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