DEVILS LAKE – Dick Johnson, mayor of Devils Lake, said he’ll often see the same thing on Highway 2: an ambulance transporting patients to Grand Forks.

To him, it’s a symbol of his city’s dependence on big medical centers outside of town, where most of the big surgeries and procedures – and, he says, many of the smaller ones – are now done. The patients heading elsewhere are often leaving Devils Lake because they can’t get the services they need closer to home.

“You can talk to anybody in town. We’re not getting the services that we need,” Johnson said. “I know people who have fallen and broke an arm and they don’t even stop in Devils Lake. They just have their wife or husband take them straight to Grand Forks.”

He’s hoping a sudden rush of attention could change that. Devils Lake’s hospital, a 25-bed critical-access hospital on Seventh Street, could be sold soon. Johnson is hopeful a major provider could swoop in and revitalize health care in Ramsey County.

Altru Health System, based in Grand Forks, sent thousands of emails to local residents and even held a recent listening session as its leaders court the community. Altru officials have pitched the possibility of a purchase or even community ownership, but with Altru set as the facility manager. Based in Grand Forks, Altru already operates a health clinic in Devils Lake, and looks poised to grow.

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“We have had a lot of positive feedback from the community,” Altru CEO Dave Molmen told the Herald on July 13. “Our philosophy and approach is that health care should have local decision making and we’re partnering with that community to try to make that happen.”

South Dakota-based Sanford Health recently announced, on July 23, that it will open a clinic in the community, too, inviting questions about the company’s own hopes for the hospital. A senior official with Sanford Health Network said through a spokesperson that the company has “no other plans in the area at this time,” but continues to “explore growth opportunities locally, regionally and nationally.”

RELATED: Sanford Health to open clinic in Devils Lake

The mayor is realistic: he doesn’t see Devils Lake becoming a major trauma center anytime soon, which means it won’t likely be taking on a role like facilities in Grand Forks or Fargo. But he sees a future where a medical provider invests in more small surgeries and more complex medical care, making Devils Lake a local medical hub.

“All the (minor) surgeries … are done in Grand Forks. Nothing stays in Devils Lake,” he said. “We’re 90 miles (away from) Grand Forks. Jamestown is 100, Minot is 120. We should be a regional center, and the people we talk to agree with that.”

Exactly what will happen with the future of Devils Lake’s St. Alexius Hospital, owned by CommonSpirit Health, still isn’t clear. But Johnson said he hopes whoever takes the helm will not only provide hospital services, but local clinical services, too. The way things have previously worked, he said – with Altru running a clinic and a separate provider running the hospital – have meant disjointed care.

“We just really feel we deserve a better health care system than we have, where you have Altru doing the clinic and another provider doing the hospitalization,” he said.

All the attention on Devils Lake comes not long after big changes in Grand Forks, too, as Altru continues to work toward a new $380 million flagship hospital, and as Sanford prepares to open a new clinic on Grand Forks’ south end. Across the region, there has been a flurry of health care expansion.

RELATED: Altru announces expanded hospital plan, going back to a seven-floor facility

Brad Gibbens is the acting director of the Center for Rural Health at UND’s medical school. He said it’s no surprise big names like Altru and Sanford are looking to grow. The health care industry has been shifting business models for years now, toward a style of service that values the quality of community health more than the number of tests or surgeries billed to patients. That’s putting financial pressure on providers to expand.

And it also comes as modern technology sends more competition into the industry. Walmart is starting to open health clinics, and Amazon is launching an “on-demand” telehealth service. That means competition for Sanford, Altru and providers like them.

“We don't think of Amazon as a health care provider yet — but they're there,” Gibbens said.

The shifts also come after the COVID pandemic caused dramatic changes in the health industry, canceling nonessential procedures and keeping many patients at home. For Altru in particular, it came at a difficult moment — just after it had launched into its hospital project. Altru laid off more than 160 workers last summer, and for months, its new hospital project was on hold.

Johnson said Devils Lake has certainly noticed. In his recent interview with the Herald, he said there’s broader concern in the community about Altru’s financial viability.

“They started the hospital in Grand Forks, and they had to stop — I know COVID got involved, and that type of thing … but that resonates through the community,” Johnson said. “People say, ‘Look at that. They can’t even do their own hospital.’”

He said local leaders have spoken with top Altru officials, who have reassured them that Altru has the resources necessary to support an expansion in Devils Lake.

“They’re confident that they can handle it, they’re on an even keel, that things are getting better,” he said. “So that’s good.”

There’s also significant excitement about what health care expansion could mean for Devils Lake’s business community, too. Gibbens points out that small hospitals like the one in Devils Lake can generate millions in local economic impact.

Dr. Steven Weiser, president of Altru, said Altru has invested in Devils Lake and has supported the hospital there, no matter who has owned it. Because of that investment, Altru is interested in the future of the city’s health care and has engaged in talks with community members, Weiser recently told the Herald.

“We said, ‘we know you have had a challenge with health care. We have had a challenge with (Devils Lake hospital owners), because they haven’t done any infrastructure with the hospital so it’s hard for us to get surgeons to want to do local surgery there because the infrastructure was that worn down.’ ”

Weiser said that in conversations between Altru and Devils Lake leaders, discussion turned to years past, when Devils Lake had doctors who could do an assortment of basic surgeries and minor procedures.

Altru’s response, according to Weiser: “You can have that and we’ll partner with you for that. But you should control your care locally. … You should have that control there and work with us, partner with us and we’ll collaborate with you to get you the care you need.”

Doing so, Weiser said, can allow communities like Devils Lake to “have strength so they can maintain their vibrancy and businesses.”

Local business leaders are aware of the business implications. Paula Vistad, the executive director of the Devils Lake Chamber, said a revitalized health care industry could mean not only new jobs, but a better pitch to help bring businesses to town.

“I think we're going to see a trend moving upward,” Vistad said. “I'm excited for the future.”