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North Dakota's 'Northern Exposure'

Hoping to put a dent in the shortage of family doctors in rural North Dakota, UND's medical school is offering full rides to students willing to serve in rural areas of the state for at least five years.

Hoping to put a dent in the shortage of family doctors in rural North Dakota, UND's medical school is offering full rides to students willing to serve in rural areas of the state for at least five years.

This month, the RuralMed Scholar program signed up its first scholar, Stephanie Lee.

The whole thing sounds a little like the setup to an early '90s 'dramedy' about a young doctor stuck in a rural town because he was contractually bound to do it to pay off a med school loan. But "Northern Exposure" this isn't, and Lee is no persnickety city-slicker like Joel Fleischman.

Lee, who's in her second year of med school, is from Mercer, N.D., a town of about 80 an hour's drive north of Bismarck. And she already has plenty of experience with rural health care from her job as a nurse's assistant while in high school.

"It was really fun; everyone was really busy," she said. Most of the work was done by physician assistants or nurse practitioners, she said, and doctors visited from larger towns only once a week or once a month.


The shortage of doctors is expected to sharpen as the state's population ages, requiring more care, even as few young doctors are willing to serve in rural areas. Dr. Joshua Wynne, dean of UND's School of Medicine and Health Sciences, has been sounding the alarm on that for some time.

"This is not a solution to all of North Dakota's health care problems," Wynne said of RuralMed. "But it's a step; it's an important step, and we think it will help."

The program will offer eight full rides per year, which means that once it really gets going, there will be about 32 scholars at the med school at any one time. RuralMed is funded by the state Legislature through this biennium.

Wynne said that if a student decides not to serve in a rural area, he or she will have to repay all or part of the loan at competitive interest rates, depending on how many of the five years have been served.

Reducing barriers

Lee knew from a young age that she wanted to be a doctor, she said. Starting at 16, she worked as a nurse's assistant at the medical center in nearby Turtle Lake and continued during summer breaks for a few years while an undergraduate at UND.

She remembers how Turtle Lake did have a doctor, but when the doctor left, there was no replacement and doctors simply rotated now and again. If a Mercer or Turtle Lake resident wanted to see a doctor or a specialist, she said, it would be an hour drive to Bismarck.

Lee said she plans to go into family medicine with a specialty in obstetrics and women's health, ideally somewhere in eastern North Dakota.


"The expectation is Stephanie is just the first of many," Wynne said. The average med school debt nationwide is $150,000, he said. "To the extent that servicing debt after medical school is a barrier, this will dramatically reduce that barrier."

Having to repay that can make serving in bigger cities and in specialties other than family medicine where pay is higher much more attractive.

UND isn't doing that bad compared with other universities, said Wynne, who cited a recent study looking back over 10 years that ranked UND's med school No. 4 in the nation in the number of graduates going on to serve in rural areas.

"There is a need out there," he said. "Even fourth isn't good enough. We have to do better."

Keeping them there

The question is how many of the young doctors will stay after five years and how many will serve for five years just to fulfill the contract and then leave.

Wynne said it has to be based on "good faith on both sides." If students say they truly want to serve in rural areas, UND would believe it, he said, because statistics show that if doctors serve in an area long enough, there's a high probability they'll want to continue serving in the same area.

Plus, he said, if their hearts aren't in it, the university wouldn't want to force them because that's not good for them or their patients.


Besides the scholarship, he said, UND also has a specialist in its Center for Rural Health that would help new doctors find jobs in rural areas.

Reach Tran at (701) 780-1248; (800) 477-6572, ext. 248; or send e-mail to ttran@gfherald.com .

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