WRPRAP Grant Program Aims to Create and Expand RTTs, Rural Residencies

As part of its new grant initiative, the Wisconsin Rural Physicians Residency Assistance Program (WRPRAP), a state-funded program administered by the Department of Family Medicine (DFM), recently received two letters of intent to establish new or expanded rural training tracks (RTTs) or rural residency programs in Wisconsin.

It’s an important step toward increasing rural training opportunities for residents—and ultimately, addressing Wisconsin’s critical need for rural physicians.

New RFP Supports Deeper Initiatives

Initial letters of intent are the first phase of a new Request for Proposal (RFP) process that WRPRAP announced in November. The program just invited successful applicants from this step to submit full implementation proposals, and plans to announce funding awards in early March.

Applicants are competing for a two-year grant (up to $150,000 in the first year; up to $125,000 in the second year) to develop a new residency program or RTT—or expand an existing program—that supports long-term rural graduate medical education.

Program Coordinator Wilda Nilsestuen, MS, said the proposals must demonstrate commitment, clarity, feasibility, and sustainability. “The ultimate goal is to train residents [who ultimately will practice in] the rural workforce,” she explained.

“WRPRAP has been supportive of eight-week rural rotations and enhancing rural training track education,” said DFM Professor Byron Crouse, MD, who became the program’s director in October 2011.

“However, to increase the number of rural residents and rural residency positions, the development of new residency infrastructure is needed. This RFP is intended to support those working to expand the needed rural residency capacity in Wisconsin,” he added.

WRPRAP will continue to award smaller rural medical education grants, which are continuously accessible on the program’s web page and not subject to the RFP process. Previous grants have supported:

• two years’ salary and benefits for a family medicine resident at the Baraboo RTT;
• a subscription to a rural medicine e-curriculum, also at the Baraboo RTT;
• an 8-week rural rotation in Tomah, offered through the La Crosse-Mayo family medicine residency program; and
• faculty professional development and curriculum planning for procedural workshops training at Richland Medical Center.

Medical and Economic Impact

Wisconsin already has an acute physician shortage. It needs 100 new doctors per year just to keep pace with current health care demands, estimates the Wisconsin Hospital Association.

The shortage is even worse in rural areas, where 28% percent of Wisconsinites live, but only 11% of physicians practice—a disparity higher than the national average.

The problem goes beyond access to health care. “Having a physician in a rural community provides a greater benefit than people realize,” Nilsestuen explained. “It fosters economic activity.”

In fact, according to a report from the National Center for Rural Health Works, one rural family physician can generate approximately $1.5 million in revenue, $900,000 in payroll, and 23 jobs in the clinic and hospital—economic value that would otherwise flow out of the community.

WRPRAP’s Rural Roots

Despite the medical and economic benefits, the challenge remains how to recruit and retain primary care physicians—many of whom were trained in urban, referral-oriented residency programs—for rural practice, where fewer institutional resources and specialists are available.

WRPRAP aims to cultivate them. Characteristics that predict successful rural physicians include a service orientation, a rural background, and commitment to community involvement, Nilsestuen explained. But most important, they need to have spent a considerable portion of their residency in a rural setting.

“Quite simply, physicians who train in rural areas are more likely to end up in rural practice,” she said.

In fact, WRPRAP itself has roots in rural Wisconsin. It was established through Wisconsin Act 190, legislation that was lobbied for by small, rural Wisconsin hospitals, and is funded by hospital taxes, not general revenue.                                    

“It has been encouraging to see the interest in medical residency education by rural hospitals and clinics,” commented Dr. Crouse. “Moving this vision into reality represents a significant commitment, and will require the collaborative efforts of academic centers along with rural hospitals, clinics, and their communities to successfully create new rural training track programs and/or rural residencies.

“WRPRAP is committed to working with partners throughout the state to help see that this process succeeds and helps address the Wisconsin rural physician workforce shortage.”