MADISON – When students begin medical school, most usually face two key questions: Where will I end up practicing? And, What area of medicine will be best for me?
For the five medical students who make up the inaugural class of the Wisconsin Academy for Rural Medicine (WARM) at the University of Wisconsin School of Medicine and Public Health (SMPH), at least one of those big issues has been resolved-they know for sure that they eventually will be based in a rural Wisconsin community.
The WARM program was created specifically to produce thoroughly trained physicians who are committed to working in areas of the state where there are not nearly enough practitioners to meet the health care needs of the people living there.
“The physician shortage is a very serious national problem affecting every state,” says WARM creator Byron Crouse, associate dean for rural and community health. “With this program, we are beginning to address the problem and will be producing 25 rural physicians each year by 2015.”
The WARM students already are deeply immersed in biochemistry, histology and other classes that are part of the school’s traditional MD curriculum, and they are encouraged to take electives that are relevant to rural practice. The biggest change will occur during their third and fourth years, when the students will relocate from Madison to regional and rural learning communities for their clinical training. This first WARM group will be placed at the Marshfield Clinic’s Rice Lake clinic, starting in 2009.
The student-centered program is unique, adds Crouse, in that it offers participants the option to train in multiple specialty areas, not just primary care medicine.
Hailing from medium-sized to tiny communities across the Badger State, the WARM students appreciate the many virtues of small-town life, including low crime rates, small school districts, proximity to recreation and the support and involvement of fellow townspeople.
The students also are painfully aware of the problems of delivering health care in such communities, where, in addition to the physician shortage, residents tend to be sicker, poorer, older, uninsured and scattered widely.
Undaunted by the problems, the first five WARM students are committed to making things better. The following are brief profiles of the inaugural class:
– CARLA CARLSON:
For almost her entire life, except during college and now medical school, Carla Carlson lived on her family’s beef farm outside of the tightly-knit northwestern Wisconsin community of Boyceville, west of Eau Claire. All of her immediate and close family members still live in Boyceville and the surrounding community, as do the friends and neighbors with whom she has built such strong bonds over the years. She dreams of one day purchasing the farm and living on it with her own family.
Carlson knows that she and the four other students in the first WARM class will pave the way for others to come – and she likes being a trailblazer. She was one of the only members of her high school class to attend UW-Madison as an undergraduate.
“I persevered-and have been able to inspire others to accept the challenge and attend UW-Madison,” she says.
It was at UW-Madison that Carlson first became enthralled with the biological sciences. “I became fascinated with the human body while attending anatomy laboratory and lectures,” she says. Now she is taking gross anatomy and other first-year medical school courses.
But Boyceville calls her.
“I cannot imagine having a better life than practicing rural medicine around the people I love,” she says. “The WARM program will help me achieve my ambition of becoming a rural doctor and one day going back to Boyceville to set up a primary care clinic.”
– CLAY DEAN:
Before he was accepted into the WARM program, Clay Dean worked as a living assistant in Pittsville, a town of 900 located in the center of the state. He helped local residents with mental disabilities conduct their lives as independently as possible, building their skills and confidence as he assisted them with activities of daily living. Dean would drive them to the pharmacy in Nekoosa or accompany them on doctors’ visits in Marshfield, about a 45-minute round trip.
“I liked taking responsibility for my patients and having close interactions with them,” he says. “I want to continue doing that as a rural physician.”
Getting his patients involved in the community was also an important part of the job, whether it was taking walks around town, going shopping or finding employment. Dean views community involvement as a natural extension of what the typical rural doctor does.
“Rural physicians are not only responsible for the lives of their patients, but for the lives of their communities,” he says.
Dean developed his sense of community growing up in the Grant County town of Blue River, where he experienced first-hand some of the challenges of rural medicine.
“I had health check-ups and physicals done every year at the little clinic in Muscoda, but would rarely see the same doctor for two consecutive years,” he says. That lack of continuity can prevent patients from having the trusting relationships with their doctors that are so important to optimal care, he says.
Dean plans to put down roots in rural Wisconsin and provide years of sustained care to his future patients and community.
– SHANNA BERGER:
Both of Shanna Berger’s parents have worked for years in a critical-access hospital near their hometown of Baldwin, a northwestern town near Hudson. Her father is a physician assistant and her mother is a nurse. In dinner table conversations and focused discussions, Berger learned about many of the issues surrounding the creation of these federally-designated facilities located in areas of the country where shortages of physicians abound and thousands of patients do not get the care they need.
“The United States is a leader in health care as far as technological advances are concerned, but despite this, millions of people are underserved in this country and one of the most significant underserved populations exists in rural communities,” Berger says. “I see a growing need for rural physicians and I want to be a part of improving the care of rural patients.”
Living and working in rural Wisconsin in the future will also allow Berger to fulfill her life goal of raising her children in the same kind of community she was raised in, a goal all her WARM classmates share.
Growing up in Baldwin provided her many opportunities that may not have been possible in a city, she says. She held leadership positions in high school, participated in many clubs and, above all, was very active in community volunteer work, like her WARM compatriots.
“Working on behalf of the people of Baldwin was a meaningful way for me to give back to my extended community,” she says. “I will continue to do that throughout my life.”
– NATHAN VAKHARIA:
Nathan Vakharia is interested in many areas of medicine. During high school in McFarland, he took part in a school-to-work program that allowed him to shadow a local physician whose practice included many patients from surrounding Dane County communities. He interned at a local dentist office the second year of the program, and during college he joined the emergency medical services department.
Now as a WARM student, Vakharia looks forward to exploring several specialties as he clarifies his future in rural medicine, where physicians of all kinds are in short supply.
“The WARM program lays the foundation for multiple rural specialties, and this was an important consideration for me when I was applying,” he says. “Having flexibility in my practice will allow me to grow and extend my capabilities.”
Vakharia’s capabilities include a record of success in the classroom, as well as an impressive list of volunteer activities in the community. His parents taught him, he says, “that a community is much more than a place to live-it is an extended family and a way of life.”
Vakharia and his young family hope to settle in a small Wisconsin town such as the one in Upper Michigan where his wife was raised. Conversations with residents and health care providers there have helped him focus on improving rural care everywhere.
“I hope to help solve rural health problems by drawing on my humanistic principles, community service goals and creativity,” he says. “I want to build on the positive aspects of rural life while addressing the needs.”
– DIANE ANDERSON:
As part of her senior honors research at UW-Superior, Diane Anderson undertook an internship with UW’s Spirit of EAGLES, identifying cancer health care disparities among tribal communities in Wisconsin and Minnesota. Among other things, the project revealed that, for a variety of understandable reasons, many people living in rural areas are prone to delay seeking medical attention.
For Anderson, this realization was an up-close illustration of a problem that has frustrated health care providers for years: when patients seek care only after a problem becomes serious, their condition may have deteriorated dramatically.
The community-based research project with American Indians also taught Anderson how to successfully build relationships with people in diverse rural communities.
Medicine is a second career for Anderson. After leaving the business world that had taken her to several large cities, and with the ability to live anywhere, she and her husband chose to make Bayfield their home in 2000. One reason was to be closer to family. In addition, Anderson had grown up outside Waupun next to Horicon National Wildlife Refuge and wanted to live where she could appreciate nature again. She was also looking for the sense of community urban areas could not provide.
Even before she completed her individualized pre-medical studies at UW-Superior, Anderson thought she wanted to be a rural doctor. Now her vision is crystal clear.
“I hope to become a beacon in a rural Wisconsin community where I can contribute to addressing disparities in diverse populations and work with underserved patients,” she says.
