Richard Failing, Hallock, Minn., column: How to train more rural family doctors

By Richard Failing HALLOCK, Minn. -- Dr. Eric Holten's letter last month stated his opposition to the UND School of Medicine's request for legislative funding to educate an additional 16 medical students and for the training of another 17 physici...

By Richard Failing

HALLOCK, Minn. -- Dr. Eric Holten's letter last month stated his opposition to the UND School of Medicine's request for legislative funding to educate an additional 16 medical students and for the training of another 17 physician residents ("Med school expansion won't solve problem," Page A4, Oct. 21).

Holten felt that not enough UND-trained physicians are staying and practicing in North Dakota to warrant adding more.

While UND's medical school is an excellent program, it is not the school officials' fault that more of their trained physicians do not stay and practice in North Dakota. The dynamics of this issue are complex and show the changes in our society across all size communities.

As a rural health care administrator for more than 25 years in both North Dakota and Minnesota, I have experienced firsthand the difficulty of recruiting and retaining primary care physicians.


The younger physician wants a professional and personal balance in his or her life. And even if that physician hopes to practice in a rural community, the spouse -- who likely is professionally trained as well and possibly raised in a city -- finds it hard to get meaningful employment and/or accept the rural lifestyle.

I would urge officials at the UND medical school to approach this expansion of 16 additional medical school slots similar to the INMED component at the school.

The INMED program designates a few of each year's incoming first-year medical student slots specifically for American Indian applicants. In similar fashion, the 16 additional slots could be set aside for nontraditional North Dakota resident applicants.

I define such a nontraditional student as a person who, for example, may be working as a registered nurse, a lab technician or an EMT/paramedic while raising a family in a small town and now would like to become a physician before returning to that town.

Without degrading its criteria, the UND medical school should look at developing modified admission requirements for the nontraditional students who'd be admitted into these 16 new slots. The modified requirements would recognize these applicants may have been out of college for 10 to 12 years.

I would suggest for these 16 applicants, a five-year rather than the current four-year medical program would be appropriate. The first year would provide these students with customized remedial training to refresh and fill in the educational gaps so they successfully could complete the rigors of the next four years of their medical training.

Additionally, those individuals who accept one of 16 medical-school slots must agree to either enter a family practice or internal medicine residency upon graduation or pay a financial penalty.

The residency then should be highly tailored: For example, the program should bring the physician back to his or her local community as often as possible in order to reinforce the new doctor's previous ties to that community.


Another often overlooked source for potential physicians for rural North Dakota are mid-level practitioners such as nurse practitioners and physician assistants, many of whom provide primary care services in rural communities across North Dakota.

I would urge UND medical school officials to consider a pilot program in which nurse practitioners and physician assistants who have at least five years of experience and commit to returning to their current small town undergo a medical knowledge-and-skills assessment. Based upon that assessment, the person then would be placed into the appropriate level of medical school to earn an M.D. degree.

Additionally, the required three-year family practice residency could be shortened in relation to their prior experience.

Last but not least and regardless of what criteria the medical student is admitted under, I would suggest a larger tuition fee be assessed to reduce the state's initial subsidies for their training.

Then, after the physician completes seven years of practice in North Dakota, he or she would get a rebate of all of this additional tuition (and interest) cost.

If the physician practices in a truly rural community, the physician could receive the rebate after only four years. This would provide a "win-win" for all parties, especially the state's taxpayers who are generously supporting one of the finest primary-care-focused medical schools in the country.

Failing is chief executive officer of Kittson Memorial Healthcare Center in Hallock.

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