As rural physician shortage hits home, clinics try new recruitment strategies

Affiliated Community Medical Centers needs three family practice doctors, three internists, another neurologist and another oncologist -- and that's just at the clinic in Willmar.

Dr. David Newcomer, medical director for ACMC, lists the needs at some of the regional multispecialty network's other sites: two internists, another family practice doctor, another obstetrician-gynecologist, and surgical subspecialists in Marshall. More physicians in Litchfield, even though a recent merger with Allina's Litchfield clinic brought five more physicians and two physician assistants on board.

"All the doctors' panels are full there," Newcomer said.

Family Practice Medical Center is recruiting. Rice Memorial Hospital is looking for another emergency room doctor.

A growing shortage of rural physicians is hitting home. Departures and retirements this past year have pushed up the vacancy rate. It's taking more effort and more time -- often months -- to recruit new physicians.

Patients are feeling the crunch. They're waiting longer for non-emergency appointments. More of their care is being handled by mid-level practitioners. Many primary care physicians are no longer taking new patients.

When a longtime family physician at ACMC's clinic in Atwater retired this spring, the clinic closed because another doctor couldn't be found.

Doctors are under stress too.

Patient utilization hasn't changed, but there are now fewer physicians to go around, Newcomer said.

"That makes our doctors busier," he said. "There are a lot of worries in primary care. Our primary care doctors have said, 'We're working as hard as we can already.'"

The situation is unlikely to change any time soon, said Dr. Ronald Holmgren, president of Affiliated Community Medical Centers.

"We are looking at a long-term shortage here," he said. "I think it's going to continue to be the highest priority for our organization, other than quality health care. I think all our physicians share that."

The shortage is rooted in many factors: fewer medical students opting for primary care, challenges with reimbursement, the rising cost of medical school, the disadvantage of being rural, even the lifestyle goals of a new generation of physicians.

"The environment for recruiting really has changed in the last four or five or six years," Newcomer said.

Clinics and hospitals used to have some ability to select among candidates, he said. "Now it's much more the residents driving things and deciding. ... There is a change in a lot of the candidates coming out and what they're looking for. The focus is much more on lifestyle."

When prospective recruits come for a visit, they're often "surprised at how much we have to offer," Holmgren said. Yet it remains difficult to sell them on the idea of rural practice, especially when other opportunities abound, he and Newcomer said.

"We're already behind from the start," Newcomer said.

At ACMC, physician recruitment has intensified.

"I would say we've doubled and tripled our efforts in reaching out in the last three or four years. We're going out now even to residencies and visiting residents in their first year to get that contact and visit with them," Newcomer said. "We think that's really key."

Because regional ties can help predict whether a physician will settle in a given geographic area, ACMC is targeting its recruitment to candidates who have ties with the upper Midwest.

Last year ACMC began a scholarship program to support local students in the health care professions and encourage them to consider coming back to their hometown when they complete their training. The organization even added a second recruiter last year to help step up the effort.

It's not only patients who have a stake. The physician work force is an issue for hospitals too.

"Almost all of the patients seen at the hospital are referred by doctors in the community," said Dale Hustedt, interim chief executive of Rice Memorial Hospital in Willmar. "That affects the hospital and what we're able to provide."

Fewer orthopedic surgeons, for instance, has meant fewer of these surgeries at Rice, with a resulting drop in patients and revenue. Cancer care wouldn't be available locally if there weren't local oncologists.

The ability of the clinics to attract new doctors also partly depends on the strength of the hospital, Hustedt said. "Physicians are not interested in coming to a community where the hospital has limited services."

This relationship is seen as so critical that it was a key issue in the recent hiring of a new chief executive for Rice Hospital.

How clinics and hospitals can work together has become a top strategic issue, not only in Willmar but in other towns as well.

"All the hospitals are trying to do what they can. They know how critical that is," Newcomer said.

Hustedt sees this extending to communities as well. The quality of the school system and suitable work opportunities for a spouse are selling points that can make or break a health care professional's decision to come to Willmar, he said. "Often it isn't just the physician who makes the decision. It's the spouse as well. ... It's all the more apparent to us that we have to work with the entire community."

What the hospital and clinics pin their hopes on are candidates who will be a good match with the community.

"What you have to do is find the physician that wants to be part of your culture, whether it's the internal culture or the culture of the community or the geographic area," said Gary McDowell, administrator of Family Practice Medical Center.

Recent success with recruiting suggests this approach is the most likely to help in the long run.

But it's not a process that happens overnight, Hustedt said.

"Recruiting physicians is usually a long process. You may be working for a year or a couple of years before you sign someone," he said. "You have to be able to convince someone to get here and understand the community. ... We want there to be a full contingent of medical specialties here, but we don't want to rush into bringing someone on board. We want to be real thoughtful and wise about who comes to the community, and we want the fit to be one that lasts for a long time."