LEGISLATIVE COUNCIL CONFERENCE ROOM1 EAST MAIN STREET, SUITE 401 │

MADISON, WI

FEBRUARY 14, 2011

DEVELOPING WISCONSIN’S MEDICAL WORKFORCE

MEDICAL COLLEGE OF WISCONSIN

PRESENTATION TO THE

LEGISLATIVE COUNCIL SPECIAL COMMITTEE ON HEALTH CARE ACCESS

John R. Raymond, Sr., MD │ President and CEOKenneth B. Simons, MD │ Associate Dean, Graduate Medical Education

Alan K. David, MD │ Chairman, Department of Family and Community Medicine

OVERVIEW

MCW Education Mission Motivating Factors for Medical Students Pipeline Programs Admissions Process and Criteria Focus on Wisconsin Students Focus on Diversity Primary Care Graduate Medical Education Family Medicine Training Future Vision

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MEDICAL COLLEGE EDUCATION MISSION

Be a national leader in the education and development of the next generation of physicians and scientists

Over 15,000 alumni caring for Wisconsin / SE region citizens

Current enrollees820 medical students

439 graduate students644 physicians in residency training127 physicians in fellowship training

180 post-doctoral scientists* 7,000 continuing health professionals

*Includes Blood Research Institute post-docs 3

THE PHYSICIAN’S JOURNEY

18 years 4 - 5 years 4 years 3 – 7 years 2 – 4 years

CONTINUING MEDICAL EDUCATIO

N

career

specialty choice 4th year

4

K – 12

HIGHER ED

MEDICALSCHOOL

RESIDENCY TRAINING

(GRADUATE MEDICAL

EDUCATION)

SPECIALTYFELLOWSHIP

TRAINING

PIPELINE

WORKFORCE

2010 MATRICULATING STUDENT PERSPECTIVE

*Source: AAMC Matriculating Student Questionnaire 2010 - MCW

When did you definitely decide that you wanted to study medicine?*MCW %

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2010 MATRICULATING STUDENT PERSPECTIVE

*Source: AAMC Matriculating Student Questionnaire 2010 - MCW

How did the following factors influence your decision to study medicine rather than pursue another career?*

Neg

ativ

e

Po

sitiv

e

Science courseHealth-related work experienceCompetitiveness / challenge of medicineParent / Relative / Friend / PhysicianExperience with illness/accidentProfessor / teacherParticular book, article, film, TVAnticipated future salaryHealth professionals advisorCareer / guidance counselor Anticipated lifestyle balanceAnticipated financial debt

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SIX MCW PIPELINE PROGRAMS

High School Programs

Apprenticeship in Medicine (AIM)(12 students)

Research Opportunity for Academic Development in Science (ROADS)

(7-10 students)

Sickle Cell Summer for Science Program(3 students)

American Chemical Society – Project SEED (2 students)

Undergraduate Programs

Diversity Summer Health-related Research Education Program (DSHREP)

(14 students)

Environmental Health Sciences Training Program (EHSTP)

(3 students)

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66% graduated high school65% attended college

6 physicians1 graduate student (Epidemiology)

1 Associate Director DeVry University

34% high school graduation N/A

74% graduated high school60% attended college

5 physicians2 nurses

2 graduate students

26% high school graduation N/A

Research Opportunity for Academic Development in Science (ROADS)

77 trainees since 1996

Apprenticeship in Medicine (AIM)170 trainees since 1996

SUMMER PIPELINE PROGRAMS – HIGH SCHOOL

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SUMMER PIPELINE PROGRAMS - UNDERGRADUATE

27 (22%) are physicians19 (16%) are in medical school

14 (11%) are completing undergraduate studies12 (10%) are health/science professionals

2 are in graduate school for a PhD1 has a PhD

75 (62%) are now in health-related fields

Diversity Summer Health Related Education Program 121 total trainees since 1996

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MEDICAL SCHOOL 5-STEP ADMISSIONS PROCESS &

CRITERIAInitial Review

Grade Point Averages (GPAs) and Medical College Admissions Test (MCAT)

Screening Review by Committee application, personal statement, letters of recommendation and activities

Selection of Candidates to Interviewbased on outcome of two previous reviews

Interview pre-determined intrinsic qualities sought in a medical student and future clinician

Committee Decision

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MEDICAL SCHOOL ADMISSIONS SUMMARY 2010

APPLICANTS ACCEPTS ENROLLEES

MCW Total 6254 477 204

Wisconsin Residents 639 140 69

Total Underrepresented 334 61 13

Wisconsin Underrepresented 25 7 1

Non-SE WisconsinOutside Kenosha, Racine, Milwaukee, Ozaukee, Waukesha counties

459 92 47

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COMMITMENT TO WISCONSIN STUDENTS:

WISCONSIN CAPITATION APPROPRIATION

State Appropriated Capitation (tuition assistance to in-state students)

Amount of aid to student is pro-rated annually depending on number of in-state applicants that year

1975 - 2002 FY 2003 - 2005 FY 2009 - 2011 FY 2011 - 2013 proposed

$4,105,100 $2,052,5500 $1,926,600 $1,734,000

50% cut 10% cut 10% cut

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MCW STUDENT ENROLLMENT &CAPITATION APPROPRIATION TREND

Cap

itatio

n A

ppro

pria

tion

MC

W Enrolled Students

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DIVERSITY AND UNDERREPRESENTED IN MEDICINE

(URM)AAMC

Association of American Medical Colleges

Native Americans (American Indian, Alaska Natives, Native Hawaiians)

African Americans

Mexican Americans

Mainland Puerto Ricans

Current AAMC shift in defining “underrepresented”

MCW + AAMCGrowing up in poverty or in a disadvantaged socioeconomic status

Being the first person from one’s family to attend college or graduate school

Overcoming educational disadvantage (graduating from a high school with little resources or with a high dropout rate)

Having primary language other than English

Living in a rural area

Overcoming a significant handicap

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MCW COMMITMENT TO DIVERSITY

Senior Associate Dean, DiversityAssociate Dean, Student Affairs and DiversityDean’s Diversity Advisory Committee Graduate Medical Education Diversity CommitteeDiversity Scholarships6 Pipeline Enrichment ProgramsMilwaukee Academy of Science

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GRADUATE MEDICAL EDUCATION:

KEEPING OUR GRADUATES IN WISCONSIN

977 physicians have graduated from MCWAH* residency programs in the last 5 years

45% of MCWAH graduate trained physicians stay in Wisconsin to practice

41% of those who stay in Wisconsin practice in primary care fields

2006 – 2010

2006 – 2010

16*Medical College of Wisconsin Affiliated Hospitals Residency Programs

FAMILY MEDICINE:FORGING PRIMARY CARE TRAINING

Adaptability of family physicians Infant Geriatrics Procedural Behavioral Rural Suburban Urban

Longitudinal Experience Academic Enrichment Electives Urban Community Pathway Family Medicine Student Interest Groups Clerkships in clinical years Rural medical student placements

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FAMILY MEDICINE GRADUATE TRAINING:

A WISCONSIN PARTNERSHIPPartnership = MCW + Community Hospitals + State of Wisconsin

Since 1975 the Department of Family and Community Medicine has educated over 961 Family Physicians.

58% of Family physician graduates stayed in Wisconsin.

Each Family physician employs, on average, 4.5 FTE staff. Thus over 2,484 Wisconsin jobs have been created since 1975 in addition

to the physicians.

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MCW FAMILY MEDICINE PHYSICIANS IN WISCONSIN 1976 – 2010

Of the 961 Family Medicine Residency Program Graduates

since 1976,

552 (57%) entered practice in

Wisconsin.

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MCW FAMILY MEDICINE GRADUATES STAYING IN WISCONSIN

60% AVERAGE IN-STATE

RETENTION SINCE 1995

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MCW FAMILY MEDICINE GRADUATES BORN IN WI WHO PRACTICE IN WI

84% AVERAGE

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1998

$3,371,900 State Appropriation5 programs ■ 108 residents

$3,371,900 State Appropriation4 programs ■ 96 residents

$3,165,000 State Appropriation3 programs ■ 54 residents

200382010

MCW FAMILY MEDICINE STATE APPROPRIATION TREND

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MCW FAMILY MEDICINE STATE SUPPORT

1993 – 2012 PROJECTION

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EXPANSION PROPOSAL:MCW FAMILY MEDICINE RESIDENCY

TRAININGProposal: Expand residency program capacity through increased State appropriation of $1.5 million / year

2 new residents/class/program/year (priority to applicants with WI connections/roots)New faculty/program

Timeline: 3 years – will result in an increase of 6 graduates/year new program within 5 years

End Result: Creation of a new program – less costly output and shorter time-frame

Benefit: If paired with Capitation increase, great likelihood of increasing family physicians in Wisconsin

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FUTURE VISION

Restore Capitation Capture the students Wisconsin is losing to other states and careers

Increase Family Medicine Residency TrainingExpand current residency program capacity

Expand Pipeline ProgramsDevelop and grow enrichment opportunities for high school and undergraduate students

Increase Number and Scope of PracticeJudiciously review expansion of allied health professional care

Expand Medical Education in WisconsinStatewide team approach to medical and allied health professional education

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