The merger of Sanford Health and Marshfield Clinic Health System in 2025 created a rural health organization with almost 56,000 employees, 58 hospitals and about 4,500 physicians and other health professionals throughout the upper Midwest including Wisconsin, South Dakota, North Dakota, Minnesota, Wyoming, Iowa and Upper Peninsula of Michigan.
“The two organizations shared so much from a cultural and mission standpoint,” said Brian Hoerneman, MD, president and chief executive officer at Wisconsin-based Sanford Health Marshfield Clinic. “That included commonalities around strong physician voice and leadership, similarly aligned research profiles, and a commitment to providing world class care close to home.”
Now, that combination of expertise and reach has improved recruiting and retention of staff at all roles and levels. More than that, it has expanded access to care for generally underserved rural communities.
Sanford Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Combining health systems
Marshfield leaders had concluded that remaining a self-contained organization would make the already difficult task of recruiting and retaining its workforce even more so, not to mention exacerbating existing challenges around access in rural communities. A nationwide search was launched for another organization that would complement and expand Marshfield's competencies and offerings.
“The best path forward was through a partnership into the future to achieve that sustainability,” explained Dr. Hoerneman. “The Sanford organization rose to the top with a proposal that was head and shoulders above everybody else.”
Through the merger, opportunities for research and physician training expanded. The newly combined system now offers more than 40 graduate medical education programs, with plans for further expansion. It also supports more than 1,300 active clinical trials, giving patients in rural communities access to advanced therapies and emerging treatments.
A three-pronged approach to recruitment and retention
Another driver was workforce shortages, which are more prevalent in rural areas. In Wisconsin alone the average physician age is a little over 54, and about 40% of those physicians will reach retirement age by 2030. Recruiting healthcare professionals, already difficult in rural areas, was even more crucial given those demographics.
Addressing that challenge required more than simply hiring more physicians and other health professionals, however. Recognizing that workforce sustainability and patient access are inseparable, a three-pronged strategy was developed that focused on retaining existing staff, recruiting new physicians and nonphysician providers while expanding the reach of the workforce already in place.
“Sometimes it's a little bit harder to recruit into a rural geography, despite it being a fantastic place to live and a wonderful place to practice,” said Dr. Hoerneman. “You can have fantastic technology and make great advances in medicine, but at the end of the day you still need to have people bedside. Without that, care just doesn't happen. Retaining more staff means being able to offer more care.”
The organization invested in ambient listening technology and AI-assisted in-box management to reduce administrative burdens. The leadership structure was revamped too, with physician chair positions created to give doctors a larger share of voice in departmental decision making. Other initiatives included implementing Sanford’s SAFE patient safety program, expanded physician recognition programs and $500 million in capital investments to drive practice development and growth throughout the Marshfield region.
As a result of those efforts more than 1,500 employees have joined the organization, including more than 120 physicians in 2025 alone. Notably, more than 20% of those hires were former employees who chose to return to the organization.
"If patients, physicians and APPs feel supported, they're going to come to us and stay with us,” Dr. Hoerneman added. “In fact, we’re hiring a new physician or APP about every three days now.”
From merger to integration
The two organizations moved quickly to integrate operations and standardize practices across the newly combined system. Sanford Health's internal Integration Management Office coordinated the complex merger and implementation process across departments and markets. Rather than relying on outside consultants, access to an experienced in-house team enabled the organization to make decisions and align processes faster and establish consistent operational and clinical practices throughout the system.
Standardization also included physician governance. Physician chair positions across departments were adopted and aligned with Sanford’s broader physician governance model. Now, more than 60 physician chairs work with managers to develop action plans and share best practices across the system.
“Having the integration management office in-house facilitated rapid integration and got our teams working together quickly,” Dr. Hoerneman said. “The physician governance piece was huge for us to become a unified organization, not just a holding company with several regions functioning under the new name. Now, we function as an integrated system.”
Additional efforts underway include a system-wide implementation of Epic. Besides serving as a universal EHR, analytics, standardized billing, documentation and operational processes, and best practices will be easily shared across facilities and markets.
Finally, Marshfield is actively working to maximize the effectiveness of the clinical workforce. Physicians and nonphysician providers are deployed in complementary roles that allow everyone to work together as a team. Surgeons, for example, can focus on operating room responsibilities while nonphysician providers facilitate office-based care and follow up visits. As a result, patient access is expanded without a proportional increase in staffing.
Expanded access through innovation and outreach
The combined organization has also expanded access to care by finding new ways to connect patients in rural communities with physicians and specialists. Virtual care has become an increasingly important part of that strategy. Through Sanford Health’s $350 million virtual care initiative, the system has launched a strategy of opening clinics staffed by nurses and diagnostic services onsite while physicians provide care remotely.
Telehealth is allowing patients to access care from home, while virtual hospitalists, infectious diseases physicians and stroke programs bring specialty expertise to smaller hospitals that otherwise might not offer those services.
Behavioral health has been one of the areas where virtual care has had the greatest impact on access.
“That’s probably the area where we’ve seen the most patient utilization,” Dr. Hoerneman said. “It’s really been fantastic to see the engagement there,” adding that most patients prefer virtual visits with their behavioral health physicians and care teams. Without the need to travel to a clinic, behavioral health services are more convenient and accessible for the system’s patients in rural areas.
Outreach clinics have further extended the reach of specialists across Wisconsin and South Dakota, providing care to more remote communities that wouldn’t otherwise be able to support a specialty practice.
"That is tied closely to our mission, bringing world class care close to home, and making sure that patients don't have to travel four or five hours to get to Milwaukee or the Twin Cities and instead get that care here in North Central Wisconsin," Dr. Hoerneman added.
Physicians now regularly travel to smaller communities to provide services closer to home. Pediatric cardiology is one example, with specialists visiting rural sites to evaluate and treat children with congenital heart disease, arrhythmia and other cardiac conditions.
Meanwhile, the new Marshfield Medical Center–Wisconsin Rapids Campus offers emergency care, urgent care and imaging services, giving local residents a new access point for care while providing a pathway to higher-acuity services when needed.
The hospital had been on Marshfield's “wish list” for several years, but organizational and staffing challenges slowed its progress. The merger provided the stability needed to move forward.
"It acts as a ‘front door’ to our overall system,” Dr. Hoerneman said. “If patients need more advanced care, like a cardiac procedure, or they need to see a specialist quickly, they can be moved to one of our higher acuity hospitals or one of our tertiary hospitals and get that advanced care when they need it."
A blueprint for expanding rural healthcare access
The experience of Sanford Health and Marshfield Clinic Health System demonstrates that improving rural healthcare access requires more than simply adding physicians, opening facilities or investing in technology. Sustainable access depends on building an environment where physicians and other health professionals want to practice, where patients can receive care close to home, and where organizations have the scale and resources to continue investing in both.
The partnership has been successful because it addressed all three challenges simultaneously. Workforce shortages, physician burnout, geographic barriers and financial pressures remain realities throughout rural healthcare, but the combined organization has shown that those obstacles can be addressed through a combination of strategic investment, cultural alignment and operational innovation.
Perhaps most importantly, the merger brought together two organizations that already shared a common mission and vision for rural healthcare. The resulting stability allowed leaders to invest in people, expand virtual and in-person access points, strengthen physician leadership and accelerate initiatives that might otherwise have remained out of reach.
“Overall, it just comes back to the fact that the combination of the two organizations really is a testament to what's possible when you bring together like-minded health systems,” Dr. Hoerneman said. “That shared commitment to patients and communities has been great to see.”
