Primary Care and Psychiatry Shortage Grant Program/Act 128

Wisconsin must add 100 new physicians per year to avoid a shortfall of 2,000 physicians by 2030. Most of these physicians are needed in primary care and in underserved areas of the state. The Academy seeks to aid lawmakers in meeting the state's health care demands. View Health Shortage Area in Wisconsin.

1. Increase the number of primary care physicians practicing here, serving our highest-need populations in rural and medically underserved areas;
   
   • Primary care includes: Family Medicine; Psychiatry & Child Psychiatry; Pediatrics; Internal Medicine; and General Surgery.
   • These vital needs within our health care system and our economy will be satisfied by additional numbers of Wisconsin students.
2. Retain these Wisconsin-grown primary care physicians on a career-long basis;
   
   • This robust & geographically broad program provides opportunities throughout many areas of the state, creating significant flexibility and attractiveness.
3. Transform the entire financial landscape of "Choosing Wisconsin";
   
   • Students will more easily pursue education here, GME training here, and ultimately live, raise families and practice here.

1. Reduces the $3.5 million career "income gap" between primary care & subspecialty careers - a major disincentive to enter primary care;
2. Provides significant opportunities for debt relief; and
3. Creates opportunity & certainty for debt-averse, prospective students who wish to pursue a medical education, but ultimately follow other paths due to financial concerns.

A 2004 study analyzed 69 state-based programs to attract primary care physicians into rural & underserved areas. The best programs achieved 93% completion/retention rates vs. 44.7% for the least efficient. Participants also cared for more Medicaid & uninsured patients & were more likely to own their own family medicine practices, particularly in needy settings.

The Primary Care and Psychiatry Shortage Grant Program incorporates the best aspects of the most effective programs in the nation, but also incorporates a much longer-term retention strategy than even the best of these programs. 

The Primary Care & Psychiatry Shortage Grant Program encourages primary care physicians and psychiatrists to locate in medically underserved areas of the state by providing service-based financial assistance to Wisconsin residents who have graduated from a Wisconsin medical school and completed a medical residency training program (with a primary care or psychiatry emphasis) in Wisconsin. After meeting these eligibility criteria, physicians may begin claiming the financial assistance if they then go on to practice primary care medicine or psychiatry in a medically underserved area of the state.

For the purposes of eligibility, students must have established residency in the state prior to entering a medical school located in Wisconsin (currently either MCW or UWSMPH). This residency requirement mirrors the UW's residency requirements establishing in-state vs. out-of-state tuition rates (s. 36.27(2)), or the formula used to provide Capitation funding to in-state MCW students.

Participants must sign up for the program prior to accepting an employment offer within a designated health shortage area (see map link at top of page) in Wisconsin and may enroll (but may not receive grant payments) while still participating in an eligible GME training program. These GME programs include: Family Medicine; Internal Medicine; Pediatrics; Psychiatry; and General Surgery. Qualifying GME programs may be geographically located anywhere in the state.

Following completion of a qualifying GME program, participants must begin practicing primary care medicine or psychiatry within a medically underserved area of the state. Primary care practice is defined as the following Medical Examining Board licensure codes: Family Medicine; Pediatrics; Internal Medicine; and General Surgery. The practice of psychiatry includes the following codes: Psychiatry & Child Psychiatry. Medically underserved areas are defined as Health Professional Shortage Areas (HPSA's); Medically Underserved Areas/Populations (MUA/MUP); and Governor's Designation of Shortage Areas for Rural Health Clinics.

Annual grant payments are made directly to participants and are unrestricted (i.e., they are not required to be used toward loan repayment). Eligibility is lost if a participant leaves the shortage area or begins practicing within a non-qualifying subspecialty. There is no repayment penalty for leaving the program early, as payments are based on previously completed service. The program will be administered by the Wisconsin Higher Educational Aids Board (HEAB). Rule-making authority is provided to administer, track & enforce the program.

The program is funded with a one time, $2 million appropriation, of which, $1 million would be used for grants directed to primary care physicians and $1 million directed to psychiatrists. Limit the number of participants to 12 primary care physicians and 12 psychiatrists (24 physicians overall) that may receive annual grant payments over a three year period. Prioritize assistance to eligible physicians in conjunction with the order of applications received and with the shortage area's HPSA score (which reflects an area's overall medical need).

The program will begin providing assistance to participants who complete GME training programs in calendar years 2014 and beyond. The grants assistance is exempt from Wisconsin income tax.