Pilot Rural Psychiatry Residency Program will increase access to mental health care

A pilot rural psychiatry residency program will welcome its first two residents, Tovah Aho and Ann Marie Botros, to the Upper Peninsula (UP) in July of 2021. Michigan State University College of Human Medicine’s Dr. Stuart Johnson, community assistant dean at the UP campus, and Dr. Jed Magen, associate professor and chair of the Department of Psychiatry in East Lansing, presented on the need and opportunity for a rural psychiatry residency track in the UP at the Upper Peninsula Healthcare Solutions meeting last fall.

The MIDOCs program is a joint venture between four medical schools in Michigan, including MSU College of Human Medicine, and the State of Michigan. The program provides the funding to expand residency positions where half of the experience will occur in a rural site. Residents involved in this program receive a loan up to $75,000 which may be used to pay off medical school debt. The loan is forgiven if they practice in the Upper Peninsula for two years after they complete their training.

The State of Michigan requires the contribution for loan repayment come from local sources. In response to the dire need of psychiatric providers in the UP, the Portage Health Foundation generously agreed to cover the finances for the first two loan forgiveness recipients, committing $18,750 each for four years, totaling $150,000.

“I have worked in health care and I know how difficult it is to recruit doctors that specialize in this medical field,” said Kevin Store, executive director of Portage Health Foundation. “We had this thought a few years ago…if we can’t recruit providers, then we need to grow and train them right here! This is our contribution towards ensuring our community has the psychiatric care providers that are necessary to meet the ever-present mental and behavioral health care needs of our community.”

Data from the Upper Peninsula Community Health Needs Assessment 2018 (UPCHNA 2018), published by the Western Upper Peninsula Health Department, provides insight on the lack of mental health providers in the UP.

“Every UP county but Marquette is a federal designated HPSA (Health Professional Shortage Area) for mental health care based on the number of psychiatrist per capita.” (UPCHNA, 2018). Additionally, the data shows a ratio of roughly “one psychiatrist per 39,000 people” across the Upper Peninsula.

The capacity of inpatient beds are not being utilized due to the shortage of care providers. Currently there are a total of 39 inpatient beds in two locations, Marquette/32 beds and Kinross/7 beds.

Primary care physicians who fill in the void for mental health care in the Upper Peninsula have limited resources.

“70 percent of primary care physicians do not have psychiatric providers to which they can readily refer.”
(UPCHN 2018)

Patients with referrals for mental health conditions, are burdened with lengthy wait times and often have to travel long distances for treatment.

The new hospital, UP Health System – Marquette, will see an increase of inpatient beds (50) which will be utilized as new providers move into our region.

“There is a tremendous need to improve access to mental health across the Upper Peninsula,” said Dr. Khouli, chief medical officer at UP Health System – Marquette. “Because of this, we have significantly expanded the size of the inpatient psychiatric unit at the new hospital. However, if we don’t successfully recruit additional psychiatrists, we won’t be able to take on more patients to fill the expansion. The psychiatry residency pilot will offer a fantastic opportunity to accelerate recruitment and take us to the next level as an academic program.”

“We are fortunate to have a partnership with MSU and the Portage Health Foundation,” Khouli added. “Without them, this psychiatry training program here in Marquette would not be possible.”

The rural psychiatry residency pilot program is designed to help increase the number of psychiatric care providers and improve the distribution of psychiatric care in the Upper Peninsula. Resident physicians will train in East Lansing for two years, then come to Marquette July 2021 to complete the last two years of residency education.

This isn’t the first time psychiatry residents have been trained in the UP. Over the course of the past 20 years there have been several residents from the Marquette Family Medicine Residency Program who have trained and stayed in the UP to provide care.

“The Michigan State connection to Marquette and UPHS has been in place informally for a number of years,” said Dr. Cameron Wilcox, psychiatrist at UP Health System – Marquette. “Currently there are four psychiatrists practicing the UP that have completed their training in conjunction with the MSU psychiatry program. I completed my training through them back in 2007 and have remained here to practice.  I am hopeful that formalizing the program will increase that number and will bring more psychiatrists up to practice in the UP.”

The commitment and advocacy from UP Health System-Marquette, MSU College of Human Medicine, local faculty psychiatrists and students of the pilot rural psychiatry residency program will help mitigate the shortage by increasing the access to mental health care providers.

“If the retention rate is as successful as the Family Medicine Residency Program (with 40 percent of the graduates staying in the area long-term) there would be a positive impact on the way care is provided in this rural area within a few years,” said Dr. Stuart Johnson. “I am grateful for the way the State of Michigan is partnering with medical schools, residency programs and local providers, as well as the commitment from our local psychiatrists, to improve care in shortage areas like ours.”

According to the Michigan Department of Health and Human Services, The Upper Peninsula is the leading region of the state when it comes to depression. The CDC reported a 32.9 percent rise in Michigan’s suicide rate from 1999 to 2016. Primary care physicians across the UP have reported that their patients encounter barriers in accessing mental health resources (UPCHNA, 2018). Local authorities are tasked to provide extra resources as well; in the past year the Marquette Police Department has had 417 mental health related calls.

The statistics illustrate the needs in the UP region. The pilot program aims to alleviate the shortage of providers with the goal of having two psychiatry residents each year graduate from this program and stay in the area starting with the graduating class of 2023. The collaborative efforts and goal is to help increase the workforce in our Upper Peninsula rural communities making mental health care accessible to all.

About Michigan State University College of Human Medicine Upper Peninsula Region Campus

The MSU College of Human Medicine Upper Peninsula Region Campus works in conjunction with the UP Health System-Marquette to coordinate the training of family medicine residents and Michigan State University College of Human Medicine medical students. Since its inception in 1974, 286 medical students and 198 resident physicians have graduated from the two programs. Currently, approximately 30 percent of the MSU College of Human Medicine Upper Peninsula Region Campus physicians are practicing in the U.P. in every primary care and additional specialties of medicine.

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