WILMER — When Kandyyohi County Commissioner Roger Imdik heard that the only pharmacy in town, the CentraCare New London Clinic, was closing, he emailed Centrcare representatives to share their frustration. bottom.
“It got me thinking about the state of rural health care in Minnesota,” Imdek said at the Kandyyohi County Board of Governors’ May 2 meeting.
In that email and in the discussion that followed, the county commission invited Dr. Cindy Firkins Smith, vice president of CentraCare and longtime Willmar physician, to discuss the future of rural healthcare and how CentraCare will maintain its vibrancy. We started talking about what we were planning to do.
“I don’t have all the answers,” said Smith. “We are looking to the future and trying to do as much as we can. There are many challenges.”
These challenges included not only finances, but also provider recruitment and retention. Fixed costs for both staff and staff continue to rise.
Rural facilities typically have concentrations of government-funded uninsured and underinsured patients. These patients also tend to be sicker and require more expensive treatment, and are more likely to receive this treatment in the emergency room, which is the most expensive place to get this treatment.
As all these costs rise, government reimbursement rates are falling, Smith said.
Then there is the challenge of finding medical professionals to practice in rural areas. Throughout her rural medical career, Smith has recruited other doctors to come to the Wilmar area. It will only get harder and the coronavirus pandemic has made it even worse.
Health care providers of all kinds suffered from higher levels of burnout, moral damage, fear, and differing views about masks and vaccines. These people work in various hospitals for a period of time to fill urgent vacancies, but are not considered permanent employment.
“We’ve seen little recovery from there, but we’re nowhere near the recovery we need,” Smith said.
According to data presented in Smith’s presentation, about 20% of the US population lives in rural areas, yet only 11% of doctors practice in those same areas. Not having enough doctors is a big problem when trying to improve rural health.
“There is a big mismatch,” Smith said.
Considering the age of the local doctors makes it even more difficult. The average age of local doctors is he is 58 years old.
“One in three rural doctors will retire within the next three to five years,” says Smith, according to data from the Minnesota Department of Health. “It’s a reality. Amazingly, we’re on the brink.”
One way to help fill that gap is to train more rural doctors. Rural medical students are five times more likely to practice in rural areas than students in more urban areas, Smith said.
But rural students make up only about 5% of medical school enrollment, and the situation is even worse for rural students of color, who make up less than 0.5% of medical students. To meet the needs of rural doctors, the graduation rate of rural medical students would have to quadruple hers.
“Far fewer rural kids are applying, being accepted, and getting into medical school than when I started,” Smith said. it won’t.”
local medical school
That something is a joint venture between Central Care and the University of Minnesota School of Medicine to create a regional medical school campus in the area. The campus covers both undergraduate and graduate medical education, and students live in and around the St. Cloud area.
“We believe having a rural western Minnesota campus in our area is the answer to this challenge,” Smith said.
Prior to that, he was senior vice president of CentraCare Rural Health and worked as a dermatologist at Wilmar for over 30 years.
The University of Minnesota serves as the degree-granting institution. For undergraduate medical education, commonly referred to as medical school, it is a four-year campus that allows students to meet both classroom and clinical rotation requirements in Western Minnesota. Twenty-four students are accepted each year to join the regional campus. The first freshman classes are expected to arrive in Fall 2025.
“We will place students starting their first-year anatomy classes on the ground in St. Cloud,” Smith said, adding that about 50% of classroom instruction will be available online.
Students at the University of Minnesota School of Medicine will begin their clinical rotation in surgery in their junior or senior year of medical school even earlier. Clinical rotation opportunities are available throughout St. Cloud and CentraCare’s coverage areas, including Willmar.
Once students graduate from a four-year undergraduate program, they have the opportunity to participate in a graduate residency program. The St. Cloud-based family practice program accepts six graduates a year, and the Wilmar-based family practice program accepts her two graduates a year.
Creating a campus is “a big step,” Smith said.
According to Smith, being able to really connect with the local community is something CentraCare feels is very important if students want to stay and practice.
“We envision creating a very community-based medical school atmosphere,” Smith said.
Regional campuses function like any other medical school. Students must have a bachelor’s degree and apply for admission to the University of Minnesota Medical School.
This means CentraCare will help increase the number of rural doctors, and we need to find ways to increase the number of rural students enrolled in medical colleges. Principals and superintendents told Smith that they didn’t seem to believe that students could graduate from medical school.
To do this, CentraCare will need to find ways to engage and connect with students at all levels of school, from elementary school to college undergraduates, Smith said. Having medical students in these communities helps show local students what is possible.
“We just need to get in there and show what they can become,” Smith said.
With hospitals and clinics in 12 counties and service areas spanning a total of 17 counties in south central and western Minnesota, CentraCare is considered the largest rural healthcare system in Minnesota. This is the system’s proud hat, and the new system’s focus, called Making Rural Life Healthier, seeks to find ways to invest in the future health of people, communities and regions. increase.
“We have made it our goal, mission and vision for the decade to address these issues, and we are not running away from them,” Smith said. “We are dedicated to our patients in rural Minnesota.”
CentraCare gladly accepts, but does not wait for, financial assistance and other forms of assistance from both the federal and state governments.
“We are not relying on anyone in St. Paul to solve these problems,” Smith said. “We have to take responsibility. We rely on everyone in our community to take responsibility for these issues.”
It probably won’t be easy, but Smith feels CentraCare must be Minnesota’s leader in rural health care.
“We are asking who if not us? When if not now?” said Smith.