Teaching the Art and Science of Rural Family Medicine... for Wisconsin

What unique challenges are faced by family physicians who practice in rural communities? How do you give residents the right mix of academic and clinical training to meet those challenges? Why is this important for Wisconsin?

The Baraboo Rural Training Track (RTT), a separately matched and accredited Department of Family Medicine (DFM) residency training program, is working to answer those questions. For ten years, the Baraboo RTT-the last program of its kind in the state-has successfully been growing doctors for rural communities throughout Wisconsin. And it wants to see that trend continue... for the health of Wisconsin.

The Rural Medicine Difference

It's important to understand the differences between rural medicine and traditional family medicine, says James Damos, MD, Baraboo RTT program director. He explained it through an example:

"Several months ago, a Milwaukee woman and her family were on vacation in Wisconsin Dells. The woman was 28 weeks pregnant, and suddenly her water broke. She came to the hospital in Baraboo eight centimeters dilated and having contractions, and was met by the resident on call.

"We don't have an obstetrician on staff or a neonatal intensive care unit (NICU) here, so the resident and attending family physician delivered the baby themselves. After delivery, they had to arrange for the mother and premature baby to be transported to the NICU in Madison, and had to sustain them both while waiting for the ambulance to arrive."

Both mother and baby were fine, according to Dr. Damos, but this example illustrates some of the key characteristics of rural medicine. Family physicians who practice in a rural community must care for patients without immediate access to the consulting specialists or advanced equipment found in larger cities.

They also must have razor-sharp diagnostic and triage skills, especially in emergency situations. Rural physicians have to consider a patient's current and potentially future medical status when deciding if and when to arrange transport to a larger center-a center that could be more than an hour away.

A Collaborative Curriculum Offers the Best of Both Worlds

Through a unique collaboration with the DFM and the UW-Madison campus-located just 45 minutes away-the Baraboo RTT program offers residents a blend of academic and clinical experiences in two locations.

First-year Baraboo RTT residents complete the same coursework and rotations as the Madison residents. Then, in the second- and third- years, residents live and practice in Baraboo, but continue to participate in Madison-based educational activities.

This provides the hands-on experience so critical to rural practice. "Often, resident education is based around a medical center," said Dr. Damos, "but we need to teach future rural physicians how to think beyond the infrastructure available during their education."

In this way, Baraboo RTT residents truly get the best of both worlds. "Residents can participate in a seminar series led by top-notch teachers in Madison, and then come back here and problem-solve the way you need to in a rural setting," said Dr. Damos. "When they graduate, they can then hit the ground running."

Proximity to the UW-Madison campus also helps Baraboo RTT faculty develop, as well. "A result of our collaboration with the DFM and UW-Madison is that many of our doctors are now wonderful teachers, too," Dr. Damos added.

Supporting the DFM and Wisconsin

The Baraboo RTT directly supports the DFM's mission of developing educational programs to train healthcare providers for Wisconsin-a mission closely aligned with the mission of the UW School of Medicine and Public Health and the spirit of the Wisconsin Idea.

And the numbers back it up: ten years after the Baraboo RTT was established, 76% of its graduates have stayed in Wisconsin to practice, and three have remained right in Baraboo.

This statistic takes on even greater importance when considering that, according to Dr. Damos, almost one-third of the primary care physicians in Baraboo are due to retire in the next decade. Furthermore, a report from the Wisconsin Hospital Association and the Wisconsin Medical Society (pdf) indicates an overall shortage of primary care physicians in Wisconsin's rural and underserved communities-a shortage projected to increase.

"This program is built around caring for people in communities where there is little on-site, daily specialty care available," Dr. Damos said. "Not only does it benefit us in Baraboo, it benefits people throughout the state who choose to live in rural areas."