When Rebecca Radue began her work providing psychiatry services in rural Wisconsin, she met patients who had previously driven from Green Bay to Wausau and back, just to receive psychiatric care.
“There were people driving three hours north to see a psychiatrist,” Radue said. “That really stuck with me, so I wanted to train myself to work in a rural environment.”
Radue is a resident in UW-Madison’s Rural Psychiatry Residency Program. The program is aimed at meeting the needs of psychiatric patients in the states most underserved regions.
The Wisconsin Office of Rural Health identifies 48 of Wisconsin’s 72 counties as facing a “geography-based shortage” of mental health care providers.
But Radue says the problem isn’t just the lack of mental health resources in rural counties. Psychiatrists are often under-prepared to meet the unique needs of rural populations. Poverty in rural areas is different than in urban areas, and can have significant effects on patients’ physical and mental health, according to Radue.
Mental health concerns affect all populations, but in varied ways.
Because most medical schools and psychiatry programs are located at major research universities in cities, residents are often trained to handle patients in an urban setting. UW-Madison’s rural psychiatry program aims to change that, giving residents the chance to rotate through different rural clinics across the state.
Additionally, because graduates often choose to live near the university they were trained at, rural counties currently see a shortage in these services, according to Art Walaszek, director of Residency Training in the UW-Madison Department of Psychiatry.
“Physicians in general and psychiatrists … tend to cluster in more urban areas,” Walaszek said. “There’s kind of a mismatch between where these providers are located and where these services are needed.”
Recruiting psychiatrists to work in rural settings is also difficult because of the high cost of medical school and the promise of a higher salary in an urban setting.
The Wisconsin Office of Rural Health helps encourage recent graduates to work in rural environments through funding for the Health Professionals Loan Assistance Program, which helps health care providers who have served in an underserved part of the state repay student loan debt.
The office also acts as an “extra set of hands” for providers seeking to fill openings at clinics in underserved areas of the state.
“If there is a job opening for a psychiatrist that isn’t filling, we’ll do our best to help,” said John Eich, director of the office. “Since there is such a shortage of providers, it’s just as challenging for us, but at least we’re another set of hands and eyes to look.”
The Rural Psychiatric Residency Program was started four years ago through a one-time grant from the state of Wisconsin. So far it has been able to expand using grants from the federal government and other state agencies.
But, Walaszek said, these are short-term grants and in recent years, Medicare has stopped expanding long-term funding for psychiatry in rural areas.
Currently, there are 950 patients seeking mental health care for every one provider in rural Wisconsin, compared to nearly half that in urban settings.
For patients in these areas, any amount of mental health care close to home is appreciated, according to Radue.
For Radue, the program has not only given her a chance to provide a vital service to underserved parts of the state, but the experience has given back to her as well.
“Not only are they appreciative, but I really am too,” Radue said. “I learn so much.”
