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Challenges and Opportunities in Building a Sustainable Rural Primary Care Workforce in Alignment With the Affordable Care Act: The WWAMI Program as a Case Study

Allen, Suzanne M. MD, MPH; Ballweg, Ruth A. MPA, PA-C; Cosgrove, Ellen M. MD; Engle, Kellie A.; Robinson, Lawrence R. MD; Rosenblatt, Roger A. MD, MPH, MFR; Skillman, Susan M. MS; Wenrich, Marjorie D. MPH

Academic Medicine:
doi: 10.1097/ACM.0000000000000008
Articles
Abstract

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation’s most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.

The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

Author Information

Dr. Allen is clinical professor of family medicine and vice dean for regional affairs, University of Washington School of Medicine, Seattle, Washington.

Ms. Ballweg is professor of family medicine and director, MEDEX Northwest Program, University of Washington School of Medicine, Seattle, Washington.

Dr. Cosgrove is professor of medicine and vice dean for academic affairs, University of Washington School of Medicine, Seattle, Washington.

Ms. Engle is director of operations, Office of Regional Affairs, University of Washington School of Medicine, Seattle, Washington.

Dr. Robinson is professor of rehabilitation medicine and vice dean for graduate medical education and clinical affairs, University of Washington School of Medicine, Seattle, Washington.

Dr. Rosenblatt is professor and vice chair of family medicine and director, Rural/Underserved Opportunities Program, University of Washington School of Medicine, Seattle, Washington.

Ms. Skillman is deputy director, WWAMI Rural Health Research Center and UW Center for Health Workforce Studies, University of Washington School of Medicine, Seattle, Washington.

Ms. Wenrich is affiliate assistant professor of biomedical informatics and medical education, University of Washington School of Medicine, and chief of staff, UW Medicine, Seattle, Washington.

Funding/Support: None.

Other disclosures: None.

Ethical approval: Not applicable.

Correspondence should be addressed to Ms. Wenrich, Box 356350, University of Washington, Seattle, WA 98195-6350; telephone: (206) 616-8226; fax: (206) 685-8767; e-mail: maxter@uw.edu.

© 2013 by the Association of American Medical Colleges