Finding their calling in Greater Minnesota
The U of M's Rural Physician Associate Program showcases the benefits of practicing medicine in rural Minnesota.
On an early-October morning near the peak of fall color, Bigfork displays its place in the colorful tapestry of northern Minnesota. Near the north end of the Main Avenue business corridor, the town’s namesake Big Fork River river flows languidly—a mirror for the riverbank leaves—past a small park and statue honoring the legendary figure "White Water Slim" from the town’s logging days.
Bigfork is many things to its 400 residents and to the surrounding communities. Among them: It’s a center for high-quality rural health care, with its Scenic Rivers Medical Clinic abutting the Bigfork Valley Hospital, and a robust roster of family physicians, PAs, nurses, and specialists. But what it has in seeming abundance, many other towns in Minnesota lack.
For years, rural Minnesota has faced a shortage of family physicians, and that gap is projected to grow perilously wider. The state Department of Health reports that one in three rural physicians plans to leave the workforce within the next five years, just as our population of older adults continues to expand.
Fortunately, healthcare providers and Minnesotans continue to benefit from the U of M’s Rural Physician Associate Program (RPAP)—an innovative and incredibly successful 53-year-old initiative designed to provide a pipeline of doctors interested in rural primary care.
RPAP offers third-year medical students the opportunity to live and train for nine months in a smaller community. Since its founding in 1971, RPAP has trained over 1,700 physicians, and more than 120 rural communities in Minnesota and western Wisconsin—ranging in size from 300 to over 30,000 residents—have hosted an RPAP student.
The students make connections with people in their adopted towns, who often take them under their wing, and discover the benefits of living in a rural community. Bigfork is a giant billboard of the program’s success.
Sampling medical care in Bigfork
Ed Anderson guides the RPAP program here as its preceptor. Anderson is the chief medical officer at Bigfork Valley Hospital and also teaches medical students through the University of Minnesota Duluth. He was an RPAP student himself in 1993. After talking with him for a short time and seeing him in action, you quickly realize he cherishes his community—and his role in bolstering rural health care.
Bigfork represents a lot of what has changed and been lost in small-town medicine, he says. A few decades ago, family medicine practitioners worked in clinics, nursing homes, in hospitals delivering babies, the ER when on call, and even in private residences.
"It’s pretty rare to find people in family medicine that still do all of those things. Up here we are still able to do [most of] that," Anderson says. "We might be taking care of a little kid with an ear infection in the clinic and then have to run next door to the hospital and take care of the motor vehicle accident that just came in. And that happened yesterday! For those of us that like that kind of variety, it’s pretty rewarding. It’s pretty challenging, but that’s what keeps us doing it."
Ed Anderson goes over X-ray results with patient Dennis Groenewold, while new RPAP student Katelyn Henningsen looks on.
RPAP students immerse themselves not only in their communities, but in hands-on medical care. They may be putting in a chest tube or intubating a patient themselves, with Anderson looking over their shoulders or with his hands over theirs.
"They’re the ones doing it," he says. "They get so much better so quickly that by the time they leave here they can handle probably 80-90 percent of what comes into the clinic and the ER even without asking me questions. (But, of course, they do ask questions.) It’s just so fun to see. They really learn to fly."
Barret Wolfson is a physician at the Bigfork Medical Clinic and was an RPAP student here under Anderson’s guidance in 2012. She says that RPAP students become an integral part of the team, making it easier for everyone else to get through the day.
"And you learn so much more that way when you feel like the work you’re doing is important and makes a difference in your patients’ lives; makes a difference in your preceptors' lives. You get to the end of nine months and you feel like you’re part of the practice."
Adds Anderson: "I've told the students who have worked with me over the years that just about anybody can teach you the medicine, but we can show you what it’s like to live in a small community—how that community steps up for you and you for them—and how there can be some good [work-life] balance in this job."
