Wanted: Rural doctor recruits
Dr. Shawn McMahon usually starts his work day shortly after 7 a.m. at Lake View Hospital in Two Harbors.
He checks in on hospitalized patients he sees regularly before heading over to the Lake View clinic, next door to the hospital, to begin seeing patients with appointments. He sees patients in the mornings and afternoons, spending his lunch and early evening refilling prescriptions, reviewing lab tests, notifying patients about results and updating medical records.
He spends at least 11 to 12 hours a day at Lake View. The addition of electronic medical records has added an another level of requirements for patients, thereby reducing the number people he can typically see in a day. At one time, McMahon was able see more than 20 patients in a day. Now, that number is around 15.
"The actual going in and visiting with patients hasn't changed since day one," he said. "What's really changed are the things haved surrounded that. It's the extra tasks that have come about with the changes in medicine. It's getting used to how to navigate the electronic medical record."
McMahon is a family physician in the the truest sense of the term; he sees patients in the hospital and clinic.
He is one of four family physicians at Lake View who have worked there for more than 25 years. Every six days and every sixth weekend, the four rotate being 24 hours on call.
All four of Lake View's family physicians will see retirement in the near future. Lake View is in the beginning stages of recruiting new physicians to Two Harbors.
President and CEO Greg Ruberg is finding that physicians like McMahon — those willing to do hospital and clinic work — are a vanishing breed.
"Those guys did it all — they were the small-town family doctor," Ruberg said. "We're having a hard time replacing that. We're not finding physicians who are coming out that are able or willing to do the 24/7 call, especially to cover the ER, cover the hospital. Physicians are coming out saying: 'I'm trained to be an outpatient physician in a clinic. That's what I want to do.' We're struggling because we have a hospital to run."
Rural areas hardest hit by shortage
Hospitals all over Minnesota are grappling with how to deal with a growing shortage of primary care physicians, particularly in rural areas like Two Harbors and the North Shore.
The Association of American Medical Colleges released a report earlier this year that said there could be a shortfall of between 34,600 to 88,000 doctors in the U.S. by 2025. Rahul Koranne, chief medical officer of the Minnesota Hospital Association (MHA), said there could be a shortfall of 850 in Minnesota by 2024, with rural areas being hit hardest.
Physicians tend to concentrate in urban rural areas because there are simply more people to serve. Also, many of the nation's medical schools are concentrated in large cities.
A local resident may go on to college or medical school in Minneapolis, Boston or another major metropolitan area with the intent of returning to a rural home, but after experiencing the amenities and benefits of living in a large city, fewer are returning to rural areas.
It also takes 10 years or more to train new physicians, so the issue needs to be tackled now instead of several years down the road.
Compounding the problem for hospitals are the demographics of rural communities, which tend to be older and less healthy. By 2030, more than 60 percent of the population of Lake County will be age 60 or older. The county already ranks 81 out of 87 counties in Minnesota in health outcomes.
Hospitals get creative to fill gaps
Lake View has six total providers and isn't yet having the coverage problems other rural hospitals are experiencing. But with four of those physicians inching ever closer to retirement, it's an issue Ruberg says keeps him awake at night as he looks to recruit a new generation of doctors.
If Lake View can't recruit enough physicians to serve its patients, the hospital could keep running an emergency room, but there wouldn't be an inpatient facility in Two Harbors. Patients needing a hospitalization would have be sent to Duluth or other hospital.
"That is what we do not want to happen," Ruberg said. "We want people to receive care in their own communities and really high-quality care, so our goal is to figure this out. I think it all comes down to being flexible, creative and innovative. We have to redesign how to provide care with the resources that we have."
Ruberg, Koranne and MHA are working on strategies to attract new doctors to rural areas as well as strategies to deal with the shortage.
One strategy is is the Rural Physician Associate Program through the University of Minnesota Medical Medical School. The program is nine-month, community-based educational experience for third-year medical students.
"These aren't physicians yet, but they are encouraged to go out into the community across the state of Minnesota in rural areas to partner with physicians and learn what it is to be a physician there," Koranne said. "It has been a great way to also encourage graduates to stay and work in Minnesota."
Other options include using nurse practitioners and telemedicine to help provide care in rural communities. With a physician sponsor, nurse practitioners can can see their own patients and make their own plan of care. Telemedicine has show some promise providing mental health care and some hospitals and emergency departments are experimenting with providing care remotely.
At the Essentia Health-Northern Pines facility in Aurora, physicians connect using a telepresence to provide additional support to providers in the building when patients are transferred between facilities.
"The thinking we keep talking with our team about is we have to be creative," Ruberg said. "It's going to look different at Lake View next year than it did last year — there is no question. Our goal is to provide high-quality care that is cost-effective. It's just going to be different."