Although Sauk and Columbia counties are not yet experiencing a noticeable shortage of primary-care physicians, a statewide study suggests a dearth of doctors is looming.

A study released recently by the Wisconsin Hospital Association shows Wisconsin is short by nearly 375 primary-care physicians across 31 counties.

The study said Wisconsin's population older than age 75 will increase about 70 percent by the year 2030, and the number of people older than 65 will grow by 94 percent. In comparison, the study showed the average number of medical school students has remained steady for two decades.

"No single factor will impact our health-care delivery system as much as the aging of our population," George Quinn, WHA senior vice president, said in a prepared statement. "Older people require more health care, and we're expecting our graying demographics to drive up the number of physician office visits by 65 percent."

Local assessments

Randy Munson, a physician recruitment program manager from the Wisconsin Office of Rural Health, said he has been recruiting doctors to Wisconsin for 20 years, and said he believes "this is as bad as it has ever been by far."

About five years ago, he had about 55 physician jobs to fill. Now he has 109.

"These young doctors in residency programs, they don't have a lot of time to interview at 109 places. They can interview at five places or 10 at the most. And all of these places have to have everything perfect if they want that doctor's foot in the door," Munson said.

"Of every 100 doctors who call me saying where their interests lie - it's usually the southern third of Wisconsin. Anything not in the southern third in the state has a lot of trouble."

Baraboo and Portage were about as far north as doctors would be willing to travel for a job, Munson said.

Just a year ago, Portage was considered a federal physician shortage area before Munson helped recruit a doctor to all three major health groups in the city. Munson said the loss of that federal designation means additional physicians will not be eligible for loan repayment options that appeal to physicians sometimes with about $150,000 of student loan debt.

"The physician shortage in our area is a real problem for our community," said Michael Decker, Divine Savior Healthcare chief executive officer. "The current strain on the system, especially with regards to primary-care physicians, often results in increased patient load for the physician and increased waits for patients in our community."

Decker said his hospital will remain committed to the process of recruitment and retention of physicians to the area, especially family medicine practitioners. The new state-of-the-art facility, he said, can be a major attraction for potential physicians looking in the area.

A recruiter for Reedsburg Area Medical Center, Dennis Schommer, said that like Portage, the center is focused on recruitment and just added three physicians to resolve a shortage of primary-care physicians.

At Sauk Prairie Memorial Hospital and Clinics, Larry Schroeder, chief executive officer, said his organization is not experiencing a shortage, but that is not to say it might not happen.

Even though his hospital is closer to Madison, which he said is a large recruiting advantage, after many months a clinic still has an opening in Lodi for a physician.

This might mirror a pattern that Munson said he sees in areas of southeastern Wisconsin that typically never had problems recruiting doctors due to the proximity to Milwaukee and Madison.

A physician's perspective

For Dr. Timothy O'Neil, who formerly practiced family medicine in Columbus, there's one key reason why physicians might be reluctant to practice in a rural area such as Columbia County.

"If you're going to be a family practice physician," he said, "you have to be willing to work. That might mean that you can be a family practitioner, but you can't have a family."

It's not unusual, O'Neil said, for a rural or small-town family practice physician to be on call almost constantly, with few or no other physicians available to cover the calls. That can cut deeply into the physicians' personal time.

But even though there are clinics in rural areas whose doctors aren't perpetually on call, there's still the issue of how family practitioners are reimbursed.

O'Neil characterized this dichotomy as "cognitive medicine" vs. "procedural medicine."

Cognitive medicine is primarily what a family practitioner does. It might involve, for example, assessing a patient with numerous different health challenges and discerning the source of the symptoms with which the patient presents.

But physicians typically are reimbursed at a higher rate for doing procedures. Medicare, Medicaid or private insurers typically pay doctors more for, say, removing a mole than for the assessments of the whole patient that typify a family practitioner's work, O'Neil said.

"Historically, it's flawed," he said. "Cognitive medicine is not well reimbursed, and that's what family-care physicians do."

This discrepancy, he said, is one of many reasons why medical school students often opt to enter higher-paying specialties rather than family practice.

The problem for rural physicians usually isn't the quality of the hospitals, laboratories or clinics in rural areas. Nor is it necessarily an aversion to rural life.

"I like rural life," O'Neil said. "I enjoy seeing the corn and beans harvested every fall."

But, although he continues to live in Columbus - and is a member of the Columbia County Board of Supervisors - O'Neil said he's now doing urgent care in Madison, instead of doing family practice in Columbus, because of changes in ownership in his former Columbus clinic.

The next generation of physicians needs to, and usually does, contemplate the realities of family practice in rural areas while in medical school.

Even the incentive of partial payoff of student loans for practicing in a medically underserved area, O'Neil said, may not be adequate to attract and keep family practitioners in rural areas, if the issues of workload and reimbursement equity are not addressed.

A model program

James Damos heads the Baraboo Physician Rural Residency Training Program - originally one of six such programs in places such as Mauston, Prairie du Chien, Menomonee and Black River Falls. All of the other programs have ended because of a lack of funds.

He said such a program in Baraboo is so important because with fewer primary care physicians able to handle the demand, patients lose a "medical home."

"We desperately need people to do preventive health, immunize children, do a normal delivery and handle depression. If you have a medical home, you have one doctor to do that. The nice thing about it as a primary-care doctor is I know who to send you to," he said.

Damos allows first-year medical college graduates in his program to split their time between classroom training in Madison and clinic practice in Baraboo. The following two years are spent primarily working in Baraboo with local physicians.

Damos said studies have shown that physicians tend to join practices in regions similar to where they trained.

Since the program opened in 1996, he said, 100 percent of the 12 Baraboo physician graduates have chosen rural or underserved community practice. Fifty percent of the graduates have chosen rural practice in Wisconsin, and three graduates have joined the staff of Baraboo's St. Clare Hospital.

The training program appeared to be a success to medical-school graduates such as Bridget Delong, a first-year resident.

"In Madison, when I tell St. Mary's physicians that I'm a Baraboo resident, I'm often told that I'm learning from some of the best family physicians out there, and that makes me both proud and happy," Delong said.