinx patients and their families.5 In June 2023, the Froedtert & the Medical College of Wisconsin Forest Home Health Center opened; it serves as the home for this new 3-year family medicine residency program training six residents per year – with 18 total residents by the third year. The goal of the program, led by MCW Associate Professor Sabrina Hofmeister, DO, is to train family physicians with the expertise and skills to provide individualized, evidence-based, culturally competent care to patients and families to address the growing need for compassionate and skilled family physicians who can provide care to underserved communities.
In October 2022, the Froedtert & MCW North Side Family Residency Program achieved full accreditation through a partnership of Milwaukee’s North Side community health centers – led by Milwaukee Health Services, Inc. (MHSI), MCW’s Department of Family and Community Medicine, and Froedtert Hospital.6,7 The new residency program will address the growing need for compassionate and skilled family physicians who can provide outstanding care to underserved communities, directly addressing existing health inequities, especially among the Black/African American community. Funding for this new 3-year residency in family and community medicine is being provided by the US Department of Health Resources and Services Administration (HRSA) to MHSI, which will pass it along to MCW through the Medical College of Wisconsin Affiliated Hospitals, Inc. (MCWAH).8,9
Training of the first 14 residents in the initial cohort began in July 2023 under the leadership of residency program director, MCW Associate Professor Camille Garrison, MD. By July 2025, the program will be training the full complement of 42 residents. Outpatient rotations will occur at MHSI and other affiliated northside Milwaukee affiliated community health centers, Froedtert & MCW specialty office practices and northside community organizations. Inpatient adult medicine rotations and specialty rotations will occur at Froedtert Hospital and inpatient pediatric rotations at Children’s Wisconsin. The program will promote physicians to become health advocates within their respective communities as well as the medical community at large – incorporating a deep understanding of social determinants of health and a commitment to actively reducing health inequities. Through competency-based education and interaction with innovative health care systems and leaders, this new residency program will equip graduates with the foundation needed to practice successfully in the most challenging of clinical settings and align with the needs of the community. The program also seeks to help build a pathway for underrepresented in medicine (URM) students for primary care practice while increasing healthcare access for people living on the north side of Milwaukee.
The diligence and exceptional planning of the people of MCW and its health system and community partners enabled this new residency program to be created and funded by HRSA within a period of less than 6 months instead of the usual 2-year process!
MCW’s Department of Family and Community Medicine has a rich 50-year history of training family physicians in the Milwaukee area and beyond to serve diverse individuals through full-service clinics with proactive clinical and social service offerings. Today’s MCW family medicine residents can expect a broad and rich experience with learning opportunities across the spectrum of care, specifically dedicated toward learning the aspects of care most important to underserved and underresourced patients and communities.
The new health center and residency programs will increase MCW’s reach and improve access to quality health care in the communities we serve – building on the foundation of providing the right care, in the right place and at the right time to the region’s diverse populations.
We hope that MCW’s recent efforts to expand residency programs in family medicine will be duplicated throughout the state so that our communities (and our patients) will not face as dire a shortfall of primary care physicians as is expected at present. Additionally, we hope that MCW’s model of partnering with community health centers will become the gold standard in family medicine residency training.
REFERENCES
- America Needs More Family Doctors. 25×2030: American Academy of Family Physicians. Accessed July 12, 2023. https://www.aafp.org/membership/initiatives/25×2030.html
- WCMEW Report Projects Primary Care Physician Shortfall. The Hamilton Consulting Group, LLC. July 30, 2018. Accessed July 12, 2023. https://www.hamilton-consulting.com/wcmew-report-projects-primary-care-physician-shortfall/
- The Health of US Primary Care Baseline Scorecard Data Dashboard. Milbank Memorial Fund. Accessed July 12, 2023. https://www.milbank.org/primary-care-scorecard/
- Kerschner J. Helping to alleviate the projected physician shortage. WMJ. 2019;118(2):103-104. Accessed July 12, 2023. https://wmjonline.org/wp-content/uploads/2019/118/2/103.pdf
- Froedtert & MCW South Side Family Medicine Residency Program. Accessed July 12, 2023. https://southsidemkefmr.org/
- Milwaukee Health Services, Inc. Accessed July 12, 2023. https://mhsi.org/
- North Side Milwaukee Health Centers Family Medicine Residency Program. Accessed July 12, 2023. https://northsidemkefmr.org/
- Bureau of Health Workforce. Health Resources and Services Administration. Accessed July 12, 2023. https://bhw.hrsa.gov/
- MCWAH Overview. Medical College of Wisconsin. Accessed July 12, 2023. https://www.mcw.edu/education/graduate-medical-education/mcwah-overview