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UW has residency program for treating rural women

DR. LAURA MCDOWELL is the first graduate of UW Health’s rural OB-GYN residency, which became the nation’s first such program in 2017. (John Maniaci/UW Health)

MADISON, Wis. (AP) — When Dr. Laura McDowell finishes her obstetrics and gynecology training at UW Health this month, she will be the first person in the country to complete such a residency program focused on caring for women in rural areas.

With a nationwide shortage of OB-GYNs and many rural hospitals in Wisconsin and elsewhere ceasing to routinely deliver babies, the UW School of Medicine and Public Health started the first rural OB-GYN residency program in the U.S. in 2017.

McDowell was the first medical school graduate to enroll. After four years of training, including time working with doctors in rural Wisconsin towns, she will join an OB-GYN practice in Willmar, Minnesota, near her family.

“I feel more comfortable and at home in a rural setting,” said McDowell, 30, who grew up in small towns in Minnesota and Iowa.

She said she likes the variety and continuity of OB-GYN care, including clinic visits, surgeries, prenatal care, labor and delivery and women’s health conditions such as cervical cancer, the Wisconsin State Journal reported.

“I like getting to know these women and know their excitements and fears, especially around obstetrics and also going to the operating room if necessary,” McDowell said.

UW accepts seven OB-GYN residents each year for four years of training after medical school, one of whom does the rural track, said Dr. Ryan Spencer, who oversees the program. The rural residents have six rural rotations, learning from OB-GYNs at Aspirus Divine Savior Hospital in Portage, Monroe Clinic, Waupun Memorial Hospital and Western Wisconsin Health in Baldwin.

Spencer said the need is considerable, which led the University of Iowa this year to start the nation’s second rural OB-GYN residency track. A shortage of 6,000 to 8,000 OB-GYNs in the U.S. today is expected to grow to 22,000 by 2050, with a disproportionate impact in rural areas, according to the federal government.

In Wisconsin, 11 rural hospitals stopped routinely delivering babies from 2010 to 2017, according to a 2019 report by the Wisconsin Office of Rural Health. The state’s proportion of rural counties without delivery services went from 20% in 1997 to 39% in 2016, and about a third of Wisconsin counties have no OB-GYN.

The hospitals that stopped delivering babies are: Bellin Health Oconto Hospital, Oconto; Burnett Medical Center, Grantsburg; Gundersen Boscobel Area Hospital, Boscobel; Gundersen St. Joseph’s Hospital, Hillsboro; HSHS St. Clare Memorial Hospital, Oconto Falls; Indianhead Medical Center, Shell Lake; Marshfield Medical Center, Ladysmith; Memorial Hospital of Lafayette County, Darlington; Marshfield Medical Center, Neillsville; Ripon Medical Center, Ripon; and Spooner Health, Spooner.

Rural women often have to drive long distances for prenatal or gynecological care, which can lead some to put it off, Spencer said.

“When you eliminate opportunities for preventive medicine for women, whether they’re pregnant or not pregnant, you increase the risk of developing more significant and consequential health conditions,” he said. “There’s not only specific health consequences but also consequences to how people live, and how they’re able to work and function throughout their pregnancy.”

McDowell lived in Hastings, Minnesota, a small city near the Twin Cities, until she was 8, when her family moved to Alvarado, a town with fewer than 400 people in northwest Minnesota. She spent her high school years in Storm Lake, Iowa. The moves came from her father being a pastor.

After graduating from the University of Minnesota and the university’s rural medical school program in Duluth, she came to Madison.

Her rural residency rotations in Wisconsin were varied, with five OB-GYNs working together in Monroe, two in Baldwin and solo practitioners in Portage and Waupun.

She said she valued all of the experiences, including observing Dr. Scott Hansfield in Waupun as he encouraged a high-risk pregnant woman to come in for late-stage fetal testing and have her labor induced, even though she said she was too busy working.

McDowell also watched as Hansfield informed two patients they had different kinds of cancer and discussed treatment options, knowing one patient would want an operation and the other wouldn’t.

“He really knows his patients super well, which I think is different compared to some urban practices,” she said.

As much as she admired his dedication, she learned being a solo practitioner is not easy.

“As a medical student coming in, I thought, ‘Oh, I bet I could be a solo practitioner,’ not really understanding what that entails, how exhausting that can be to be on call 24-7,” she said. “From a work-life balance, it would be best to have at least one partner.”

She interviewed at hospitals in Wisconsin but decided to work in Willmar, about an hour from where her parents now live. The city of about 20,000 people in southwest Minnesota has meatpacking plants that attract a diverse group of workers, which she said was another draw.

The goal is for graduates of the UW program to work in rural Wisconsin, Spencer said, but he understands that Willmar was a good fit for McDowell.

“I can’t begrudge our neighbors to the west for stealing back Dr. McDowell,” he said. “They’re going to be very lucky to have her.”

Two of the three other residents in UW’s rural OB-GYN program are from Wisconsin. Dr. Alexa Lowry, who is in her third year, is from Cumberland. Dr. Kaley Gyorfi, in her first year, is from Eau Claire.

Before their residencies, Lowry and Gyorfi participated in the UW medical school’s Wisconsin Academy for Rural Medicine, or WARM. Started in 2009, it accepts 26 students a year in each medical school’s class of about 176 students, exposing the WARM students to rural experiences.

Among WARM graduates who have finished residencies, 80% are working in Wisconsin.

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