EVANSVILLE, Ind. | "Are you using the breast or the bottle?" Dr. Adam Wadlington asked.
"Bottle," answered stay-at-home mother Tamberly Hassell, 31, her adorable 6-month-old daughter, Jerriah, seated on her lab.
"Six ounces," Hassell said. "And she's eating sweet potatoes, green beans."
"How many wet diapers a day?"
"Seven to eight."
"How many poop diapers a day?"
The doctor examined Jerriah's eyes, ears and mouth.
"She looks good. No problems at all, honestly," Wadlington said. "She gets three shots today. And then the oral one, that's the last time she needs that. Other than that, we'll see you back in three months, OK?"
This recent appointment at Deaconess Family Practice in Evansville, Ind., was the same as any old 6-month well-child checkup. But while Wadlington is a doctor, he is still technically in training. The Eddyville, Ky., native was in the second-year of his residency, which physicians must complete before they can be certified.
Numerous studies have found doctors are likely to practice in the regions where they did their residencies. Take Wadlington. The 30-year-old grew up an hour-and-a-half southwest of Evansville, but now plans to stay in the city after his residency to work at Deaconess Hospital.
"For me, I would normally probably never come to Evansville for any other reason, but since I'm doing a residency here and know the system and everything, it's going to be a lot easier to stick around and just be streamlined into it," he said.
Deaconess has 24 residency slots, but entered into a consortium with three other Evansville-area hospitals. With it, it is hoping to bring an additional 70 to 100 residents to southwest Indiana in 2017. The new residencies will be in such specialties as family medicine, general surgery and psychiatry.
The arrangement was spearheaded by Steven Becker, director and associate dean of the Indiana University medical school campus in Evansville.
With an aging population coupled with a graying medical workforce, the U.S. is facing a deficit of physicians, which the Association of American Medical Colleges predicts will number 90,000 by 2025. Parts of Northwest Indiana, such as Gary, are already designated by the federal government as primary-care shortage areas.
But even though the region has a plethora of hospitals and clinics, not to mention a medical school at IU Northwest, it has no residency slots. Some local stakeholders hope to change that. They are using Evansville as a model of how they can get there.
"We've got to do something in Northwest Indiana to try to help recruitment," said Beth Wrobel, CEO of HealthLinc, a health center based in Valparaiso.
"When you have residencies, you have that potential recruit standing right in front of you. You've got them in town. Now it's your job to keep them here."
Looking due south
Evansville, the third-largest city in the state with more than 120,000 people, is about 250 miles due south of Schererville (U.S. 41 takes you directly there). Its downtown is seated on the Ohio River, right across from Kentucky, a fact made obvious by the predominant dialect in the area. Its riverboat casino, waterfront factories and slow-moving freight trains bear a slight resemblance to the Northwest Indiana lakeshore, albeit on a smaller scale. With Evansville's impressive skyline and growing downtown, it compares with Gary or Hammond in their heydays.
The idea for the southwest Indiana residency cooperative was hatched about four years ago, when a group of Evansville businessmen approached Becker about how to best leverage his school to maximize the community's economic and health-care potential. For one, he knew the region had to address the looming physician shortage by growing its own physicians.
He also recognized IU's medical school in Evansville, on the third floor of the Health Professions Center at the University of Southern Indiana, needed to expand. He suggested building a campus to house his school and other college-level health-care courses, and form a consortium of hospitals to host medical residents. He looked for a similar-sized community with a comparable arrangement and found one: Grand Rapids, Mich.
That city of about 190,000 located 25 miles east of Lake Michigan, long a hub for furniture manufacturing, is now known for health-care innovation. Its so-called Medical Mile (it's on Michigan Street — get it?) includes Michigan State University's medical school, a children's hospital and a cancer-research institute.
Nearby is the headquarters of the Grand Rapids Medical Education Partners, a residency-and-fellowship consortium of two major hospital systems and universities. Late in 2011, after visiting, Becker brought the example of Grand Rapids back to a group of community leaders in Evansville, saying there was no reason they couldn't do the same thing there.
For years, state Rep. Charlie Brown, D-Gary, has envisioned a similar project for Gary, backing the construction of an academic medical center near the IUN campus to include a Level I trauma center and teaching hospital.
He thought it would increase the quality of health care in Northwest Indiana and help economically revitalize Gary, a city that, like Grand Rapids, was ravaged by the decline of American manufacturing.
But after area hospitals reported having too many empty beds and a consultant's report recommended against the idea, local support for the project waned.
IUN School of Medicine Associate Dean Pat Bankston turned his focus to a residency consortium to train his graduates at the region's existing health-care facilities. He presented the plan to executives from area hospital systems and publicly funded health clinics, and is in the process of raising $150,000 to pay for a feasibility study of the partnership. He is using Becker and the Evansville cooperative as inspiration.
Cooperation among competitors
Bankston's counterpart in southwest Indiana garnered support for his plan from three other local colleges and four Evansville-area hospitals. The result is a planned health-professions campus in Evansville, expected to break ground later this year, that will include classes from IU, the University of Southern Indiana and the University of Evansville, as well as the administrative offices of the residency consortium.
Each of the four hospital systems has committed $250,000 annually for the first four years of that program.
While two of the hospitals — Deaconess and St. Mary's — are based in downtown Evansville, the other two are each more than 50 miles away. To get to one of them, Good Samaritan, you have to drive north from Evansville, through scenic country towns and rolling farm fields, past a colossal Toyota plant and into Vincennes, Ind., a sleepy community of about 18,000 that was the site of a famous Revolutionary War battle and lays claim to being the hometown of the late vaudeville comedian Red Skelton.
"With the consortium, one, you share the cost and, two, you share the knowledge base," Good Samaritan CEO Rob McLin said at the hospital, an imposing structure that sits kitty-corner from the bomber jets and submarine missiles of the Indiana Military Museum.
"Even though health care is so competitive, it's not so competitive to avoid working together for the betterment of everybody."
For Good Samaritan and the other rural facility involved in the consortium, Memorial Hospital in Jasper, Ind., joining the partnership was a no-brainer.
"The big problem we have in a smaller town is a difficulty in recruiting doctors," Memorial's Dr. Terry Brown said. "In Chicago or Indianapolis, where all the training is done, that's where the young doctors get their degrees and do their residencies. So the physicians finally finish all their residency training, and their spouses have been living in, say, Indianapolis, for six, seven years. They have a job. They have their friends. Now let's think about it. What do you think a spouse would rather do: stay in their nice tight circle, or move to a town of 14,000 and start over again?"
What does this have to do with NWI?
Paul Umbach, founder and president of health-care consulting firm Tripp Umbach, said Northwest Indiana is, in a sense, in greater need of a residency consortium than Evansville.
"Evansville's the big town for two hours in every direction. People go there from Kentucky, Illinois, the whole southwest part of the state," he said.
"In Northwest Indiana, you have Chicago close by, so it's even more critical that graduate medical education expand: to keep the hospitals strong in that area and also develop service lines so patients can stay in Indiana for care and not migrate to Chicago. They don't really have that problem in Evansville. They don't have people saying, 'I can't wait to drive all the way to St. Louis!'"
On the other hand, the fact Evansville is a regional hub, something Northwest Indiana lacks, may have made this project easier to do. Still, Cathy Zimmerman, interim director of the planned medical campus, noted that the University of Southern Indiana, a commercial development in Evansville and a bordering county all submitted bids for the new facility. But, in the end, Evansville's more than $50 million in incentives and location proved too attractive.
"It has truly been amazing to see how a whole region came together," Becker said. "Sometimes I pinch myself to think this really happened — four universities, four hospitals, the business community, the legislative community, our inner-city community."
"And two of our hospitals are 40 to 50 miles out in smaller communities. To their credit, they haven't viewed this as an 'Evansville project,' even though the campus is downtown. This really is a regional approach."
The three participating public universities requested roughly $50 million in funding for the venture in this year's state budget. In the end, IU was awarded $19.2 million, the University of Southern Indiana received $6 million, while Ivy Tech Community College Southwest was left out (it had asked for $22.9 million); the University of Evansville is raising $6 million in private funding. The state also provided $2 million for campus design planning in its 2013 budget.
"What makes this project attractive, not only for our region, but (also) for the state, is we're pulling together four different institutions of higher education and four different, competing medical-care facilities, and they're all working collaboratively with the intent of building a new pipeline of health-care professionals," Evansville Mayor Lloyd Winnecke said from his office, overlooking the planned site of the medical campus, which will be connected by skywalks to a convention center, 11,000-seat sports arena and not-yet-built 240-room DoubleTree Hotel.
"I think the absolute key is collaboration and creating a model that might push different institutions' comfort level a little bit."
Costs and benefits
Like Winnecke, supporters of an Evansville residency partnership assert it will create a "physician pipeline" — an inverse of the medical brain drain — to keep Northwest Indiana natives who prosper in secondary, post-secondary and medical education in the region, rather than losing them to bigger cities like Chicago and Indianapolis with a multitude of residency slots.
At the same time, the residencies would be open to students from anywhere in the country.
Tripp Umbach, which figures to get business from a consortium in the region, estimates communities get an annual economic benefit of $200,000 for each resident they host and $1.5 million for every doctor who stays there to practice.
For all the perceived advantages of having medical residents, the main drawback is cost. Residency programs take a lot of money to establish and maintain, and reimbursement from the federal government has declined. Plus, hospitals that host residents in the past are capped from getting federal funding for new slots.
That's why Bankston and others are proposing a consortium: to get around some of that government red tape and save money by having one administrator and office for all the health-care facilities involved. In addition, the Indiana General Assembly passed a law recently that provides state funding for new residencies to pay anywhere from 10 percent to a third of the roughly $130,000 a typical resident costs each year.
Back at Deaconess Family Practice in Evansville, Carla Essling, a very pregnant third-year resident, saw patients on a recent day. The 29-year-old soon-to-be mother of three grew up in Battle Creek, Mich., and studied medicine at Southern Illinois University. While the family medicine residency program was what originally attracted her to Evansville, she and her family now intend to stay.
"The kids love it — we did kindergarten roundup last night. My husband also really likes it here and has a job he loves. He doesn't want to move," said Essling, who plans to practice at a Deaconess family medicine clinic in nearby Newbergh.
"So that's what I'm going to do, and it's really just because I like the town because, I mean, I'm not from here."