Need for health professionals in small-towns prompts job security for incoming doctorsWhen Matt Horning applied for a job, it was with the understanding that his wife would be hired at the same place, even though she wouldn’t be available for another 2½ years.And with the understanding that at some unspecified time, in the not-distant future, he would be away for nine months to a year. No problem.
By: John Lundy, Forum News Service
When Matt Horning applied for a job, it was with the understanding that his wife would be hired at the same place, even though she wouldn’t be available for another 2½ years.
And with the understanding that at some unspecified time, in the not-distant future, he would be away for nine months to a year.
Horning, 31, is a doctor, in family medicine, willing to practice in a small town.
For him, that small town is Ashland, at the St. Luke’s Chequamegon Clinic, where he’ll soon be joined on the staff by his wife, Monica Lee, who just finished her residency at the Duluth Family Medical Residency Program. That’s where Horning also had his residency.
They could have gone almost anywhere.
“Every place that we went, contacted or even whispered that we might be interested in, really, said, ‘Oh, gosh, we’ll do whatever we can, almost,’ ” the Chokio, Minn., native said in a recent interview.
Horning and Lee are not unique.
A growing shortage of health professionals, especially in small-town America, is prompting hospitals and clinics to go to extraordinary lengths to land doctors for their communities. It provides unquestionable job security for incoming doctors willing to be spread thin.
There won’t be enough of them to go around, health-policy experts say. For patients, that means adapting to new ways of receiving care — seeing a nurse practitioner for most needs, or consulting with a medical doctor in a bigger city via a television screen.
“I think that’s where it’s going to go,” said Terry Hill, executive director of the Duluth-based National Rural Health Resource Center. “I think that’s where it’s going to move, partially just out of necessity. We are not going to have enough primary-care providers.”
For young doctors choosing from a wealth of offers, they know they will quickly go from being the recruited to being the recruiters.
“The more intimidating factor for me is recognizing how hard it was to recruit me to a practice,” said Dr. Heather Danckwart, a Kellogg, Minn., native who also just completed her third year of residency in the Duluth program. “That’s soon going to be me trying to recruit a partner, and … that’s only going to get harder.”
Duluth’s rural focus
The aging of the medical workforce combined with the aging of the general population portends “a huge wave of shortage coming at Minnesota,” said Mark Schoenbaum, director of the Office of Rural Health and Primary Care at the Minnesota Department of Health.
The shortages are particularly acute in small towns and rural areas and among the primary-care doctors — pediatricians, internists and family-practice — who serve them, Schoenbaum said.
That makes the Duluth residency program a hot spot, because its 30 residents — 10 each year in the three-year program — are training specifically for those roles.
“Since its inception in the 1970s it has had a rural focus,” said Kate Dean, director of health science and graduate medical education for the Essentia Institute of Rural Health. Dean has administered the program since last July, when Essentia Health agreed to take over its management.
Both Essentia Health and St. Luke’s undergird the residency program financially, Dean said, and they’ve taken more of the burden as the state of Minnesota has taken less.
“Both hospitals are committed to education,” Dean said. “They know we need those residents; we need those students coming up here to survive.”
It’s not easy to get into a residency program. For the three-year 2013 residency at the Duluth Family Medical Residency Program that begins on MondayJuly 1, there were 106 applicants. Ten were accepted, said Kim Kaiser, spokeswoman for Essentia Health, which manages the program.
Nationally, there aren’t nearly enough residency spots for all medical school graduates, said Dr. Ray Christensen, associate dean for rural health at the University of Minnesota Medical School, Duluth campus.
The Duluth campus, which has a rural and American Indian focus, has 60 students in each class who eventually will need residencies before establishing their practices. There isn’t room for all of them.
“If you look at the family residencies that are in rural Minnesota, you’ve got 10 down the hill (in Duluth), four in St. Cloud and four in Mankato,” Christensen said. “That adds up to — what, 18? That’s it.”
Feeling the love
But once residents get into the program, they start feeling the love right away.
Horning said he got a call from a hospital CEO during his first week of residency. “Matt, there’s an offer for you,” the CEO told him. “We want to talk. We know it’s three years away, but we want to have you here.”
Danckwart and Dr. Maggie Neudecker, a Little Falls, Minn., native who also just completed the Duluth program, said offers came while they were still in medical school.
“We didn’t even know we were going to do family medicine then, and people would still sign you to work,” said Neudecker, who only recently made the decision to practice in Moose Lake. “And they would pay you every year while you’re still in training, as part of a bonus.”
Danckwart said the offers increased during her third year of medical school, when she was in the University of Minnesota’s Rural Physician Associate Program, another training ground for rural doctors. The medical students work rotations in various small-town clinics and hospitals.
“Every single day, it was, ‘We hope you return. What can we do to get you to return?’ ” Danckwart related. “I was only in my third year, I still had at least four years before I’d be able to return there, but they were willing to say: If you could sign, we would sign with you.”
$200,000 in debt
The attention cascaded when they entered the residency program, said the women, both 29. Danckwart stopped answering her phone because she was hearing from so many recruiters. Neudecker said she was averaging five e-mails a day from recruiters even after committing to Moose Lake.
The interest won’t necessarily go away.
“Even as I was established and didn’t have plans to move, I was getting fairly regular (recruiting) messages either by mail or e-mail,” said Dr. Debrahcq LaBarre, who practices in her hometown of Duluth at the St. Luke’s Mount Royal Clinic after eight years in La Crosse, Wis., and Wyoming, Minn.
The attention can be lavish. Neudecker described being flown to Colorado, put up in a hotel, treated to meals and then getting a gift in the mail at Christmas. “I was shocked by … how crazy it was,” she said.
The flip side is the money they owe. Neudecker and Danckwart each left medical school with close to $200,000 in student loans to pay off. And the family-practice specialties pay less than all other medical specialties, according to the Medscape Physician Compensation Report.
Still, money isn’t the prime driving force for most doctors, Hill said.
In surveys of what doctors want, “salary is not at the top of the list,” he said. “It comes in about seventh. Toward the top of the list is the clinic itself. Who are the partners? Do they have electronic health records? Can a spouse get a job in the community?”
Intangible factors drew Dr. Andrew Broadmore and his wife to St. Luke’s Denfeld Medical Clinic after three years in Grinnell, Iowa.
“My wife did a bunch of research and decided that this is where she would like to live,” Broadmore said about the move to Duluth, adding that it also fit his interest in outdoor activities. St. Luke’s in particular was a good fit, he said, because he could “round” — see his patients when they’re in the hospital as well as at the clinic.
“In family medicine, you pretty much decide where you want to go, in the Midwest at least,” Broadmore said.
Money wasn’t Horning’s primary motivation.
“I do not feel underpaid, but certainly I’m paid less than specialists in (Duluth) or even in Ashland,” Horning said. “But I didn’t go into medicine to be a millionaire. … I went into medicine to help people, and because it’s challenging and fun and fulfilling.”
More important to Horning as he looked for a job was that he not be too far from Duluth, where Lee still had two years of residency left. Also, he and Lee wanted to work in the same clinic once she finished her residency.
Moreover, he wanted to serve a term with the humanitarian organization Doctors Without Borders, which requires its volunteers to serve on two weeks’ notice for anywhere from nine to 12 months.
“And Sandra Barkley said, ‘Yeah, that’s OK; we can work with that,’ ” Horning related.
St. Luke’s is willing to deal with logistical challenges, said Barkley, who is in charge of recruiting for the hospital.
“If they’re people that you want, yes,” she said. “You try to figure out a way to make it work.”
For young family doctors, it puts them in a far different position from many of their peers.
Some of Danckwart’s college classmates who went into teaching are struggling to find work, she said. She sometimes feels guilty about all the options she has.
“It’s absolutely unbelievable demand,” Danckwart said. “Essentially, there are very few communities in Minnesota and Wisconsin that are not hiring family practice.”