1. So You Want to Start a Rural Residency Program? The University of Wisconsin Community General Surgery Program Mara C. Snyder, MA Program Manager, General Surgery Residency University of Wisconsin

2. Meeting Demands AAMC estimated a national physician shortage of 130,000 by 2015 – Aging population – High rates of individuals with chronic diseases – More diverse population – Physicians retiring from practice Impact of shortage is especially acute in rural areas – Lack of access to healthcare professionals

3. Contributing to the Problem Increased sub specialization of surgery – Training sub specialists who will likely practice at academic institutions – Decreased general surgery mentorship of trainees

4. … And at the University of Wisconsin Are we training small town community based general surgeons? – 84% of our categorical graduates did 2 years of research as part of their training (now required) – 90% of graduates go on to subspecialty fellowship training – Only 4 graduates since 2007 are practicing community general surgeons

5. Our reality calls us to take action... But are we required to go at it alone? Diminished Healthcare Access Negatively Impacts:  The economy (job creation, purchasing, tax revenues…)  Population health  Individual costs (avoidable hospitalizations) Support for Change

6. In Wisconsin 1.Wisconsin Rural Physicians Residency Assistance Program (WRPRAP) 2.Department of Health Services (DHS) grants 3.Primary Care and Psychiatry Shortage Grants 4.Rural Physician Loan Assistance Program (HASLAP)

7. Applied for and Awarded: Wisconsin Rural Physician Residency Assistance Program (WRPRAP) Grant DHS New Program Grant DHS Stipend Grant The University of Wisconsin- Community General Surgery Training Model

8. Options for Shifting the Training Paradigm OPTION #1: Increasing support/ development of community based residencies OPTION #2: Fellowship training in “rural surgery”  Following 5 years of traditional training

9. So You Want to Train Community Surgeons OPTIONS, OPTIONS, OPTIONS… 1.“Fellowship” training during residency – Instead of research time, trainee “rotates” at rural sites 2.Separate rural surgery track in traditional program – Identify residents AFTER recruitment, who divert into rural track 3.Integration of small community rotations in curriculum – Elective – Mandatory …

10. The University of Wisconsin- Community General Surgery Training Model Creation of a Community General Surgery Track embedded within the traditional academic training program – Track v. New Program?

11. The University of Wisconsin- Community General Surgery Training Model Obtaining Support – Obtained Department Support – GMEC Approved our request for a complement increase (institutional support) – RRC-surgery approved complement increase, with 1 resident /year identified in rural surgery track

12. The University of Wisconsin- Community General Surgery Training Model Fundamental Model – Separately identified and recruited residents – Embedded into 60 months of general surgery training – Composite of traditional training, with some unique experiences

13. The University of Wisconsin- Community General Surgery Training Model General Curriculum – Majority of training in traditional program – 12-18 months of unique training with regional partners Endoscopy Community general surgery- breast, benign biliary, colorectal, Specialty training- c- sections, urology, ent, gyn. Mentorship Decreased emphasis on advanced transplant, HPB oncology, colorectal – Rural Rotations in years 2,3,4

15. The University of Wisconsin- Community General Surgery Training Model Identifying Partners – Nearby regional hospitals were identified – Travel to sites to assess interest in training residents – 2 partner sites selected Theda Clark Hospital in Neenah, WI Waupun Memorial Hospital in Waupun, WI

16. Current Status Successfully recruited and matched our first resident to the community general surgery track (PGY1 in 2015-16) Continue to work with partner sites to plan and develop curriculum Beginning recruitment of 2 nd community track resident for 2016 match The University of Wisconsin- Community General Surgery Training Model

17. The need is unquestioned The solution - contributions from community based and university based programs Requires a multifaceted approach – Individualized based on program type/design Summary

18. Thank You