Northland hospitals get creative to attract doctorsThere’s no one right approach to the growing shortage of doctors in rural America, experts say. What follows are a couple of those approaches, one for areas that lack certain specialists and another aimed at bringing health professionals to places they might not consider otherwise.
By: John Lundy, Duluth News Tribune
There’s no one right approach to the growing shortage of doctors in rural America, experts say.
Terry Hill, the executive director of the National Rural Health Resource Center in Duluth, summarized what was said in a conversation among leaders of four of the biggest health-care systems in the country:
“The shortage of primary-care physicians is going to be so acute that there’s no way we can continue to provide primary care as we’ve been providing it.”
Rick Breuer, CEO of Community Memorial Hospital in Cloquet, agreed.
“The shortages are real, both today and what’s projected for the future,” he said. “And so I think you have to have a variety of approaches.”
What follows are a couple of those approaches, one for areas that lack certain specialists and another aimed at bringing health professionals to places they might not consider otherwise.
Technology helps hospitals get access to specialists
A dermatologist on the Iron Range consults a patient in Idaho.
A nurse practitioner places a chest tube in an emergency room patient in Aurora under the guidance of a doctor in Duluth.
Your doctor no longer has to be standing beside your bed to offer bedside service.
Telehealth, in which a specialist in a medical hub supervises care in satellite facilities, is being used increasingly to meet some of the needs in smaller communities. It also keeps patients from having to drive long distances to receive care.
“There are a couple of things on the horizon that I think are going to help, and one of them would be telehealth,” said Terry Hill, executive director of the Duluth-based National Rural Health Resource Center. “We think it is going to take off here really very shortly.”
Maureen Ideker has worked with telehealth since 1994, when she applied for grants to establish programs in rural areas for the University of Minnesota. She came to Essentia Health a couple of years ago to direct the health system’s fledgling telehealth program.
Specialists want the links to distant patients, Ideker said.
“A lot of them drive now, and they want to cut down on the driving and use technology fully so they can actually see more patients and see them more often,” Ideker said.
Ideker describes telehealth as a hub and spokes. The specialist is at the hub, and the spokes bring his expertise to outlets, with the two connected by video monitors.
Essentia’s fast-growing telehealth system has some surprising hubs.
A dermatologist in Virginia is linked to hospitals in Orofino and Cottonwood, Idaho. Medical weight-loss management is linked from Ely to International Falls, Deer River and Aurora. A pharmacist with a doctorate in Aurora offers medication therapy management for diabetes patients in Deer River.
The hub is wherever the specialist happens to be, Ideker said. In most cases, that means Essentia Health-St. Mary’s Medical Center in Duluth.
Programs based in Duluth include stroke care, cardiology, wound care, nephrology (kidneys) and dietician services and emergency-room care, Ideker said.
The latter is the most complex, she said. A nurse practitioner or physician’s assistant in emergency rooms in Aurora and Sandstone can summon help via the video link from Duluth with a touch of a button. That might involve guidance in preparing a critically ill or wounded patient for transfer to Duluth or a rarely performed procedure such as putting in a chest tube to reinflate a patient’s lung.
Telehealth combats the isolation of a rural emergency room, Ideker said.
“Here in Duluth, there’s all kinds of people around in that emergency room,” she said. “There’s other physicians, there’s other nurses, other mid-level providers. But when a person is providing services in an emergency room in a very rural area, they are the only provider there and there are probably one or two nurses in the whole hospital available to them. So now you have a patient that has a lot of needs, and you could use more hands. You’re not going to get more hands, but you are going to get some help support-wise.”
Mental health is particularly ripe for telehealth because mental health professionals are in such short supply, Hill said.
Obstacles have included lack of broadband capacity and the fact that Medicare doesn’t pay for telehealth procedures, Hill said. But those barriers are starting to be surmounted, and more applications of telehealth are certain to come.
Even robotic surgery could take place in one town, guided by a surgeon in another, Hill said. In some instances already, the surgeon isn’t in the room where the operation is taking place.
“The technology is there,” Hill said. “You’d have to have a support system in place, but we’re capable of that. We’re going to see that.”
Time off attracts doctors who want to pursue mission work
Recruiting doctors who, one day, plan to leave for foreign missions could be a winning formula, the CEO of Community Memorial Hospital said.
“If they know that Cloquet is a good home for those people right after school until they are ready to embark internationally, that could be a really nice relationship to develop,” Rick Breuer said.
Two doctors scheduled to join the staff of the Cloquet hospital this year share a desire for international service, Breuer said. For one, an emergency room doctor, a block of time for mission work is written into his contract.
“Their mentors have told them (that) working in rural ERs you see a wide variety of stuff; you’re asked to manage a wide variety of stuff,” Breuer said. “You’re not going to be handing these things off to subspecialists just down the hallway. And it’s actually great training for international work.”
In welcoming doctors with missionary aspirations, Community Memorial is informally following the path of a tiny Kansas hospital that pioneered allowing its staff to take time off for other pursuits.
At Ashland Health Center in Kansas, all 90 employees — from doctors to maintenance workers — get between four and eight weeks of paid time off per year, said Benjamin Anderson, who was CEO until leaving for another small Kansas hospital on June 21.
The employees can use the time in whatever way they wish, said Anderson, 33. But last year, nine — including Anderson — used it for international work.
In the process, the hospital has drawn doctors who otherwise might never notice an out-of-the-way farm town near the Oklahoma border.
Anderson himself was recruited to the hospital four years ago to find a way to attract those doctors.
“It was a board chairman at the time who said, ‘Ben, our facilities are 55 years old, our finances are upside down, we have no doctors and no administrator for over six months now,’ ” Anderson related. “‘Our morale is low, our turnover is high, and if things don’t change quickly here we’re going to lose this facility. And if we lose our hospital, we’ll likely lose our school. And if we lose both of those, we’ll lose our community.’”
That assessment might have given another up-and-coming hospital administrator second thoughts. But Anderson and his wife always have felt “called to places where it’s difficult to get people to go,” he said.
About 3½ years ago he established the paid-time-off policy, and since then, the hospital has recruited four health professionals, including two doctors, Anderson said. There is “no way” either of them would have come without the policy.
“The thought process behind it is that people that are willing to serve in underserved countries are also willing to serve in underserved counties,” he said. “The person who is willing to practice medicine in a mud hut in Africa or on a boat in the Amazon doesn’t need Nordstroms or Starbucks or reserved seating in restaurants or large malls.”
Dr. Heather Licke, a Grand Rapids native, is one such person.
Licke, 32, who began medical school at the Duluth campus of the University of Minnesota Medical School in 2006, already had Christian missionary work in Africa under her belt by then.
She just finished her residency in Wichita, Kansas, and will begin her practice at a hospital in Goodland, Kan., near the Colorado border in 2014, because “it’s rural enough that you can do everything.”
She and another doctor beginning in Goodland negotiated for four extra weeks of time off so they could do overseas work, Licke said.
Before starting in Goodland, she’ll spend July in West Virginia in a tropical medicine course, five months in the African nation of Niger and then get six additional months of training in Wichita.
“They’re all for it,” she said of the Goodland hospital.
The ER doctor coming to Cloquet eventually plans full-time missionary work, Breuer said.
“We won’t have him for 20 years,” Breuer said. “Coming out of medical school, he and his wife are going to pay off student debts and be here for however many years. But they’ve already spent time during their residency over in Africa. … He knows that’s where he wants his family to be in the long term. And we’re going to fully support that.”
Breuer said he envisions a “real possibility” of becoming known as a hospital identified either with people who want a rural life or are interested in international missions. As doctors leave Community Memorial for full-time missionary work, they could be replaced by doctors with similar aspirations, he said.
The hospital would benefit, Breuer said.
“These tend to be very high-flying, top-of-the-line medical students who have these ambitions,” he said. “Not that there’s anything wrong with the rest of the medical students, but they tend to be up near the head of their class.”