It’s hard to believe: Only 6 percent of all OB-GYNs in the United States practice in rural environments.
An effort to boost that number brought Dr. Laura McDowell to Portage.
“We have to start somewhere,” the 27-year-old obstetrician-gynecologist said of her participation in the University of Wisconsin-Madison’s rural-residency program for OB-GYNs — the first such program in the nation.
McDowell is the first participant, and Portage is her first stop on her clinical rotations. She’ll train in hospitals in Monroe, Watertown and Ripon, too, for a total of eight rotations during her four-year residency, training in each location twice.
“The need has been there for so long,” McDowell said of her goal to work in a rural environment like Portage.
She’s very much aware of the shortage of rural OB-GYNs, in part because she grew up in rural Minnesota, in communities with populations as low as 370, she said. Last year she graduated from medical school at University of Minnesota-Duluth, where the city’s population is less than 90,000 and where the focus of the school was centered, naturally, on rural medicine.
She’s learning at Divine Savior Healthcare in Portage from Dr. Brenda Jenkin, who grew up on a pig farm near Brandon, Wisconsin.
“Population: 853,” Jenkin had memorized.
Jenkin, the only OB-GYN practicing in Portage, earned her medical degree from UW-Madison in 1987 and completed her four-year residency in Philadelphia in 1991. She spent the majority of her career working in urban settings — once part of the 94 percent of OB-GYNs who do so today — before she left Madison for Portage about three years ago.
Nearly half of the counties in the U.S. do not have an obstetrician/gynecologist, according to the American College of Nurse-Midwives.
“What happens is people need to travel long distances for care,” Jenkin said. “People don’t always have the means to travel long distances for care. Everybody doesn’t have a car, everybody doesn’t have a driver’s license, there’s no public transportation and sometimes they’re working two or three jobs.
“So there are the same barriers to health care that you have in the inner city, except you add on that it’s an hour away.”
Rural Residency Program Manager Jody Silva said it took the university about three years to develop the program for OB-GYNs after receiving a $375,000 grant from the Wisconsin Rural Physicians Residency Assistance Program. WRPRAP, itself funded by the state budget and housed at UW-Madison, launched in 2010 and each year helps fund rural rotations for various Wisconsin medical schools in fields like psychiatry, surgery and OB-GYN, program coordinator Kimberly Bruksch-Meck explained.
“It’s a pioneering effort,” Bruksch-Meck said of America’s first rural residency program for OB-GYNs. “Women’s health in general is in high need in rural Wisconsin, where there’s a large shortage of physicians, even among family physicians.”
McDowell, who spent the first year of her training in Madison, is the only doctor in the rural-residency program, but the school expects to add a second doctor soon and will have four residents on a rural track by 2021. McDowell and the others who follow her will spend about 80 percent of their residencies in Madison, Silva said. Participants get picked for the program if they want to practice in rural areas, the university also considering if they’re from from rural settings and if they had rural experience during medical school.
“Our ultimate goal would be to expand the program even more,” Silva said. “What the program was built upon was providing a larger OB-GYN workforce in rural Wisconsin because it’s in great need right now, and we definitely don’t have any plans to stop (adding doctors and rural sites). We hope to increase our numbers as the demands increase.”
There will be between 6,000 and 8,800 fewer OB-GYNs than needed in the U.S. by the year 2020 and a shortage of 22,000 by the year 2050, according to the American Congress of Obstetricians and Gynecologists, the estimates noted by the university.
“Pregnant women driving an hour-plus to seek medical care, that can be dangerous for both the mom and baby,” Silva said. “Another issue is maternal mortality: women dying after giving birth is on the rise, and so these two things have reached a critical point where pregnant women need easier access to doctors.
“We expect the population to increase in rural locations while the doctors decrease, so it will only get that much worse.”
Only about 19 percent of the U.S. population reside in what’s considered rural areas, or roughly 60 million people, according to the U.S. Census Bureau in 2016. This is despite the fact 97 percent of the nation’s land is considered rural.
But the 94-6 ratio in favor of urban OB-GYNs is “very disproportionate,” no matter how you analyze it, McDowell said. “In my experience, some people don’t even feel comfortable going to the bigger city, and so that’s another barrier,” she said. “Some people choose not to seek care, in general, because their fear of being in the city is so much.
“I can’t blame them.”
Better late than never
Why did it take so long for the U.S. to get its first rural track for OB-GYNs?
“The light bulb went on. Somebody just finally saw the need,” said Jenkin, referring to doctors in Madison who helped develop the program.
“There is a global track for people interested in international medicine, so maybe somebody thought, ‘Gee, if we’re sending people to Ethiopia, maybe we can send some people to rural locations.’”
“Like Portage,” McDowell said.
After young doctors complete their traditional residencies, they typically seek jobs that look similar to what their programs had offered them, Jenkin said. Their comfort levels will most often take them to urban settings, accordingly.
“You’re not going to throw yourself into a place where there’s nobody in the hospital except you and a nurse,” Jenken said
“Here, it’s like a big mix of everything,” she said of McDowell’s training in Portage. “We’re floating all day, and every day is a little bit different.
“But it’s all right here. We do it all without running to another hospital.”
Said McDowell: “This was the program I wanted to go into because I knew it’d give me that ‘rural reality,’ versus an academic-centered residency program that you can get everywhere. I thought having that dichotomy would be really beneficial for my understanding once I get out of residency and establish a practice then.”
“It’s the full gamut,” Jenkin said, “which is really nice because in an academic setting you’re on labor and delivery for specific period of time, then on gynecologic surgery for period of time, and so on, whereas here it’s all integrated.”
McDowell is attracted to the more personal nature of the job and variety of work in rural hospitals, and she’s certain that she’ll choose to work in one after completing her residency, she said. “In the cities, it’s more like you’re doing shift work, whereas here, you’re literally on all the time.
“There’s no passing the hat, so to speak, to a partner, or at least not as much.”
“It takes the right person,” Jenkin said. “It’s not for everybody, and it shouldn’t be.”