The shortage of primary care physicians in North Dakota just got worse.
It was approaching a crisis situation before expansion of Medicaid kicked in on Jan. 1. That expansion will eventually add 20,000 to 30,000 to the patient load in North Dakota.
Add this to the 40,000 newcomers working in the Bakken oil fields and we have something equal to a new city of 65,000 people with no additional doctors.
This shortage of primary care physicians is most serious in the smaller communities across the state. Unless we beef up medical services in these communities, more of their residents will be moving to the larger cities just to be close to medical services.
To consider the problem, let's start with the admission and retention of primary care physicians.
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Folks at the UND Medical School may think they are doing everything possible to recruit and admit candidates for community medicine but some physicians in the field think more needs to be done.
Dr. Gary Ramage, practicing in the middle of the Bakken oil field at Watford City, has been quoted as saying that "if UND does not change the process by which they choose students, we will never solve the problem of health care or health care access in places like Watford City - and all of Northwestern North Dakota."
Dr. Richard Johnson of Devils Lake has agreed. He labelled the Med School's admission policies as unimaginative and failing to address primary care needs for the past 50 years.
It is true that the new $125 million Med School building can result in expansion of classes but that won't necessarily mean more primary care physicians for smaller communities unless those seats are filled with students who come with a community orientation.
We need an admission policy that dedicates half of the seats to students from communities in North Dakota. As stated earlier in this column, a student from Killdeer or Finley is more likely to practice in Killdeer or Finley than someone from Sioux Falls, Minneapolis or another country. Bribery isn't necessary.
Once admitted, all students should be exposed to primary care practice. Look at the University of Minnesota-Duluth.
According to Dr. Robin Michaels, since Duluth's first graduating class in 1976, 49 percent of its alumni have chosen family practice. North Dakota hasn't achieved half that.
Michaels explains that medical students at Duluth are teamed up with two family physicians, one in Duluth and one in a rural setting. They then have a weeklong visit with their rural partner early in their education experience.
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The location of residencies is also important. North Dakota has four sites for residencies but they are underutilized as far as family practice candidates are concerned. We can argue about the degree of usage but the bottom line is the same no matter whose figures we believe: there are not enough family physicians in North Dakota residencies.
We are 12 years away from physicians trained in the new Med School building. Besides, more students won't mean more family practitioners if we keep doing what we are doing.
In the short term, we should look at physician assistants and nurse practitioners for quick solutions. Starting with their present education and experience, registered nurses and other medical staffers could complete either program and be practicing in two or three years.
Not only should we aggressively recruit candidates for these disciplines but we should offer them full financial support to make their participation possible - make them an offer they can't refuse.
It seems that more feet must be put to the fire if this shortage of medical professionals is going to be solved.
