Rural Health Crunch

Ground Level video chat about challenges facing rural health care

In rural Minnesota, health systems and independents compete for doctors

By Jennifer Vogel

MPR News

Joining a larger health system makes it easier to recruit doctors, said two participants in a video chat on hospital consolidation, conducted today by MPR News’ Ground Level project.  “It’s becoming easier,” said Mary Klimp, chief administrative officer at Mayo Clinic Health System in New Prague. Her hospital joined Mayo just over a year ago. “Now, (we’re) recruiting to the Mayo name, the Mayo brand, the Mayo quality of care. We are seeing some benefit from that and we anticipate that will continue.

Rural communities have long grappled with a doctor shortage and recruitment is a significant issue. Health systems like Mayo Clinic, Sanford Health and Essentia Health are expanding outstate. According to the Minnesota Hospital Association, 16 independent hospitals have joined systems since 2005. They promise communities help with expensive technology like electronic medical records and physician recruitment.

Paul Hanson, president of Sanford Health of Northern Minnesota in Bemidji reported that since his hospital joined the system last year, “that exposure to the system has helped us tremendously in not only developing some stability here in Bemidji but also in the surrounding area.”

The flipside is that it’s becoming harder for some independent clinics and hospitals to draw doctors.  According to Jeff Tucker, chief executive officer of Integrity Health Network in Duluth, which represents independent doctors and clinics in Minnesota and Wisconsin, expanding systems are “Making it more difficult to recruit because some of the bigger systems are offering big signing bonuses.

He also said that system doctors may spend less time on call. “They get to a big system and they may not have to take call, whereas at an independent clinic, particularly a smaller independent clinic, they are taking call every couple of days if not every other day,” said Tucker. “That’s tough to compete with.

The importance of collaboration emerged as a theme during the half-hour video discussion.  Dan Odegaard, chief executive officer of the independent Bigfork Valley hospital in Bigfork, in northern Minnesota, said his facility works with a network of other providers on the implementation of electronic medical records. And it partners with a system of clinics to keep doctors in town. “That does help tremendously to help provide high quality services here in the north woods,” he said.

The conversation highlighted tensions that can exist between the drive to maintain quality and the hometown touch and the impetus to lower costs through standardization and other means.

Odegaard is determined that Bigfork Valley will remain independent, and he’s growing the hospital campus, especially to serve seniors, in order to make that happen.  “Our plan is to remain independent and to maintain local control and to provide the residents who live in this area the high quality of service we have been providing for a long time,” he said. “Hospitals that do remain independent in this state will remain because of strong leadership and high quality leadership. I believe that at board level, physician level and the management level.

Asked to predict what the rural hospital landscape will look like in the future, Terry Hill, executive director of the National Rural Health Resource Center in Duluth, said, “Healthcare is going to change incredibly in the next five years. “ He said there will be more focus on prevention and wellness. “Hospitals across the country are going to need to change their role. They are going to need to be places where they are stepping up and helping to keep people healthy. I’m really excited about the shift we will be seeing.

“We may very well have fewer hospitals,” Hill said. “But I think the hospitals as we know them now are going to change so dramatically in five years. We’re going to see healthcare campuses. I really think rural hospitals and clinics will play a major role here, I’m just not exactly sure what they are going to look like.

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