By Joshua Wynne, Gwen Halaas, Dave Molmen and Jon Backes
GRAND FORKS -- North Dakota is expected to experience a significant health care work force shortage over the next 15 years. Already a problem (especially in rural areas), the state will be short an estimated 210 physicians by 2025, not to mention a shortage of nurses, physical therapists, physician assistants and other health care providers.
The UND School of Medicine and Health Sciences has developed a comprehensive health care work force plan to avert the impending crisis, through a combination of retaining more of our own graduates as well as expanding the size of both the medical and health sciences classes.
Called GOOD for North Dakota (Growing Our Own Doctors), the plan is based on successes here and elsewhere and has been vetted and subsequently endorsed by the school's advisory council and the State Board of Higher Education.
The work force proposal now is pending before the upcoming legislative session that will begin in January.
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A recent column questioned the need for such a plan ("Med school expansion won't solve problem," Page A4, Oct. 21). The piece disagreed with the proposed expansion of the class, based on the following condensed argument: Medical students won't go into primary care because they make less income than specialists; nothing has convinced them otherwise in the past, and nothing will in the future.
The one part of the argument with which we agree is that the salary gap between primary care docs and specialists is a significant issue. But we reject all of the other propositions advanced for the following reasons.
First, the writer has reframed our health care plan solely through the lens of the primary care physician. Our plan is much more comprehensive than one limited simply to primary care docs.
While they are an essential component of our plan, we also address the needs for a whole spectrum of other providers. In this era of team-based medical care, focusing on just the physician component is too narrow and limited and will not effectively address the needs of our aging population and the increasing number of people living with chronic diseases.
Second, the suggestion that nothing has worked before to convince physicians to practice primary care in North Dakota and its rural areas simply is wrong. We exceed the national average of primary care physicians per capita, and almost half (about 45 percent) of the primary care providers in this state graduated from UND's School of Medicine and Health Sciences.
Just think where we would be today from the standpoint of primary care medicine were it not for the efforts of the school.
Additionally, the UND medical school leads the nation in the percentage of our class going into family medicine -- the foundation of North Dakota primary care. In fact, of our current senior class, 25 percent have expressed a serious interest in pursuing a family medicine career. That compares with the national average of about 8 percent.
We are fifth in the nation in the percentage of medical school graduates who have stayed or returned to practice in a rural area of our state. So, to say that the programs in place have not worked is uninformed and incorrect.
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Finally and perhaps most important, our plan is one that is developed by North Dakotans for North Dakotans. It does not wait for a magical "cure" coming from Washington to solve our problems (such as the salary inequity issue).
Rather, it is a plan for the future based on reasoned proposals and the evidence of what has worked. It is a local solution to a local problem and relies on state resources to address the problem.
And the plan encompasses more than just an expansion of class sizes. It focuses as well on greater retention of our graduates, for example, by reducing the debt burden of medical students who agree to practice primary care in rural areas of North Dakota (through our RuralMed program).
Can we guarantee that each and every component of the plan will work? Of course not. But taken as an integrated, coordinated plan, we are confident that it represents the best path.
The alternative that has been suggested -- do nothing -- is not acceptable to us and, we suspect, not acceptable to Herald readers as well.
Dr. Wynne is vice president for health affairs and dean of the School of Medicine and Health Sciences and a practicing cardiologist. Dr. Halaas is senior associate dean of the school and a family medicine specialist.
Molmen is CEO of Altru Health System in Grand Forks and chair of the School of Medicine and Health Sciences' advisory council. And Backes, an attorney practicing in Minot, is president of the State Board of Higher Education.
