A growing number of medical students at UW-Madison are being trained to become doctors in some of the most medically needy parts of the state: rural areas.

Home visits, job assistance and other services are being offered to parents of newborns in one of Madison's most challenged neighborhoods: Allied Drive.

Those efforts and many others, including initiatives to curb smoking and improve dental care, are supported by the Wisconsin Partnership Program. It's a $300 million endowment at the UW School of Medicine and Public Health designed to boost the health of state residents.

The fund, created after the nonprofit Blue Cross and Blue Shield United of Wisconsin became a for-profit company and reimbursed the state for tax breaks, is nearing the end of its fifth year. Administrators, who have awarded 176 grants worth $69 million, are poised to adopt a plan for how the money should be spent the next five years.

The fund leaders are preparing to direct more of the money to a few targeted areas — such as the $10 million recently pledged to tackle Wisconsin's high rate of black infant mortality.

But the leaders are also being criticized, for what some say is too much attention to the needs of the medical school and not enough to the needs of the state.

"They're helping the school get more research money and a greater reputation," said Bobby Peterson, executive director of ABC for Health, a Madison-based nonprofit that helps uninsured people find health care. "That's not the purpose of this fund."

Millions of dollars have been spent on lab equipment and basic research, which don't help state residents, Peterson said. The medical school should seek federal grants for those expenses and use more of the fund to help low-income people get medical care, he said.

Peterson, whose agency has received $447,700 from the fund to train public health advocates, unsuccessfully sued several years ago to set up an independent foundation to disperse the Blue Cross money. Most states that have approved Blue Cross conversions have established independent funds.

In Wisconsin, the state split the $600 million from the sale of Blue Cross stock between the UW medical school and the Medical College of Wisconsin in Milwaukee.

Improving health

Most of the projects supported by the UW medical school fund directly impact state residents, said Eileen Smith, director of the fund. Many address preventive health care, mental health, nutrition and violence, she said.

Several awards, Smith said, have helped bring in major federal grants. An example: The fund gave $6.8 million in 2006 to the UW Institute for Clinical and Translational Research; that helped garner $41 million the next year from the National Institutes of Health.

Much of the money from the fund has been used to launch a master's degree program in public health and increase the medical school's focus on the needs of large populations, not only on individual patients, said Dr. Robert Golden, medical school dean.

More money will be spent in the next five years on select issues, such as obesity or alcohol abuse, Golden said.

"The goal is to use all of these approaches as vehicles to improve the health of the people of Wisconsin," he said.

Meg Gaines, a UW-Madison law professor who is on one of two committees that award the grants, said the fund has directed money to several groups — such as the Hmong and gay and lesbian communities — whose health issues sometimes aren't well recognized.

Gaines, director of the Center for Patient Partnerships, an advocacy group on campus, said administrators should work toward an even split of the money controlled by each committee. Now, one committee awards 65 percent of the money for research and education, mostly within the medical school, while the other committee gives out 35 percent to community groups.

"This fund is not a gift," Gaines said. "This is a public resource that belongs to the residents of this state."

Rural and urban needs

The program that trains medical students to work in rural areas, called the Wisconsin Academy for Rural Medicine, has received more than $800,000.

Five students enrolled in the program last year, and 13 more started this year, said Dr. Byron Crouse, program director. Another 18 will join next year, with the goal of bringing in 25 students each year.

The students, who get some exposure to rural clinics near Madison during their first two years in medical school, will spend most of their last two years at rural clinics near Green Bay, La Crosse and Marshfield.

The hope is to encourage the students, most of whom are from rural parts of the state, to return to their hometowns or work in other small towns when they finish their medical training.

"A lot of rural areas have a difficult time recruiting physicians, and a lot of physicians want to go back to their roots but just don't," Crouse said. "This sets them up to do it."

On Allied Drive, the Early Childhood Initiative helps dozens of families navigate the difficult but important months after a baby is born, said Jenny Grether, program coordinator.

The program received $474,998 from the fund last year, in addition to a $450,000 grant in 2004.

Grether said the money pays for workers who help parents look for jobs, address their physical and mental health needs and build strong relationships with their babies. Some sessions cover basic skills, such as how to hold an infant and play peek-a-boo.

"Forming a bond in that first year is so important," Grether said. "We're giving the developmental milestones an opportunity to be met."