New Rural Rotation Program Exposes Medical Residents to Rural Medicine

A month-long rotation program gives residents experience in what it is like to live and work in a rural community.

Sanford Health and Hennepin Healthcare have established a rural rotation program to encourage medical residents to practice in rural communities.

About 20% of the U.S. population lives in rural areas but only 9% of the country's physicians practice in rural communities, according to the Bureau of Health Professions. A study published in Annals of Emergency Medicine found that 92% of emergency physicians practice in urban areas.

Minneapolis-based Hennepin Healthcare, which includes a 484-bed academic medical center, is sending emergency medicine and psychiatry residents on a month-long rotation to Sanford Health Bemidji in northern Minnesota. Sanford Health Bemidji includes Sanford Bemidji Medical Center.

Bemidji, Minnesota, has a population of nearly 16,000 and is surrounded by rural communities.

The rural rotation is designed to give residents experience in living and working in a rural setting.

"Most residents do not know what it is like to practice medicine in a rural hospital," says Daniel Hoody, MD, CMO of Sanford Health Bemidji. "In addition, if residents practice in an urban area, they are not well-equipped to understand what it is like to send a patient from a rural area into an urban center."

Unlike other rural residency programs across the county, where residents drive from an urban center to a rural hospital then drive home at night, the Bemidji program provides residents with an immersive experience. The program provides housing for residents in a welcoming environment, according to Meghan Walsh, MD, MPH, chief academic officer at Hennepin Healthcare.

"Residents go to and from the hospital every day, then at the end of the month, the residents return to their regular programming in Minneapolis," Walsh says. "We are already seeing that one month of a lived-in experience is leading to an interest in practicing in Bemidji and other rural communities."

The program separates the myths and truths about physicians living and working in a rural community.

"It is more exciting for the residents than they might have anticipated," Hoody says. "There are things going on in town, and we try to get the residents engaged in some of the things people experience if they live in town their whole lives."

The program shows residents that there is a good quality of life in a rural community. Hoody believes that it's easy to achieve work-life balance when you are not tethered to traffic or other discomforts of a big city.

"I like to tell recruits that you can do two things after work rather than one in Bemidji," Hoody says. "You can ski for an hour or two, go home and shower, then still have time to go out for dinner with friends. That is often not tenable in a major metropolitan area."

Daniel Hoody, MD, is CMO of Sanford Health Bemidji. Photo courtesy of Sanford Health.

Exposure to rural medicine

The Bemidji program gives residents exposure to the practice of medicine in rural areas and dispels misconceptions about what it is like to practice in a rural community.

In Bemidji, residents learn how to practice medicine with limited resources compared to practicing in an urban center, according to Walsh.

"If a patient falls and hits their head, they can have a brain bleed. In our Level 1 trauma center, literally within 10 minutes at the bedside, you can have a neurologist, a neurosurgeon, a trauma surgeon, an internist, and a critical care team for the patient," Walsh says. "At Bemidji, it is different. You do not have every single Level 1 trauma center resource at your fingertips within 10 minutes."

Many residents assume that they will be treating low acuity patients in a rural setting, but the Bemidji program shows them that rural medicine can be a challenging experience, Walsh explains.

"Residents have been ending their month-long rotation with an appreciation for the complexity, acuity, and challenge of treating patients at Sanford," Walsh says. "They feel their Level 1 trauma center skills were taken to the edge of their comfort zone, with supervision and appropriate support."

The Bemidji program residents learn how to treat patients safely in a rural setting as well as the value of treating patients close to home rather than transferring them to larger medical facilities, according to Hoody.

"The residents bring the latest and greatest care from an academic medical center to Bemidji, and they learn from the decades of experience on the ground at Bemidji to take care of patients when you have limited resources," Hoody says.

When it comes to acute care, the decision to transfer patients from Bemidji to a larger medical facility is not taken lightly, Hoody explains.

"It's a huge deal if we have to transfer a patient to Fargo," Hoody says. "The whole family must go over and stay at a hotel. They must take days off from work. It's better if we can keep patients here in Bemidji."

Bolstering Sanford Health Bemidji's staff

Hoody hopes the rotation program will help fill a need at Sanford Health Bemidji.

"Emergency medicine and psychiatry are areas of recruiting need," Hoody says. "For both emergency medicine and psychiatry, we are not fully staffed with employed clinicians, so this program is a nice adjunct to other recruiting efforts by exposing residents to rural medicine."

The partnership with Hennepin Healthcare gives Sanford Health Bemidji a capability that would be hard to achieve on its own. According to Walsh, the model is leveraging the strengths of an urban teaching hospital and a rural community that does not have the infrastructure, resources, and personnel to build their own teaching hospital.

"There is data to show that as few as one or two months of a rural experience for residents is enough to create interest in practicing in a rural setting," Walsh says. "We are testing this hypothesis."

The rural rotation program is giving Sanford Health Bemidji a chance to recruit more residents as employed physicians than they could do with their own residency programs, according to Walsh.

"If Sanford Health Bemidji had an emergency medicine residency, it would be a three-year program and probably have a couple of residents each year," Walsh says. "Every three years, there would be about six residents who came through Bemidji, and you may or may not be able to recruit all six of them to remain in Bemidji."

With the rural rotation program, Sanford Health Bemidji is working with 12 emergency medicine residents per year.

"In one year, there is the potential to recruit about six ER doctors at lower cost and lower investment than an in-house emergency residency program," Walsh says. "This allows Bemidji to put its energy into faculty recruitment and boost physician recruitment in general because physicians get to teach."