The University of Wisconsin Hospital has been home to many firsts throughout its history, and its OB-GYN residency program has recently become the first to have a separate rural track.
OB-GYN residency program director Dr. Ryan Spencer said that in Wisconsin, 40% of the counties do not have an OB-GYN doctor, and 40% of the counties do not provide obstetric services. He added that around 50% of hospitals in the U.S. are unable to provide obstetric services.
UW Department of Obstetrics and Gynecology Vice Chair Dr. Ellen Hartenbach is the original visionary of the rural track program.
Spencer said Hartenbach applied the model of rural training that had been established for other medical subspecialties.
“We, as an education and training program, are best equipped to look at how we might help the problem from the standpoint of improving the pipeline of physicians who want to practice in rural settings, and that’s how we ended up starting the rural track,” Spencer said.
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Madeline Wetterhahn is a first-year OB-GYN resident at the UW Hospital and the most recent hire for the OB-GYN rural track program.
Wetterhahn said residency programs are typically based in metro areas where the adequate volume of deliveries and surgeries helps provide training for future OB-GYN.
The OB-GYN residency program at UW contains seven openings every year, six of which are part of the normal track and one is designated for the rural track, Wetterhahn said.
The rural track program started three years ago, making Wetterhahn the third person recruited for the position. The program is currently interviewing for their fourth rural track resident, so starting next year they will have a full complement of residents, Spencer said.
Residents on the traditional track would spend the entirety of their four-year OB-GYN training in Madison, splitting their time between Meriter, UW and St. Mary’s Hospitals. The person on the rural track has opportunities to spend time rotating through rural and community hospitals spread throughout Wisconsin, Spencer said.
There are currently four partnering hospitals, including Portage, Baldwin and Waupun, through which the rural track program residents rotate, Wetterhahn said.
There has recently been a trend of shutting down women’s health or obstetric services in rural hospitals, and general rural hospitals are experiencing significant amount of closures, Spencer said.
Spencer added that in 1997, only about 20% of Wisconsin counties did not offer obsentrics services, but by 2016, that number had grown to 40%. In the last 10 years, 12 rural Wisconsin hospitals closed their obstetrics unit, according to a report from the Wisconsin Office of Rural Health.
The closure of labor and deliveries centers is multifactorial. Spencer said obstetric units are often the speciality units at hospitals and high cost could be incurred from both manpower and equipment.
During times when not enough people are delivering, the reimbursement to keep the unit open and viable will no longer be there, which could then incur a financial loss for the hospital, Wetterhahn said.
Spencer said longer distance to care services is another difficulty faced by pregnant people living in rural counties. The longer driving time for basic prenatal care could result in people missing visits. He added that rural areas already see higher maternal and neonatal mortality rates.
In general, small hospitals often have fewer subspecialists available for immediate consultation and are less likely to provide higher level trauma and neonatal care services, Wetterhahn said.
Surgeries and deliveries are sometimes more complicated than expected, and it is good to call in someone with more experience. But at rural hospitals, there could be shortages of manpower, Wetterhahn said.
“We are used to seeing more complicated, higher-risk patients and seeing how those are managed, but without the rural track program, I think you wouldn’t necessarily get the exposure to the decision making as to whether or not it’s in the patient’s best interest to keep them here closer to home or … it would be better for them to … travel further, but maybe get care at a center where there had specialists and just more staff available,” Wetterhahn said.
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Spencer said being part of the rural track program at UW Hospital does not make it compulsory for residents to work in a rural setting after their residency, but program directors do hope the experience would make residents inclined to practice in rural hospitals.
Spencer added the next step of the program is to work with different funding agencies and look for grants that can help promote the model in other states and institutions.
“We certainly don’t want to remain the only for very long,” Spencer said. “We’d love to scale this up for other locations to be able to learn from what we [have] learned and avoid the pitfalls that we’ve encountered and ultimately take the Wisconsin Idea and spread it across the country to help women who are in situations where they might not get the ideal obstetric care that they deserve.”
