Background & Overview
Of Michigan’s 83 counties, 75 counties have at least partial designation as a primary care health professional shortage area (HPSA). To recruit and retain physicians to address the physician shortage in both rural and urban underserved areas, MIDOCs was created to increase the number of residency slots in the state and to retain residents to practice in underserved communities after their training.
In 2017, the Michigan state Legislature appropriated $500,000 in funds to develop an implementation plan, which included proposals from the four institutions for increasing residency slots to address the needs in their communities. In 2019, $5 million was appropriated for the MIDOCs Program that could be matched by a contribution from institutions of up to $5 million, and any associated federal funds.
With this funding, MIDOCs has expanded and developed Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs and increased the number of residency slots in primary care and other high-need specialties to address Michigan’s physician shortage in medically underserved rural and urban communities. The MIDOCs program incorporates innovative teaching models with a focus on integrated care, the patient-centered medical home model, and the principles of health care reform, such as population health. In addition, MIDOCs residency programs utilize the established networks of federally qualified health centers, and other ambulatory clinical sites, as appropriate for each residency program. The residency rotation sites are located in primary care and mental health shortage areas that include federally qualified health centers, community-based clinics, inpatient and community mental health centers, and ambulatory care clinics.
When fully implemented, the four universities will be able to create over 30 new physicians per year practicing in underserved communities across the state of Michigan. In the first year (2018-19), the universities offered four residency slots in psychiatry, three residency slots in family medicine, and one residency slot in internal medicine. In the second year (2019-20), the universities offered a total of 24 new residency slots: seven in psychiatry, seven in family medicine, three in internal medicine, two in preventative medicine, two in pediatrics, one in general surgery and two in OB/GYN.
The MIDOCs Program also includes an incentive for residents to practice in underserved areas post-residency. Reports indicate that resident physicians who train in community settings are nearly three times more likely to practice in underserved settings after graduation. Not only will the MIDOCs residency programs support and train physicians to practice in community-based settings, MIDOCs will offer a loan repayment program for residents who practice in an eligible underserved area after graduation to help alleviate their medical debt.
MIDOCs believes that Michigan medical schools are a valuable resource and well-positioned to create innovative models for residency training that can strengthen the ability of the health care workforce to improve the health of underserved and vulnerable populations. Through this program, MIDOCs is committed to recruiting and retaining providers to improve health outcomes in underserved communities in Michigan. It is our hope that we create an innovative demonstration project to be modeled across the country.