Rural health: Two small hospitals learn how to survive

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Editor's note: This is one of several stories about what is called a rural Minnesota health care crisis.

BIGFORK, Minn. — Small-town hospitals and clinics may not have all the bells and whistles of their big-city counterparts, but they offer something patients often cannot find in the cities: quarterbacks.

"You have a quarterback here," said Dr. Heidi Korstad, sitting in the cafeteria of Bigfork Valley, a sprawling medical complex of hospital, clinic, nursing home and other facilities in a town that falls short of 500 population.

The quarterback, Korstad said, is a small-town doctor who can supervise care for patients. "You have somebody that understands you, knows your medical problems ... knows your family, knows your economic situation."

With frustration, the doctor who has been at Scenic River Medical Service clinic in Bigfork 35 years said that does not always happen in bigger facilities. Too often, Korstad said, the patient "is a complaining widget."

Korstad and other small-town health professionals say that besides providing quality medical care, they offer personal attention that cannot be obtained in bigger facilities.

"It is the people you live with," said CEO Nathan Blad of Renville County Hospital and Clinics, based in Olivia.

The Bigfork and Olivia facilities sit 261 miles apart in far different country (timber and lakes versus farming), but they are two examples of how some small Minnesota hospitals have bucked the trend of financial problems and even closure.

"A great number of rural hospitals face an uncertain financial future," said Terry Hill, a Duluth-based leader of Minnesota and national rural health organizations.

The biggest challenges come in the most-remote hospitals, said Mark Schoenbaum of the Minnesota Health Department. Bigfork, Hill said, is the most remote Minnesota hospital.

Bigfork is north of Grand Rapids in north-central Minnesota. It is surrounded by forests, with numerous lakes amid the trees. Residents call their area the "edge of the wilderness."

The Renville hospital, meanwhile, is on the open west-central Minnesota plains surrounded by farm fields in the 2,400-population Olivia. The city promotes itself as the "Corn Capital."
The Olivia facility is two years old and packed with modern technology, including a robotic surgery system, the first in the state for a hospital its size.

The robotic system, which went active in August, can be used for a variety of surgeries, with a surgeon controlling it nearby. The $1.4 million system can give a surgeon a three-dimensional view inside a patient's body and allows a doctor's hand movement to be translated into a more precise movement than a human can accomplish.

The hospital and clinic are owned by the county and under one roof, a roof built in 2015 when Blad and other hospital leaders looked at financial information and determined they could replace an antiquated facility without tax money.

The Olivia hospital and clinic have connections with specialists who visit the hospital and provide audio-video connections to doctors from St. Cloud and the Twin Cities to remotely deal with patients who suffer from stroke, cancer and other issues.

Like throughout rural America, finding doctors willing to move to Olivia sometimes is a problem.

"Oh, you don't have a Target?" is a common question early in the recruiting process, Blad said.

Bigfork, meanwhile, attracts health care professionals who like the outdoors life.

"I specially came here because I wanted to live in the woods," Korstad said.

Travis Luedke, human resources director for the Scenic Rivers Health System clinics that work with Bigfork, recruits for six medical and four dental clinics. He said many health care professionals are tough to find, but doctors are the worst.

"They are locked in the metro area," he said about medical students.

But there are medical provider shortages, too.

Three years ago, he hired a dentist from Egypt. "That was the closest dentist I could find."

One major issue is housing, he said. "I can't tell you how many I have lost because I can't find a home for them."

Retired Dr. George Rounds, now Bigfork board chairman, grew up in the large suburban city of Richfield, but moved to Bigfork because "I wanted to go to a place where I was needed." He practiced in Bigfork his entire career.

After all these years, Rounds said he still is not sure if he is optimistic about rural medicine's future. Federal programs can make or break the hospital, he said, and the political climate for continuing such programs is uncertain.

Bigfork CEO Aaron Saude said that not being in a big health care system means specialists sometimes are more difficult to schedule for visits to his community, which is 40 miles from any other hospital.

Telehealth, the audio-video connection to specialists located far away, has been difficult for Bigfork because of slow internet connections, The hospital and clinic soon likely will have a higher speed broadband access, which may allow for more telehealth work, Saude said.

Rounds, on the other hand, said he is not sure telehealth is the answer anyway. "It is hard to beat a face-to-face encounter with a person."

What it's all about

Regardless of where a doctor works, big hospital or small, there are some successes he or she will remember.

"Yesterday, somebody died and didn't stay dead and left laughing," Dr. Heidi Korstad of Scenic Rivers Health Services in Bigfork said. "That was fun."

She explained: A patient came in with a sore leg, but while at the facility suffered cardiac arrest. After CPR revived the patient, he left in a helicopter for further treatment elsewhere, and was laughing as he was leaving.

"People trust us," Korstad said. "It is really stressful because you know they are really counting on you."

But when a patient leaves laughing, it reliefs that stress a bit.