National Rural Health Day 2024: Training Tomorrow's Rural Ob-Gyn Physicians

Across the United States, rural access to obstetrics and gynecology providers is on the decline. According to the Wisconsin Office of Rural Health, 40 percent of hospitals in rural Wisconsin do not offer obstetrics services. “There is an actual crisis in rural medicine,” says Department of Ob-Gyn Chair Ellen Hartenbach, MD. “Hospitals in rural communities are closing their maternity centers, and there are parts of Wisconsin where people are long distances away from hospitals where they can give birth.”
The UW Department of Ob-Gyn has been a leader in addressing rural health disparities since 2017, when the Residency Program launched the first-ever rural ob-gyn residency track in the country. The rural residency track gives residents real-life experience practicing in rural settings with rotations at several rural hospitals and clinics around the state. “It’s a really fascinating phenomenon that we’ve seen repeatedly, the more time someone spends training in a rural area, the much more likely they are to practice in a rural area following residency,” says Ryan Spencer, MD, MS, rural residency track director.
With the help of a new grant from the United States Department of Health and Human Services through the Health Resources and Services Administration (HRSA), the Department of Ob-Gyn is poised to further expand the rural training opportunities for ob-gyn residents in Wisconsin. The HRSA grant provides $750,000 over three years to create a new Rural Training Program in partnership with the University of Wisconsin Hospitals and Clinics (UW Health) and the Marshfield Clinic Health System (MCHS) in central Wisconsin.
In the current rural residency track training model, rural ob-gyn residents spent about six months of their four years of training in rural sites. With the new Rural Training Program, residents complete just under half of their training in Madison, establishing the foundations of their clinical skills at UW Health alongside other ob-gyn residents. They will spend more than two years of residency with MCHS, where they will continue to build skills in obstetrics, gynecologic surgery, and ambulatory medicine as they care for rural, underserved patients and become comfortable providing care in a rural community.
“What I’ve heard from the residents who go out on these rotations is they get a great experience in rural areas and smaller communities,” says Spencer. “They get a feeling for what their day-to-day life would be like. In some cases, they might have clinic on the same day they do a delivery on the same day they do some surgery. That’s not the typical experience when training at UW Health.”
The HRSA grant will also support adding another rural residency spot, doubling the rural resident complement in this already highly competitive track. Spencer led the HRSA grant application, which received a perfect score. He believes the rural rotations are an invaluable experience for rural ob-gyn residents as well as their peers.
“It definitely enriches the experience of our residents who are not in the rural track,” Dr. Spencer says. “They hear about the experiences of their counterparts in rural areas, and it helps them understand why certain transfers come to Madison, what systems of care and limitations in services other providers and other places are working with.”
The UW Department of Ob-Gyn was one of 15 recipients of the $11 million investment from the federal government in rural health, and the only obstetrics and gynecology-specific program to be funded.
**This story originally published in the 2024 UW Department of Ob-Gyn Five-Year Report. Find the whole report here.