Deliberations in Lansing over a new state budget will decide whether a state-backed initiative to increase the number of new doctors serving in rural and underserved markets across Michigan can expand next year.
House lawmakers have approved Gov. Gretchen Whitmer’s proposal to direct $5.1 million for the MIDOCS program in the 2021-22 fiscal year that starts Oct. 1. A Senate-passed budget plan allocated $6.4 million, an amount MIDOCS requested and hopes to still receive to support 24 medical residents next year.
“We’re still hopeful on negotiations that we can get there and, quite frankly, there’s funding in the state budget that can get us there,” said Jerry Kooiman, assistant dean and chief external relations officer for Michigan State University’s College of Human Medicine.
MSU, Wayne State University School of Medicine, Central Michigan University College of Medicine, and Western Michigan University Homer Stryker M.D. School of Medicine (WMed) formed MIDOCS in 2019 as a way to ease physician shortages in the state. Each medical school supports MIDOCS by matching state-budget funding. MIDOCS also receives funding from the federal Centers for Medicare and Medicaid Services.
Since 2019, MIDOCS has placed 52 medical residents at health care providers in underserved markets across the state. Participating medical residents represent a “strong mix” across disciplines such as psychiatry, internal and family medicine, pediatrics, general surgery and OB/GYN, Kooiman said.
MIDOCS is a new model to begin addressing a growing physician shortage in rural and underserved markets in Michigan by funding additional residency slots.
Nationwide, the American Association of Medical Colleges estimates that the U.S. will have a shortage of at least 37,800 primary care and specialty physicians by 2034. That shortage could grow to as high as 124,000 as the nation’s population continues to age and requires more care, according to the association’s June 2021 report.
The estimated shortage of primary care physicians alone runs from between 17,800 and 48,000, according to the association.
Staying in the community
A $75,000 scholarship is key to drawing medical students into the program to serve their residencies in an underserved or rural market where care providers historically have difficulty recruiting. MIDOCS participants can use the money to pay their medical school debt if they spend two years working in a rural or underserved urban market after completing their medical residency.
The partner medical schools hope medical residents will opt to later live and work in the communities where they are placed for their graduate medical education. Surveys show that about 60 percent of medical residents end up in practice within 50 miles of where they serve their residency, a percentage that MIDOCS expects to exceed, Kooiman said.
“The goal is to have these students practicing in these areas five or 10 years out, and we want them to be looking at this program as this is where they’re going to live and practice medicine in the future,” Kooiman said.
MIDOCS started in 2019 with a cohort of eight medical residents, which grew to 24 in 2020 and then fell back to 20 positions for the new year academic that began July 1.
As more medical residents enter MIDOCS each year, the medical schools have a hard time sustaining their funding, Kooiman said. A Centers for Medicare and Medicaid Services interpretation of graduate medical education funding rules has also resulted in MIDOCS receiving a lower amount from the federal government than initially expected, he said.
Psychiatry and family medicine are the biggest specialties represented in MIDOCS, with 18 positions each. Psychiatry especially has what Kooiman calls a “huge” shortage in the northern reaches of the state. MIDOCS has been able to place four psychiatry residents in the Upper Peninsula — where just seven psychiatrists previously worked — and will place two more next year, Kooiman said.
“Three years worth of cohorts in the U.P. pretty much doubles the psychiatrists in the Upper Peninsula, and we want every one of those residents to end up practicing psychiatry in the Upper Peninsula,” Kooiman said. “If that happens ... this will be an incredibly successful program.”
Dr. Stephen Murata, a native of suburban Los Angeles who attended Loyola University Chicago Stritch School of Medicine, is among the MIDOCS medical residents in psychiatry.
Murata was attracted to MIDOCS as he was applying for a medical residency because he wanted to work in an underserved market, an interest he developed while teaching in Chicago prior to medical school. He’s presently serving his medical residency at Pine Rest Christian Mental Health Services in Grand Rapids.
Next summer, Murata will move up to Munson Healthcare in Traverse City to serve the final two years of his residency.
MIDOCS “is like a natural pathway for me to integrate my love for mental health care, psychiatry and the underserved,” particularly adolescents and their families, he said.
“It helps connect me to those particular communities,” said Murata, who wants to stay in Michigan to practice once his residency ends.