How the Dakotas Keep Their Doctors: Sanford Merit Says: 'We Grow Our Own'

You've heard the cliché: How you gonna keep ‘em down on the farm after they've seen Paree?

For rural healthcare providers, that expression might translate to something like "How do you get your medical school residents to set up practice in the buffalo lands of Fargo or Sioux Falls after they've been to New York City or L.A.?"

Great expanses of this six state region fall into the federal definition of "Frontier," areas with fewer than six residents on average per square mile.

It is well-documented that rural areas throughout the U.S. are provider-poor, and with the coming shortage of doctors estimated at 150,000 over the next 15 years, these areas may be especially challenged to find qualified practitioners.

But apparently, Sanford Merit Care, the primary healthcare network serving this six-state region, has overcome the physician recruitment challenge.

Many of the 800 physicians who practice in the Sanford Merit system, which includes North Dakota, South Dakota and parts of Iowa, Minnesota, Nebraska and Oklahoma, received training at the North Dakota School of Medicine and South Dakota Sanford School of Medicine. Those schools rank high in the number of primary care providers they bring to practice, for which they have both received awards from the American Academy of Family Physicians.

I asked Cindy Morrison, Sanford's vice president of public policy, just how do they keep their doctors, an essential part of their network of 30 hospitals, 25 of which are classified as critical access.

She answered quickly: "We grow our own."

Morrison says that recruitment and retention efforts start with 17,400 employees of the facilities in the system. They're asked to reach out to their own family members to find their future doctors.

"Recruitment is a long process" that focuses on local residents, people who understand the culture because they were born and raised in the area, she says. "We are starting before they even enter school."

There are programs that give youngsters who think they might like to grow up to be a doctor an opportunity to follow physicians around for a few days. That way, they might get a taste of the experience, and see how much providing care would mean to their family, friends and community.

Next, she says, employees are asked if they have relatives who would like to go to medical school and live in, say, Bismarck.

The system tries to make life easier for doctors who come to this part of the Heartland, too. Many physicians have concerns that one condition of receiving staff privileges might mean they have to take call in the clinic and hospital much more frequently than they would like. Perhaps they might have to be available almost every weekend and holiday.

Morrison says to allay that concern, the system makes sure there are enough backup physicians, even if it means contracting with locum tenens services.

Without having those backup guarantees for a critical access hospital, it can make a noticeable difference. "Loss of one or two doctors can shut a hospital down," she says. "We can tell by looking at the finances when a physician is on vacation" because there are usually fewer admissions.

For patient and physician convenience, the system also embraces the latest technology, such as the InTouch Remote Presence telemedicine robot, which allows a physician to see and speak with a patient in a distant clinic or hospital, through a computer monitor. This saves time and allows specialists to more promptly see patients in remote locations.

There also are signing bonuses, loan forgiveness programs, scholarships, and a bus transportation system for health providers between Sioux Falls and Fargo, three and a half hours away.

This rural region of the country has been such a desirable draw for physician training and has borne such a good crop of doctors, with training programs in internal medicine, surgery, psychiatry, family medicine and pathology, Sanford health leaders thought, why not go for a few more?

That's what they've done. Two new programs were recently added, one for training pediatricians and another for podiatrists.

After all, they grow their own.