Partnerships to Establish and Sustain Rural GME: Q and A with Ryan Spencer, MD, MS, FACOG of the University of Wisconsin Hospital and Clinics Authority

This interview is part of a series featuring Sponsoring Institutions and programs providing rural graduate medical education (GME) experiences. The series was initiated following the 2022 ACGME Annual Educational Conference presentation on Medically Underserved Areas/Populations: Partnerships to Establish and Sustain Rural GME, available in the ACGME’s digital learning portal, Learn at ACGME. Note: an account (free to create) is required to access most content in Learn at ACGME.

Ryan Spencer, MD, MS, FACOG is a Gynecologic Oncologist and serves as the residency program director for obstetrics and gynecology, as well as for the obstetrics and gynecology rural track. Dr. Spencer is also the fellowship program director for gynecologic oncology at the University of Wisconsin.

ACGME: What drew you to academic medicine and to rural GME specifically?

Dr. Spencer: Going into academic medicine was multifactorial. As a trainee, I had a number of mentors who inspired me to want to be like them. I felt like it was a natural fit with wanting to use my strengths and work in an environment that would be continually challenging, evolving, and therefore rewarding. My interest in rural GME came to me following fellowship at the University of Wisconsin (UW). Our Department of Family Medicine and Community Health were pioneers in the rural training space and our Departments of Surgery and Obstetrics and Gynecology had nascent rural tracks in an attempt to increase the number of physicians practicing in rural Wisconsin. I was able to serve as the program director of that track from its second year onward. It has been the most rewarding aspect of my career thus far. I grew up in rural upstate New York and experienced the challenges that people in rural areas can face with their health care.

ACGME: Describe the rural GME experiences within your program/Sponsoring Institution (e.g., types of sites, structure, curriculum, etc.).

Dr. Spencer: Our obstetrics and gynecology program specifically has one resident per year in the rural track. These residents get the opportunity to experience obstetrics and gynecology practice in rural community settings in a longitudinal way throughout the four total years of the program while continuing to be an integrated part of the larger program in Madison. The rural track residents currently participate in rotations with the SSM Health Monroe Hospital in Monroe, Wisconsin (a partner since the program’s inception seven years ago); Western Wisconsin Health in Baldwin, Wisconsin; and the Marshfield Clinic Health System in Marshfield, Wisconsin. Our residents gain opportunities to participate in full scope obstetrics and gynecology practice doing ambulatory care, ultrasound, labor and delivery, and gynecologic surgery – sometimes all in the same day!

ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.

Dr. Spencer: The partnerships with our rural sites – both clinically and administratively – are the lifeblood of the program. Without their service, we wouldn’t have a program. We have received a tremendous amount of support from the Wisconsin Collaborative for Rural GME (WCRGME), as well as UW’s Departments of Family Medicine and Community Health and Surgery. Support from the Wisconsin Rural Physicians Residency Assistance Program and the State of Wisconsin Department of Health Services have helped sustain the program for the future and we are so grateful for them!

ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.

Dr. Spencer: The two greatest challenges have been securing long-term, sustainable, external funding. We have had tremendous support from our partners; however, we would love to know that funding would not be a concern for the foreseeable future. The other challenge we have encountered is the very problem we are hoping to help eradicate. We have lost two previous partner sites because of the loss of obstetrics and gynecology physicians and they were no longer to provide an obstetrician gynecologist to serve as a supervising physician at those sites. To overcome those losses of sites, we consistently are engaging health care systems and institutions throughout the state to optimize the number of participating sites and ensure appropriate clinical learning environments for the rural track.

ACGME: Describe some of your program’s/Sponsoring Institution’s outcomes since establishing rural GME experiences, including the impact to the surrounding community. 

Dr. Spencer: We have data from the seven years of the program that show that our rural track residents are receiving comparable procedural experiences compared with our main track residents. This is critically important as a procedure-based specialty both to meet graduation targets, but also to instill a sense of confidence and security in the skill sets of our rural track graduates. Our initial graduate is currently practicing in a Federal Office of Rural Health Policy-designated rural area near her home town in Minnesota, and our second graduate is in a practice in western Wisconsin that allows for her to provide outreach services to rural patients.

ACGME: What advice do you have for those interested in establishing rural GME experiences?

Dr. Spencer: Any work worth doing is going to present challenge. Always remember and advocate for the mission – because it is a worthy one. Don’t reinvent any wheel…ever. Talk to anyone and everyone you can find about what they have done to be successful and what pitfalls they encountered. Find those both at your institution and in the country who do this work and create your network. The people doing rural GME throughout the country want you to succeed as much as you do and we want to help you.

ACGME: Describe the resources that have helped your program/Sponsoring Institution to establish rural GME experiences.

Dr. Spencer: I named some of them above: other departments at my institution (Family Medicine and Community Health, Surgery), grant sponsoring agencies, our university office of development, WCRGME, the Rural Training Track Collaborative, the Health Resources and Services Administration, colleagues in the Departments of Family Medicine at the University of North Carolina and the University of Washington, the ACGME, and countless others who gave me 15 minutes in a hallway to pick their brains.

Email muap@acgme.org if you want to get in touch with Dr. Spencer. Is your Sponsoring Institution/program already providing rural GME experiences and want to be featured in a future post in this ACGME Blog series? Respond to this short questionnaire to share what you’re doing and provide input on how the ACGME can engage stakeholders in this important work. Visit the MUA/P web page to learn more about the ACGME’s efforts.