Sanford Health is building more than just clinical capacity in Northern Minnesota—it is offering resident physicians a fresh perspective that could result in a new pipeline of doctors to rural practice settings.
Through a collaborative effort between Sanford Bemidji Medical Center and Hennepin Healthcare in Minneapolis, emergency medicine and psychiatry residents are getting needed exposure to the special challenges of rural practice.
The program’s aim is to build a future workforce of doctors who see rural medicine as a viable, rewarding career path.
“The rural clinician workforce gap is only expected to increase in the coming decades,” said Daniel Hoody, MD, chief medical officer at Sanford Health Bemidji. “All the numbers are going in the wrong direction but exposure to rural medicine is the first step to solving it. We can’t expect doctors to practice in rural communities if they’ve never trained there. When we bring these residents up here, we find that it’s a great opportunity for them to experience what it’s like to practice rural medicine, and for our existing clinical staff the residents add energy and excitement to the environment.”
Sanford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Getting boots on the ground
The Association of American Medical Colleges has projected an across-the-board physician shortage of up to 86,000 doctors by 2036. Meanwhile, in Minnesota, more than one third of rural providers plan to leave the workforce in the next 5 years or less. The resulting problems are likely to be amplified in rural areas, with research showing that people in rural communities experience inequitable rates of cardiovascular disease, stroke, cancer, diabetes and respiratory illness.
Making headway on these inequities in health outcomes and in the rural physician workforce is the aim of the Sanford Health initiative, now approaching its second year. The rural rotation began with emergency medicine and psychiatry residents because these are two high need specialties for Sanford Bemidji, and they also happen to be some of Hennepin Healthcare’s most competitive residency programs. This approach is an adjunct to Sanford’s larger commitment to expanding rural GME programs.
“I was surprised at the pace of the emergency department, how busy it was and the acuity of the patients there,” said Jack Goldstein, MD, a second-year Hennepin emergency medicine resident who recently completed his rotation in Bemidji.
What sets the program apart is its immersive nature. For a full month, residents live in Bemidji, a town of about 15,000 that is approximately 100 miles south of the Canadian border and perhaps best known as the setting for season one of the Emmy award-winning FX show “Fargo.” The physicians in training work alongside Sanford Health’s medical teams and gain exposure to the realities of rural practice—including what happens when specialty care is miles away.
“When you’re at a Level 1 trauma center, you have every specialty at your fingertips,” said Meghan Walsh, MD, chief academic officer at Hennepin Healthcare. “A patient comes in with a subarachnoid hemorrhage and in about three minutes I can have a neurosurgeon, a neurologist, a stroke team. In Bemidji, you have to think differently. Who do you transfer? Who can be stabilized here? There’s a whole sea of decision-making that we don’t teach in an urban center.”
Dr. Goldstein found that the experience helped to sharpen some of his clinical skills.
“Learning how to stabilize a patient and what needs to be done prior to, and after, someone is transported was a really unique experience,” he said.
The AMA has developed policy to address and eradicate the rural physician shortage. Many of the interventions the Association is calling for start in medical training.
Among the policy’s aims is to work with stakeholders in medical education “to consider adding exposure to rural medicine as appropriate, to encourage the development of rural program tracks in training programs and increase physician awareness of the conditions that pose challenges and lack of resources in rural areas.”
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, and handling medical school student loan debt along with other essential tips about succeeding in graduate medical training.
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Creating future rural physicians
While none of the residents who have taken part in the Hennepin-Sanford Health Bemidji program have yet graduated residency, there are encouraging signs that the effort could help boost the rural doctor workforce.
Dr. Hoody has spoken with residents who have expressed interest in working in a rural setting full-time following graduation. Others have returned for a second rotation to gain even more experience.
“This changes that decision that they're making, which can easily be a passive decision to never even consider a rural career, to an active one,” Dr. Hoody said. “These residents are going to graduate knowing what it is like to practice in a rural area, what it is like to live in a rural area. And so, if they still choose to practice in Minneapolis, at least it's an active decision to have experienced the rural piece.”
The barriers to creating a standalone residency program at Sanford Health Bemidji are substantial. The monthlong rural rotation gives Sanford Health Bemidji the chance to partner with Hennepin, an academic medical center with active residency programs.
Dr. Hoody pointed out that under this model, Sanford Health Bemidji can host more residents annually—about a dozen—than were it to have its own emergency medicine residency program which might have a handful of full-time trainees.
“We are starting to see that a one-month rotation is enough dwell time for residents to really experience rural medicine and be interested in rural medicine,” Dr. Walsh added.
Sanford Health makes sure the residents feel at home in Bemidji. They provide furnished housing, help them engage with the community and encourage them to explore the region's natural beauty.
“I was set up in a townhome that was about a four-minute drive from the hospital, and it was bigger than my place in Minneapolis,” Dr. Goldstein said. “One of the weekends I was there was the Bemidji State [University] homecoming football game, so that was a fun day.”
As Sanford Health looks to the future, plans are underway to bring internal medicine and general surgery residents to Bemidji. The long-term goal is for this program to serve as a blueprint for rural health care rotations at other institutions across the nation.
“Our medical group feels a commitment and responsibility to teach the future generation of rural clinicians,” Dr. Hoody said. “That’s our front-and-center objective. We feel an obligation to highlight the benefits of rural care. If someone who came through the program doesn’t end up at Sanford, but we impacted them choosing to practice in rural America somewhere, that’s still a win.”
