North Dakota rural health faces at least four major challenges, according to Brad Gibbens, deputy director of the UND School of Medicine Center for Rural Health.
Brad has spent 32 years researching and leading community discussions on the state's rural health problems with the goal of facilitating local responses to those challenges.
Here are his challenges:
- Keeping rural health systems viable.
For much of rural North Dakota, the 36 identified critical access hospitals are cornerstones of the local health system. Not only are these hospitals crucial to the patients they serve but they are primary support for community nursing homes, attracting health care professionals, the success of Emergency Medical Services units, and spreading the gospel of good health. When hospitals close, the whole community health system suffers.
The Affordable Care Act, more commonly called Obamacare, has helped hospital bottom lines and the Medicaid expansion approved by former Gov. Jack Dalrymple gave insurance to 20,000 low-income folks who can now go to clinics instead of waiting until they must go to emergency rooms.
The condition of the critical access hospitals has improved from 2014 when only 22 percent operated in the black and 2016 when 54 percent were out of the red. But more is left to be done if all critical access hospitals are to continue.
- Recruiting an adequate health workforce.
While Dean Joshua Wynne of the UND School of Medicine has developed creative ways to expand the number of doctors for rural areas, the local communities must attract health workers, including paramedics, nurse practitioners, nurses, physician assistants, mental health professionals and skilled maintenance personnel.
Medical students may now opt for free tuition in exchange for four years of service in rural communities. More students are participating in rural partnerships with doctors in rural areas to learn lifestyles in rural areas.
Emergency Medical Service units, staffed by all-volunteers, are finding it more and more difficult to recruit full crews in rural areas that are now suffering from the out-migration that is draining the pool of possible recruits.
The key to recruitment of medical professionals for rural areas is finding young people who know and love their rural lifestyle - and then raising financial support to help them get the necessary education.
- The behavioral health challenge
The mushrooming addiction to alcohol and drugs throughout the state is particularly challenging in rural areas.
North Dakota leads the nation in binge drinking and a plethora of drugs are readily accessible to willing buyers. Business is so good we even have witnessed murders among the drug dealers.
So an addict overdoses and ends up in the rural hospital emergency room. After the addict is stabilized, incarceration has becomes the only alternative for management of the problem.
The last session of the Legislature took major steps to turn the corner on incarceration of addicts by providing the alternative of release and supervision. Perhaps this approach needs to be extended to the local penal system.
- The challenge of depopulation
The viability of rural health care is threatened by unrelenting depopulation. As the demographics change, rural areas are ending up with older and smaller clienteles, meaning fewer customers for medical services.
We are still absorbing the impact of the Bakken boom on health services. The increase in the number of young men and women in the western areas of the state may balance out the aging population.
Solutions to many facets of these challenges rest in the development strategies and leadership in rural communities.
"At community strategy meetings, I tell folks straight out that not Washington, or Bismarck, or the Med School has the answers," Brad asserts. "The solutions lie in the communities themselves."
Lloyd Omdahl is a former lieutenant governor and professor at UND. His writes each Monday for the Herald.