Four medical schools in Michigan partnered to direct new physicians into areas of the state that are underserved or have a shortage of physicians.
Backed by a $5 million budget allocation that the four institutions matched with $1.25 million apiece, the medical schools each placed two additional medical residents this year to train and work in medically underserved areas of Michigan. The schools hope that once the participants complete their three- to four-year medical residencies, they will remain and practice in that market.
In return, participants can receive $75,000 in debt forgiveness if they spend two years working in a rural or urban underserved market after completing their medical residency.
As of 2017, medical school graduates who borrowed for their education carried a median debt load of $192,000, according to the American Association of Medical Colleges. One in five graduates from a private medical school had debt of $300,000 or more.
The state-backed program, called MIDOCS, offers a new model to begin addressing growing physician shortages in underserved markets by funding additional residency slots for primary care.
“Part of our mission is to try to improve health care in our region and our state,” said Dr. David Overton, associate dean of graduate medical education at Kalamazoo-based Western Michigan University Homer Stryker M.D. School of Medicine, also known as WMed.
“We have a substantial shortage of primary care physicians. If we can increase the pipeline of our people to help render care in the state, that’s what we’re about as medical educators,” Overton said.
Joining WMed in MIDOCS are Michigan State University’s College of Human Medicine, the Central Michigan University College of Medicine, and the Wayne State University School of Medicine.
While medical schools across the U.S. have expanded their capacity in the last decade to address a national physician shortage, funding for graduate medical education from Medicare has remained capped and has not grown proportionately, Overton said.
MIDOCS was able to find matches and fill all eight new residency slots in the rural and underserved areas that were available in the first year of the program “with very, very minimal marketing,” he said. He credits the loan forgiveness for drawing in students to serve their residencies in a rural or underserved market.
“I think that’s outstanding. That very much bodes well for the future success of the program to be able to attract the best and the brightest students,” Overton said. “It tells you that medical students want to do the right thing. They want to be able to practice in those areas without concern for their educational debt load.
“This takes some of that pressure off them and allows them to do what they intuitively and altruistically wanted to do. I think that’s very reassuring.”
'Pretty cool concept'
The eight residency slots for MIDOCs went for family medicine, general medicine and pediatrics, psychiatry, general surgery, and OB-GYN. WMed’s two new residency slots were for family medicine and internal medicine, Overton said.
The program came together as medical schools for years looked for ways to create new medical residency positions in markets in the northern Lower Peninsula and Upper Peninsula where hospitals generally do not have enough population density to create their own “full-fledged program,” said Jerry Kooiman, chief external relations officer at MSU’s College of Human Medicine.
The four medical schools wanted to create or expand medical residencies to train future doctors who may later practice in those markets, easing physician shortages where they’re often the most acute, Kooiman said.
The net result was a “pretty cool concept” and the formation of MIDOCS, Kooiman said. He cites AAMC research that 60 percent of medical residents end up practicing within 50 miles of where they do their residency training.
MSU this year added two psychiatric residents through MIDOCS who will serve at UP Health System in Marquette. The Upper Peninsula is a market where a “huge need” for mental health care providers exists because of a severe shortage, Kooiman said.
“We are involved in medical education across the state. We also want to be a part of bringing health care to those communities, and the best way to do that is to be training students and residents in those communities with the idea that a majority of those are going to end up staying and practicing in those communities,” he said.
The Citizens Research Council of Michigan in June 2015 estimated that the state would need 12 percent more primary care physicians by 2030, or more than 1,900 above the 16,199 at the time. Across Michigan, 90 percent of 83 counties have at least a partial shortage in primary care physicians.
Nationally, the AAMC projects the U.S. will have a shortage by 2030 of at least 42,600 doctors, with some estimates as high as 120,000 doctors.
The four founding medical schools want to make MIDOCS a permanent program. They aim to fully expand in the second year to 12 residency slots each funded by MIDOCS for a total of 48 positions annually.
The $5 million state funding in the 2019 fiscal year, plus the matching money from the four medical schools, will pay for the first cohort of residents all the way through the program.
The universities also hope to secure matching federal funds, and will ask the state Legislature for $5 million in subsequent fiscal years to pay for future cohorts of medical residents to go through MIDOCS, Kooiman said. He believes MIDOCS will continue to gain legislative backing. The program “enjoyed strong support in the legislature last year,” he said.
“To keep this going, we need the funding annually,” Kooiman said.
Gov. Gretchen Whitmer included $3.7 million for MIDOCS in her recent budget proposal to lawmakers for the 2020 fiscal year, an amount that reflects the program would not spend the full $5 million appropriation in the first year.
In an announcement last week on the program, state Rep. Mary Whiteford, a Republican from South Haven who chairs the House Health and Human Services Appropriations Subcommittee, called MIDOCS a “new avenue for the state to support participating medical schools in a highly targeted and effective way.”
“This innovative legislation and collaborative effort expands capacity in residency programs. It provides unique financial incentives for new doctors to choose to practice in primary care and commit to care for medically underserved regions and patients,” Whiteford said.
In looking to the future, Overton at WMed is hopeful MIDOCS will gain the legislative support needed to continue for years. He’d also like to see the other medical schools in the state — such as the University of Michigan, MSU’s College of Osteopathic Medicine, and the Oakland University William Beaumont School of Medicine — become involved in MIDOCS.
“If this is good for the state with us, it would be better for the state with more,” he said.