A part of Byron Crouse, MD, never really left his first medical practice in rural Spooner, Wisconsin. Throughout his 17-year career at the University of Wisconsin School of Medicine and Public Health (SMPH)—most recently as the associate dean for rural and community health—Crouse has kept a steady focus on developing the vision and skills of future physicians to serve rural areas of the state and nation.
Well known for his compassion, humility and collaborative spirit, Crouse has accomplished this through one-on-one student mentoring, but more importantly, through his leadership of programs that span the continuum of medical education—and reach every corner of the state.
A rural residency takes root
Having earned his medical degree from Mayo Medical School in Rochester, Minnesota, Crouse completed a residency at the Duluth Family Practice Residency Program and practiced medicine for six years. He joined academic medicine in 1986, when he became the assistant director of the Family Medicine Residency Program at the University of Minnesota Medical School, Duluth. In 1994, he became the first head of that school’s Department of Family Medicine. And two years later, he led the development of the interdisciplinary Minnesota Rural Health School, which linked three University of Minnesota colleges and two private colleges that were involved in educating health care professionals.
“We were fortunate to recruit Dr. Crouse in 2001 to our faculty, where he has been a tireless, thoughtful champion of rural health,” says SMPH Dean Robert N. Golden, MD, adding that Crouse has experienced many “firsts.”
In 2001, he became the SMPH’s first assistant dean for rural and community health, focusing on programs aimed at attracting and retaining physicians to practice in rural Wisconsin, with the goal of easing health disparities in rural communities.
Crouse piloted the SMPH’s Longitudinal Rural Rotation, an integrated 20-week experience that combined three existing requirements: the third-year Primary Care Clerkship, fourth-year Preceptorship Program and fourth-year Surgery Clerkship. Students completed the rotation in one of four rural Wisconsin communities— Rice Lake, Mauston, Black River Falls or Prairie du Chien—so their clinical experiences closely mirrored rural practice.
“In rural settings, students get more autonomy and hands-on management experience,” explains Crouse, the rotation’s inaugural director. “They do more things, such as deliver babies, perform intubations, first-assist with surgery and see patients who have not already had work-ups.”
WARM heats up
The success of the rural rotation and the release of the 2004 Wisconsin physician workforce report, “Who Will Care for Our Patients?” paved the way for a formal rural medical education pipeline program at the SMPH.
Thanks to startup funds from the Wisconsin Partnership Program and support from former and current SMPH Deans Philip Farrell, MD, PhD (PG ’72), and Golden, respectively, the Wisconsin Academy for Rural Medicine (WARM) launched in 2007 with Crouse as its director from the beginning through his spring 2018 retirement.
Functioning as a “school within a school,” WARM seeks students who have a strong desire to practice rural medicine in Wisconsin, a rural background or connections, and a strong record of community involvement. It provides trainees with a rural-focused curriculum and required clerkships at rural sites throughout the state. Studies show that these factors, in addition to a future residency at a rural medical center, are the biggest predictors of the ability to recruit and retain physicians in rural areas.
“I first met Byron Crouse at the WARM Symposium before I was in medical school, and found his passion and calm demeanor comforting; he helped convince me to apply as a WARM student,” recalls Mathew Herbst, MD ’15 (PG ’18), who completed a family medicine residency in the SMPH Department of Family Medicine and Community Health’s Baraboo Rural Training Track.
“As a WARM student, I had hopes and aspirations that I would get more hands-on experience, as well as be the small-town doctor that so many movies depict,” Herbst shares. “In general, it was all true, and I got much more hands-on experience than my colleagues in the regular program.”
WARM has grown from admitting five students per year to 26 per year, and it has graduated 154 students. Of the 55 graduates who are now practicing medicine, 89 percent (49) are doing so in Wisconsin, 47 percent (26) in rural Wisconsin, and 35 percent (19) in their hometowns.
“It really helps students to have someone within the school who can talk about wanting to be a rural physician,” notes Crouse, who proudly shared his practice experiences while mentoring WARM students.
For H. Clay Dean, MD ’11, one of WARM’s first graduates, who now practices general surgery at Sauk Prairie Healthcare in Prairie du Sac, Wisconsin, the program offered valuable skills and helped him see that rural physicians are not just doctors, but leaders.
“The WARM program allowed me to obtain a substantial amount of autonomy with patients, which let me hit the ground running during my residency training,” Dean reflects. “It showed me firsthand how important rural physicians can be to their communities and the sense of pride that the communities have in their hospitals, clinics and physicians.”
Building rural residency capacity
Crouse’s work also addressed another important factor about rural health care— that physicians’ residency locations can play a key role in where they choose to work. One study found that 76 percent of graduates of a rural track residency program entered rural practice. Crouse and other school leaders recognized that Wisconsin needed more rural residency positions to retain graduates.
Through their collaborative efforts, in 2010, the Wisconsin legislature provided funding for the Wisconsin Rural Physician Residency Assistance Program (WRPRAP), which distributes grants to rural hospitals and educational institutions statewide to help them develop rural residency programs, tracks and rotations. Administered by the SMPH Department of Family Medicine and Community Health (DFMCH), WRPRAP was first led by William Schwab, MD, DFMCH vice chair for education, and then—starting in 2011—by Crouse.
“WRPRAP is not just the DFMCH, the SMPH or UW-Madison. We’re working with partners and health care systems across the state,” Crouse notes.
To date, WRPRAP has awarded 74 grants to support the development of rural residency programs, rural tracks within urban residency programs, and other graduate medical education (GME) opportunities for rural residency programs, hospitals and clinics. In collaboration with the Wisconsin Department of Health Services’ GME Initiative, since 2010, WRPRAP grants have helped establish 36 new first-year rural resident and fellowship positions across six specialties—family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics and psychiatry—that are critically needed in rural communities. Program leaders project that by 2020, Wisconsin will have 208 residents and fellows participating in rural programs, compared to 67 in 2010.
Local and national recognition
In recognition of his accomplishments, Crouse has been invited to serve in many local, state and national leadership roles, including co-chair of the Rural Medical Educators group of the National Rural Health Association. Among his many honors, in 2018 Crouse was inducted into Alpha Omega Alpha and earned the Albert Nelson Marquis Lifetime Achievement Award, Marquis Who’s Who. He also received the American Academy of Family Physicians Thomas W. Johnson Award; Wisconsin Academy of Family Physicians Educator of the Year Award; National Rural Health Association Distinguished Educator Award; and Society of Teachers of Family Medicine Bishop Fellowship.
A legacy of partnerships
Crouse is proud to have brought together statewide partners to help strengthen the rural physician pipeline—from medical school admission to rural residency capacity building—which represents work that “exemplifies the Wisconsin Idea,” he says.
“The past 17 years at the SMPH have been exciting and rewarding. When I started, I was charged with developing programs to address health care disparities in rural Wisconsin. I found that there were already several rural initiatives at the SMPH, but they were like a jigsaw puzzle that had been scattered around,” Crouse reflects. “With the help of many committed and passionate rural health advocates, we were able to get the pieces in one place, create the missing pieces and put the puzzle together. We now have a robust set of programs that complement each other and other initiatives in Wisconsin to help promote the health of people who live in rural Wisconsin.”
As Crouse retires and returns to live north of Rice Lake, Wisconsin—25 miles from where he first practiced medicine— he plans to remain engaged in community opportunities, including volunteering for community medical education projects and “hammering some nails” for Habitat for Humanity.
“I will miss many colleagues, friends and students as I leave Madison. However, I look forward to living full-time in the Rice Lake/ Spooner area and enjoying the wonders of northern Wisconsin,” he reflects, adding that he and his wife, Pam Crouse, also will spend time with their two grown children and their families.
Crouse adds, “I’m not much different from some of the medical students who talk with me about careers in rural medicine. I love science, I love working with people, and I want to make a difference.”
“While I am extremely pleased with the outcomes of the WARM program, I am even more excited about future opportunities. The SMPH is in the midst of implementing the new ForWard Curriculum, and I am proud of the number of features we started in WARM that are now part of the new curriculum. It is time to strategically look at opportunities to enhance WARM. I think it will be very exciting for the new director—Dr. Joseph Holt—and the many WARM partners to develop a ‘WARM 2.0.’”
Crouse’s efforts have left an indelible mark on Wisconsin’s current and future rural physicians and communities.
“It is hard to put into words how good Dr. Crouse has been at his position as the head of the WARM program,” remembers Herbst. “He has a calming presence and has always been a great active listener.”
Herbst continues, “Dr. Crouse was there from my first year throughout graduation, helping me along my path to figure out what kind of doctor I wanted to be, as well as what factors in my practice are most important to me. I am glad that he was there to help me through my course through medical school and ultimately to become a family physician.”
Dean agrees with Herbst and others.
“What Dr. Crouse has done for the UW School of Medicine and Public Health and the WARM program will leave a lasting impact on rural health care for generations to come,” notes Dean. “I feel honored to be a very small part of that legacy.”
by Andrea Schmick
This article appears in magazine.