Minn. Medical Industry Finding Creative Ways to Combat Shortage of Medical Providers

July 05--To some degree, rural Minnesota always needs more doctors.

There was a doctor shortage when Ray Christensen, associate dean of the University of Minnesota -- Duluth Medical School, began his rural practice in 1972.

There was a shortage in the '80s and '90s as more people moved away from small-town Minnesota to the Twin Cities metropolitan area.

There was a shortage of doctors over the past decade, as Minnesota's population grew to 5.4 million people as of 2014.

Yet the ongoing shortage of doctors and other medical workers could prove disastrous as a large number of baby boomers enter retirement during the next 10 years. In the U.S., about 90,000 more doctors will be needed by 2025 to keep up with increasing medical needs, according to the Association of American Medical Colleges.

While some economists have scoffed at the idea, Christensen believes there's no further proof people need than to call up a hospital and ask how many doctors they would hire on the spot.

"I really do think that the shortage is there," he said. "I don't disagree with that at all, and I think that the shortage will grow because we have all of these positions open."

To combat the increasing doctor shortage, Minnesota's medical industry is finding creative ways to attract more medical workers and change the ways people access medical care.

"It's a huge area," said Steve Gottwalt, executive director of the Minnesota Rural Health Association.

Industry experts are trying to make it easier to recruit and train more doctors. At the same time, they're exploring technological advances that make medical service easier for the patient.

Local recruiting

Places like Mankato stand to benefit from medical care reform more than other rural areas.

Mankato's growing economic development, as well as its local colleges and universities, means it's one of a few rural areas in Minnesota that attracts younger families and serves as a starting point for physicians.

That's a key factor when it comes to keeping doctors.

"It's pretty common knowledge that physicians tend to work in communities and environments in which they've trained," said Dr. John McCabe, director of the University of Minnesota's Mankato Family Medicine Residency Program.

About two-thirds of the doctors who go through Minnesota programs stay in the state.

To feed those programs, the state's rural health association is reaching out to colleges and universities to start their own rural health organizations. In addition, medical advocates are bringing programs to high school students in rural areas, trying to convince them to choose careers in the kind of place they grew up.

"We know that recruiting from rural is a great way to do that," Gottwalt said. "We have a much better chance in identifying and retaining health care professionals in rural areas."

Minnesota's medical schools and residency programs are ramping up their recruiting efforts as well. They've reached out to lawmakers in recent years to secure more funding for medical students across the board.

State and federal lawmakers will have to resolve potential issues in getting more people into Minnesota's medical workforce. In 2011, Minnesota passed legislation that expanded paramedic programs to allow more people to become so-called community paramedics. Other states facing similar medical access issues have since passed their own versions of the bill.

This year, lawmakers passed a bill sponsored by Sen. Kathy Sheran, DFL-Mankato, to secure $2 million over the next two years in grants to physicians in family medicine residency programs throughout Greater Minnesota.

"It will go a long way toward helping our medical workforce," Sheran said last month.

Yet Congress has yet to tackle one of the biggest roadblocks for new doctors: a cap on residency program positions.

In 1997, federal legislators set limits on how much U.S. hospitals can get reimbursed by Medicare for residency spots, effectively limiting resident positions to the spots that were open in 1996.

Since then, many medical organizations and lobbyists have tried and failed to persuade lawmakers to increase reimbursement funding.

State funding isn't looking much better. Lawmakers proposed putting $9.5 million toward increasing the size of the University of Minnesota's residency programs during this year's session, but the measure wasn't included in the supplemental budget bill.

The measure is one of Gov. Mark Dayton's requirements for a potential special session that could be called later this year so lawmakers can pass a $1 billion-plus public works project bonding bill, as well as a tax bill.

Still, industry experts believe there are other solutions lawmakers can bring to the table.

Despite a decreasing birth rate, Minnesota's population is expected to grow during the next several decades thanks to a consistent stream of immigrants.

Many foreign-born doctors are used to working in rural areas, which has industry experts excited to try and place them in Greater Minnesota. If lawmakers can help reform medical training so immigrant doctors can be trained to U.S. standards, foreign-born medical workers could go a long way toward resolving access and diversity issues in rural areas.

"(Lawmakers) need to be educated about the need, and they need to be open about creative answers to issues that affect particular communities," Gottwalt said.

Changing practice

Medical facilities have coped with a doctor shortage in other ways.

Some, like Mayo Clinic, are relying more on nurses and paramedics to go outside of their traditional roles to treat patients in a team-based model, where patients are treated by a number of professionals rather than just the doctor.

Mayo also is investing in the idea of quick-care clinics such as the ExpressCare Clinic inside Mankato's Hilltop Hy-Vee, where people can get a quick checkup or treat a cold, among other minor issues. Private companies across the state are looking into providing similar clinics of their own.

And technology is allowing more people to access their doctors with telemedicine kiosks, online patient portals and other remote solutions.

With so much potential, all the medical industry needs is the drive to continue reforming care.

"We're training the right people. It's a matter of being able to put practices together," Christensen said.

Copyright 2016 - The Free Press, Mankato, Minn.