More than 50 years ago, the University of Minnesota Medical School opened a branch on the university’s Duluth campus as a way to promote rural medicine and get more physicians into small towns.
These days, nearly half of the Duluth branch’s graduates practice in towns with populations of fewer than 20,000, but that hasn’t been enough as the state’s demographic changes and population shifts threaten to leave more Minnesotans in rural areas without adequate access to care.
Twenty percent of the U.S. population lives in rural communities, but only 11% of physicians practice in such areas, according to the American Association of Medical Colleges. In Minnesota, rural communities face physician shortages, especially in specialties like family medicine, internal medicine, obstetrics and gynecology, general pediatrics, psychiatry and surgery, according to an analysis from the Minnesota Department of Health.
Help is on the way, though, as the University of Minnesota Medical School, in partnership with rural health system CentraCare, is set to open a St. Cloud branch next year.
While St. Cloud, with a population of 70,000, and the surrounding region in Stearns County is considered a metropolitan area, it is close in proximity to several rural counties, such as Todd, Morrison, Swift, Pope and Meeker. Those leading the expansion of the medical school in St. Cloud believe that training students there will bring services to people in the area and encourage future doctors to work in rural communities.
In addition to the physician shortage, other challenges — like a lack of available beds in hospitals and treatment centers, longer wait times for appointments and long travel distances for specialty care — stand in the way of rural communities receiving equitable access to rural healthcare. The labor force in some rural areas has not increased over the past decade, according to the Center for Rural Policy and Development. In 2022, the state’s southwest corner had around 10,000 fewer people participating in its labor force than it had in 2012.
Job vacancies have increased across the state, and those vacancy rates are higher in Greater Minnesota compared to the seven-county metro area. The center expects the rates to continue increasing, due to an aging population.
The median age of a physician in what are considered to be isolated rural areas of Minnesota is 59, compared with a median age of 47 in urban areas, according to the Minnesota Department of Health.
According to a 2022 MDH report, 1 in 5 rural health providers and 1 in 3 rural physicians said they plan to leave their profession in the next five years.
CentraCare, formed in 1995, is one of the health organizations that serves rural populations. It has nine hospitals across the state and more than 30 medical clinics. To address the physician shortage, the University of Minnesota and CentraCare are partnering to create the medical school branch in St. Cloud, which will enroll its first class in the fall of 2025.
“St. Cloud is urban, but rural facing,” said Dr. Shailey Prasad, the University of Minnesota’s associate vice president for Global and Rural Health. “If you look at patients who are seen at St. Cloud hospitals, a significant portion of them come from rural areas.”
CentraCare’s service area extends from Brainerd south to Redwood Falls and from Monticello west to Benson, said Dr. Cindy Firkins Smith, senior vice president of CentraCare Rural Health and a University of Minnesota Medical School faculty member.
Smith has worked in Willmar for over 30 years. The organization she previously worked for became part of CentraCare six years ago. In her time working in Willmar, she’s observed the deep need for more physicians.
“The biggest challenges we’ve had in rural healthcare delivery is recruiting people to serve our people. Recruiting physicians, in particular (to) rural Minnesota, is a big challenge. And it’s only gotten more difficult,” Smith said. “As difficult as it is to recruit a physician, as difficult as it is to get an appointment to see a rural physician (right now), to think that we’re going to have even less in five years is terrifying.”
She said there’s an emphasis on recruiting people from rural areas to be in the first medical school class. In 2017, 4% of U.S. medical students came from rural backgrounds. Smith said that people from rural backgrounds are more likely to stay and serve those populations.
“The best way to create a rural physician is to start with rural students and our students just don’t see themselves sometimes in an academic environment. They certainly don’t see themselves sometimes going to medical school,” Smith said. “Our goal with creating this medical school is to bring that educational experience close to home. So students see their peers going on to college, going on to nursing school, going on to physical therapy school, going on to medical school. And they see that if that person can do it, I can, too.”
A four-year program
The University of Minnesota currently has two medical school branches: one in the Twin Cities and the other in Duluth. Its Duluth campus, which opened in 1972, offered lessons in rural medicine for the university, Prasad said.
Kenneth Holmen, CentraCare’s president and CEO and University of Minnesota Medical School alum, said the idea for another branch came about through discussions with leaders at the university about the workforce shortage.
“This notion of how we create the next generation of physicians, and the team members that support physicians in our workforce, became critical,” he said.
The St. Cloud campus will be a four year program whereas students in Duluth spend two years there and two years in the Twin Cities.
The curriculum will include a mix of virtual, synchronous, asynchronous and in-person instruction. Students at the school will be put in clinical rotation positions in west central and southwest Minnesota.
The first class will have 24 students. By 2029, administrators anticipate the program will reach its capacity of 96 students. This addition is expected to increase the number of physicians trained in Minnesota by 10%, said Jakub Tolar, the university’s vice president for clinical affairs and dean of the medical school.
Residency is key
The medical school addition will cost roughly $100 million. Some of that money will come from CentraCare’s operating budget and some from the CentraCare Foundation, which has pledged $50 million.
During the 2023 legislative session, lawmakers dedicated $15 million to the project. Lawmakers are also seeking funding in the current session; Rep. Dan Wolgamott, DFL-St. Cloud, proposed a bill asking for $40 million in funding for the medical school that could be used in various ways, such as tuition support, funding for residency programs and rural health research.
He also has a bill that asks for $12.9 million in bonding to convert an administrative building into a centerpiece for the medical school.
One challenge is having enough spots for graduates to complete their residency and then stay in these communities, Prasad said. If the school wants to educate more students, there needs to be enough residency spots for those students to be placed in.
“Any expansion is going to be dependent on the capacity locally to train, because we need to have adequate clinical placement spots for all our students,” Prasad said. “(There’s) no point in us having all kinds of medical students being created if we don’t have adequate residency spots.”
CentraCare plans to expand its residency programs. Right now, it has an 18-physician family medicine residency program that’s been around for 20 years. The program has six residents a year. All six of those graduates from last July have stayed with the organization, Holmen said.
“That’s a 100% retention rate. Whereas if we didn’t have these programs, the odds of attracting and recruiting someone would be in the single or low double digits.” Holmen said.
In 2025, CentraCare will have a six-physician family medicine residency program in Willmar.
Smith said there is interest to start more residencies in other high-need specialty areas — such as general surgery, psychiatry, internal medicine and obstetrics and gynecology — but they need to have sustainable funding.
“We need lots of things,” Smith said. “Those are the areas that have been identified as highest need from a patient standpoint.”
A vibrant community
Several factors can affect a student’s decision to study and then practice as a doctor in a rural area. A recent opinion piece in MinnPost, written by a rural physician, discussed those factors, such as a sense of community in the area.
Smith said businesses, healthcare and education are the “lifeblood” of rural communities.
“If you don’t have all three of those, it’s very difficult to recruit people to your community. It’s very difficult to grow a business if you don’t have good health care and if you don’t have good school systems,” Smith said. “It’s very difficult to recruit a physician to a rural community if there’s not a good health care system to support their work, if there’s not a good school system for their students, and if there’s not a vibrant community for their family.”
There’s a particular focus to recruit students from rural areas for the St. Cloud school, but the program is open to people from other states and cities. The university also hopes that this will open up pathways for other health-related fields, such as nursing, physical therapy, dentistry, pharmacy and other professions.
“If this can be a little bit of a catalyst in growing the other disciplines, it would be fantastic,” Prasad said.
Research also shows that people from rural areas tend to work in rural areas. A study published in the Journal of the Association of American Medical Colleges found that around 19.5% of University of Washington School of Medicine alumni who graduated between 2009 and 2014 and participated in the Rural Underserved Opportunities Program eventually established their practices in rural communities.
“The premise of this is not complicated. People have been looking and watching this problem for years, not just in Minnesota but elsewhere, “Tolar said. “How do you get physicians to practice in rural Minnesota? And it’s simple. You get them from there. You train them in rural Minnesota and they will come back to this.”
Ava Kian
Ava Kian is MinnPost’s Greater Minnesota reporter. Follow her on Twitter @kian_ava or email her at akian@minnpost.com.
