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Although rural areas struggle to recruit docs, region having little difficulty

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WILLMAR -- Dale Hustedt is looking forward to this autumn, when a second doctor will join Rice Memorial Hospital's inpatient hospitalist service.

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"We've been looking for a hospitalist for quite some time," said Hustedt, the interim chief executive officer at the city-owned hospital.

A nephrologist, specializing in kidney disease, is arriving in June at Affiliated Community Medical Centers.

ACMC added a family physician in New London last year and has signed on two more family practice doctors, one starting in Benson this summer and one in Willmar next year.

Family Practice Medical Center brought a new family practice physician on board last fall, added some mid-level practitioners and is eyeing the possibility of a building expansion.

In spite of an extraordinarily tough climate in rural Minnesota for recruiting doctors, local health providers have notched up several recent successes.

A more aggressive, targeted approach to recruitment may be helping, said Dr. David Newcomer, medical director at ACMC.

"We hope it's because we have increased our efforts and changed our recruiting practices," he said.

But it's also a struggle. Efforts to land at least one more orthopedic surgeon, a specialty with high local demand, have yet to yield results.

And it's getting harder and harder to find doctors in primary care -- general internal medicine, family practice and pediatrics, said Dr. Ronald Holmgren, president and chief executive of ACMC.

"They're all shortages in a competitive situation," he said.

It underscores the two sides of the coin to rural physician recruitment: Although it's difficult, it's not impossible.

"It's an attractive community for the right person," Hustedt said. "It's a good place to practice."

"We seem to be able to recruit docs when we need to," said Gary McDowell, administrator of Family Practice Medical Center of Willmar. "I do believe that people are out there."

The clinic, which has nine family practice physicians, is growing and recently began considering an expansion, McDowell said.

"Right now we are looking at a space study, just to see what we could be doing and how we would do it," he said.

Still, recruitment often remains an uphill battle.

Nowhere has this been illustrated more bleakly than in the search for orthopedic surgeons. Both Rice Hospital and ACMC have tried to recruit orthopedic surgeons, with little success. In 2004 Rice managed to bring a surgeon on board and open an independent clinic, only to have it close after the first year.

A joint venture launched in 2007 by ACMC, the hospital and Heartland Orthopedic Specialists of Alexandria has been more promising.

Along with ACMC's lone orthopedic surgeon, at least two surgeons from Alexandria are in Willmar most weekdays, Hustedt said. By late 2008, an increasing number of orthopedic surgeries were being done at Rice.

But the joint venture has continued to fall short of its goal of recruiting an orthopedic surgeon to live and work in Willmar.

Two candidates showed interest this past winter and came for interviews, but "we just were not able to land them," Hustedt said. "It's a disappointment, but we keep trying."

Competition for these specialists is intense, he said. "Orthopedic surgeons are very hard to recruit because they're so well-compensated and so high in demand. They can go anywhere they want to go."

Orthopedists also tend to prefer single-specialty groups rather than a multispecialty organization like ACMC, Holmgren said.

It's a disappointment to ACMC that its recruitment efforts haven't borne fruit, he said. "It's just another example of the difficulty in bringing orthopedists in. It just happens to be one (specialty) we're having difficulty with in a rural area."

Some patients still must go out of town for orthopedic surgery, especially on weekends when there's no emergency orthopedic coverage, Hustedt said.

"I know that it's happening, and that's a reality we as a community are going to have to accept," he said. "There is some of that that is going to occur."

The struggles with orthopedic surgery have been partially offset by recruitment successes in other areas.

The addition of a second hospitalist will enhance inpatient care, Hustedt said. "It's great because it provides for more in-house continuous care for our patients. I also think it's a very good thing for the region."

For the first time, Willmar also will have its own nephrologist, starting in June.

Until now, a specialist had been providing outreach care eight days a month, Newcomer said. Now there will be someone here full time to see patients, he said. "The volume is there."

McDowell sees some light at the end of the tunnel, at least for primary care.

Nationally, there's growing recognition that primary care is part of the key to holding down costs and improving the quality and efficiency of care, he said. "There's a huge push on primary care. ... I'm pretty optimistic that primary care and family practice is going to, if anything, become more important."

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