North Dakota’s ‘grow our own’ strategy aims to tackle doctor demand

Dr. Kelly Kerber, a hospitalist at Sanford Medical Center, was hired while she was doing her residency training in internal medicine at Sanford through the University of North Dakota School of Medicine and Health Sciences. Forging relationships with residents is a key strategy for UND and providers including Sanford to train and hire physicians. Expanded residency programs are one way to address the doctor shortage.

FARGO — Kelly Kerber didn’t have to go far to find a job. She was in the second of three years of post-medical school training when she was offered a job as an internal medicine physician.

Kerber was one of eight internal medicine residents working at Sanford Health in Fargo — five of whom signed on with Sanford.

She opted to stay at Sanford, where she works as a hospitalist, despite getting bombarded with job offers from around the country.

“I would get almost 20 to 30 job offers every single day,” she said. Staying where she had gotten her training was a “huge asset,” Kerber added.

“You really get to know the place — the nurses, the staff, your colleagues — very well,” she said. “If you need someone’s assistance, a consultant, you know them already.”

Kerber, a native of St. Cloud, Minn., got her residency slot through the University of North Dakota School of Medicine and Health Sciences, which has increased its residency programs in recent years as part of efforts to recruit more physicians to the state.

Residency programs are a critical tool for recruiting physicians at Sanford Health — and a key strategy by UND medical school for increasing the number of physicians who practice medicine in the state.

Sanford participates in eight medical residency programs — including family medicine, internal medicine, general surgery and adult psychiatry — with plans to add residencies for neurology and medical oncology.

“We really view it as an investment in our future,” said Dr. James Volk, vice president of Sanford Clinic for the Fargo region. Studies show that up to half of physicians practice near where they were trained.

Because of increased competition for physicians due to the ongoing doctor shortage, recruiting of medical students and residents starts earlier, Volk said.

“We’re finding that our recruiting timeline is longer,” he said. Those who sign contracts as residents get financial support.

Kerber, who was in the second year of her post-medical school training in internal medicine when she was offered a job, said she was given a commitment bonus when she signed on.

Last year, Sanford hired 140 physicians and advanced practitioners, such as physician assistants and nurse practitioners, including 70 physicians.

But North Dakota lacks residency programs for many specialties. Urology, for example, is a specialty where Sanford has a vacancy. Ear, nose and throat doctors also are a challenge to hire, Volk said.

Patients encounter the doctor shortage in a variety of ways.

“There are certainly areas where we have longer wait times for patients to get an appointment than we want,” Volk said. Sanford monitors wait times in all departments and uses that information to set recruiting priorities, he said.

Sanford and other health providers also make use of temporary physicians as well as advanced practice professionals who work in care teams under a physician’s supervision.

Dr. Joshua Wynne, dean of the UND medical school, said an effort called the health workforce initiative has shown results in recent years.

One component of the plan has been to increase the size of medical school classes by 16 students to 78, an expansion enabled by the new medical school, which opened in 2016. Another move has been to increase residency program slots. So far, the medical school has authorized to add 51 residency slots, but has funding so far to add 35.

“Otherwise we have completely implemented the class expansion,” Wynne said. An advisory council guides the expansions, based on proposals from various medical specialties.

The expanded medical school classes and residency programs are part of a “grow our own” strategy that has been succeeding, he said.

Almost three-quarters of family medicine physicians in North Dakota, for instance, are either graduates of UND medical school or did their residency training in the state, or both, he said. Two-thirds of those who do both end up staying in North Dakota, he added.

Altogether, UND medical school graduates account for 47 percent of the more than 1,000 physicians practicing in North Dakota, where the per-capita physician workforce lags behind the Midwest and nation.

Without the efforts of the health workforce initiative, the state would face a shortage of 260 to 360 physicians by 2025, according to figures from the UND medical school. If the state’s population, now estimated at 760,077, reaches 800,000, as some expect, an additional 500 physicians will be needed.

The UND medical school’s retention rate has increased over the past decade. Now five of six students remain in the state. “That’s one measure of growing our own,” Wynne said.

Another focus is to offer rural medicine scholarship programs to encourage physicians to locate in underserved rural areas. Those who agree to stay in the rural community for five years have their medical school tuition paid for them.

“We know from other data that once they’re practiced in communities for five years they’re much less likely to leave,” Wynne said.

As the initiatives have more time to show results, “We think the trajectory is going to be even better,” he said.

At Essentia Health, which typically hires 35 to 40 physicians per year in its Fargo region, recruiting doctors is based on developing relationships, said Kris Olson, physician and professional services senior director.

Once again, residencies are an important way of cultivating those relationships, she said.

Recruiting can take many forms, however. Essentia representatives will meet at a Twins game with medical residents to visit and answer questions in an informal setting, Olson said.

“This new generation wants an experience,” she said, adding that in years past banquets were popular. “We’ve done this a couple of years in a row.”

The approach is not to “push Essentia” at the residents, but to have “real life docs talking to real life residents,” Olson said.

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