Collaborative Name Change
WRPRAPUPDATE
June 2012
Who We Are
The Wisconsin Rural Physician Assistance Program is the result of Wisconsin Act 190, passed and funded by the state legislature to address the acute and growing shortage of the medical workforce in rural Wisconsin. In addition to providing resources for health care provider loan repayment, the legislation allocated $750,000 in Budget Year 2010-11 to a new "rural physician residency assistance program" and designated the University of Wisconsin Department of Family Medicine to administer these funds, specifically for supporting graduate medical education in rural areas. The funding continues in the current biennium and is available to any Wisconsin residency program in family medicine, general surgery, internal medicine, obstetrics, pediatrics or psychiatry.
Collaborative Name Change
The Wisconsin Rural Training Track Collaborative (WRTTC) was formed early this year as a vehicle to promote the development of Rural Training Tracks in Wisconsin. This was a strategy to address the growing need for primary care physicians adequately prepared for the unique demands of rural practice. WRPRAP provided start-up funding ($150,000) and the Rural Wisconsin Health Cooperative provided leadership for nurturing a cooperative approach for small community organizations to worktogether to offer resident training experiences in their local hospitals and clinics.
Interest, expertise and organizational capacity do not always perfectly align. After several meetings of the new WRTTC, it was determined that each organization would find its own path to an appropriate role in resident education, e.g., as a continuity site, a rotation site for an existing residency program,as a partner to an existing RTT(Rural Training Track), as a new RTT, etc.. Each could make a distinct contribution to training the future rural medical workforce.
Hence, the name change to the Wisconsin Collaborative for Rural Graduate Medical Education (WCRGME). Consistent with the original intent, the Collaborative partners will share resources and administrative functions and will operate both independently and collaboratively to complement each other’s programs and services. WCRGME has been meeting monthly, usually via teleconference, to share ideas and mutual support toward developing a functioning entity with a single purpose and multiple strategies to achieve it.
Collaborative Hires Manager
Another key step in WCRGME development is hiring staff. After a long search process, WCRGME has hired a Development and Support Manager. Kara Traxler, currently Baraboo RTT Education Coordinator, has accepted the position and will begin on June 25th. She will have regular interaction with WCRGME members for whom she will provide support. This includes infrastructure development, meeting ACGME requirements, and organizing an Education Committee to develop shared resources (e.g., duty hours monitoring, PIF preparation, evaluation forms, local program policies, didactic seminars, preceptor training, etc.).
Grants Update: Six New Grants Open Doors to GME Development
In addition to the $150,000grant that created the RTT Collaborative (now WCRGME), WRPRAP has awarded six other development grants to rural organizations in the last quarter. Half will enable feasibility studies to explore options for GME that are best matched to their organizational capacity and their community’s need. Others have identified specific development goals. Awardees are:
Baraboo RTT: (Baraboo)$35,000
Design and implementation of Phase I of Baraboo RTT’s Women’s Health Curriculum Redesign. Plan includespurchase of an OB Ultrasound scanning machine for the exclusive use of the RTT for training residents, writing curriculum, resident teaching and scan supervision.
Calumet Medical Center/Fox Valley: (Chilton/Appleton)$35,000
Development of CMC as rotation site for residents of UW Fox Valley Family Medicine Residency,accepting one resident per quarter or four per year for experiences in General Surgery, OB/GYN, Otolaryngology/ENT, Ortho, Urology, health care services or patient management.
Community Health Network (Berlin): $34,970
Conduct a feasibility study to determine potential for developing a community-based RTT in a CAH setting.
Grant Regional Health Center (Lancaster):$34,974
Conduct a feasibility study to determine if GRHC has sufficient capacity to develop a rural rotation in clinic and hospital experiences (family practice, obstetrics and emergency medicine) in a CAH setting.
Monroe Clinic: (Monroe)$150,000*
Develop a fourth year rural fellowship programfor licensed physicians for emergency medicine and hospitalist specialties for rural practice. The fellowship program is a first step in developing a full rural training track in two to five years.
*Submitted as an unsolicited RFP in a different grant category
Upland Hills Health Center (Dodgeville)$35,000
Conduct a feasibility study to explore creating a sustainable Rural Training Track based in Dodgeville in collaboration with four potential partners.
WRPRAP Supports Collaborative Development
WRPRAP has arranged with two RTT Development experts to provide consultation to the Collaborative as a group and also to individual members in July and September. Both consultants are from the Family Medicine Residency of Idaho and both have earned a national reputation in RTT policy, implementation, and/or consultation/training in RTT development. Over two sets of dates in July, Dr. David Schmitz will spend time with each of our grantees to help them assess their suitability and assets for developing some brand of rural GME or provide development advice for a determined model. A detailed questionnaire has been distributed to help grantees prepare for these conversations. In September, both Drs. Schmitz and Ted Epperly will come to Wisconsin for a 2.5-day visit for further coaching and learning experiences.
Other Available Funding
Theawards described above are largely for development of new initiatives. WRPRAP support for existing resident training programs in rural communities continues to be available. Information, guidelines and application materials for all these grants are available on the WRPRAP website at
Staff are happy to answer your questions about expanding your own residency education efforts (Wilda Nilsestuen: 608-262-2764) or walk you through the uncomplicated application process (Paul Howl: 608-265-5670). Or, visit to keep up with program activities.
The Bigger RTT Picture
After more than a decade of declining interest in and unsustainable results for RTTs, the trend is reversing as demonstrated by a proliferation of programs in various stages of early development, contemplating and exploring development and searching for various models beyond the usual 1-2 standard format. Creating more rural training opportunities for future physicians is precisely WRPRAP’s mission of course, but it is gratifying to note a higher level of recognition of the urgency of meeting rural communities’ needsamong academics, policy makers, rural communities themselves – as well as the RTT “evangelists” who long have been raising the issues and experimenting with solutions.
There are both old and new challenges to the expansion of RTTS and other models of GME for building the future rural medical workforce – challenges that will require innovators, risk takers and enlightened policy makers as the whole health care system churns through unprecedented change with uncertain outcomes.
The federally funded RTT Technical Assistance Program directed by Randy Longenecker, MD is halfway through a 3-year grant that is studying both challenges and solutions and providing technical assistance to developing programs. Attached with permission is a PPT presented recently by Dr. Longenecker and Dave Schmitz, MD of the Family Medicine Residency of Idaho. It provides some RTT history and also some new approaches to the RTT strategy. More information is available at:
Websites: and including policy briefs on RTTs and graduate outcomes
Randall Longenecker MD, project director,
Dan Mareck MD, project officer, Office of Rural Health Policy
pg. 1