Growing our own

 

I have a cousin who’s a long-time family practice physician in the southern Minnesota town where he grew up. He probably could have gone anywhere, but he chose to settle in his home town after finishing medical school and he’s been a doctor there ever since.

When it comes to recruiting rural physicians, this would be considered a success story. Many times, however, it doesn’t work out this way.

Rural communities generally find it harder to attract and keep physicians and other health care professionals. If you don’t believe this, take a look at the numbers in this study by the Minnesota Department of Health’s Office of Rural Health and Primary Care. Doctors are not distributed equally throughout Minnesota. The seven-county metro area accounts for 54 percent of the state’s population and has 60 percent of the state’s practicing doctors. Rural Minnesota has 46 percent of the population but only 40 percent of the physicians.

Some of this maldistribution is simply due to a higher concentration of specialists in urban centers. Rural communities, after all, don’t have a large enough population to sustain some of the narrower specialties such as neurosurgery. But it’s also more difficult for rural communities to compete for physicians, period.

It’s not impossible, however. Indeed, some of the best successes happen when rural communities adopt careful, purposeful strategies to nurture local interest in health care careers and support future health care professionals while they’re undergoing training - in effect, growing their own workforce.

I bring this up because Kathy Huntley, the executive director of the Southern Minnesota Area Health Education Center, retired at the beginning of October. She has been the first executive director of this still relatively new program and has had the challenge of developing new programs and partnerships to encourage health care careers in rural southwestern Minnesota.

It might sound hard to believe, but until 2002 Minnesota didn’t have a formal, statewide program devoted to building a rural health care professional workforce. There are now four Area Health Education Centers (a fifth is in the process of being established) whose main academic partner is the University of Minnesota. Rice Memorial Hospital in Willmar is the host site for the Southern Minnesota AHEC, which covers more than 20 counties.

Most people are probably unaware of the magnitude of the effort to foster rural health care careers. A couple of years ago I had the opportunity to visit the Lac qui Parle Valley High School on a day when Wendy Foley, the Southern Minnesota AHEC program coordinator, was giving a great interactive and hands-on presentation to the students. Not all kids have the desire or the aptitude to go into health care, of course, but for those with even a glimmer of interest, this is exactly the kind of program that can help light the spark.

Nurturing health care careers among school-aged youngsters is one of the AHEC’s roles. Connecting students in the health professions with training opportunities in rural areas is another. Both of these are strategies that have been shown to work. Health care professionals – physicians, nurses, pharmacists, nurse practitioners and so on – who grew up in a rural community are more likely to live and practice in a rural setting. Students in the health professions who’ve had a chance to experience rural health care also are more apt to choose a rural practice when they complete their training.

These are the figures for the University of Minnesota Medical School’s Rural Physician Associate Program, a nine-month rural rotation that’s available to students during their third year of medical school. From 1971 to 2008, 63.5 percent of the students who participated in the program are now doctors in Minnesota, and 38.4 percent of them are in rural communities. That’s 366 physicians practicing in rural Minnesota who might otherwise have gone somewhere else.

Accomplishing this isn’t easy and it doesn’t happen overnight. Youths interested in a health care career need to start exploring their options early, preferably by ninth or 10th grade, so they can get involved in the coursework and extracurriculars that’ll best prepare them for their future training. Even at this pace, it can still be 15 years or longer before they graduate from high school, graduate from college, finish their training and are fully qualified to care for patients.

For students in the health professions, it’s also critical to have hands-on clinical experience and to be exposed to rural health care early in their training. What many people may not recognize is that in order for a community to be a training site for these students, it takes time and resources. This is especially the case for small rural clinics and hospitals. It’s labor-intensive to mentor medical and nursing and pharmacy students, to supervise them and to plan learning experiences that will be enriching and beneficial. Willmar has been one of the leading – and most successful – sites for the Rural Physician Associate Program but there’s a cost for doing so, and this cost often remains invisible to most people.

In one of the last conversations I had with Kathy Huntley, she made the observation that when she first became the Southern Minnesota AHEC executive director and began traveling to hospitals and clinics around the region, one of the things she kept hearing was that they didn’t have the time or the staff to supervise students in the health professions. They didn’t have the resources to offer job-shadowing or classroom experiences for interested high school students. But more recently, Kathy has seen this change as more and more communities realize the stake they have in helping grow their own health care workforce.

It’s a pretty impressive legacy for someone to leave for the future.

Update, Oct. 14: Here’s another take, from the New York Times, on a Utah community that boasts homegrown medicine.

HealthBeat photo by Anne Polta

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