For many rural hospitals, hosting formal residency programs is not feasible given the financial and structural resources required to train new medical school graduates.
This poses a significant challenge for recruitment efforts in rural areas, as most physicians tend to practice in the same region where they complete their residency training. Just 2% of medical residency training occurs in rural areas, according to the Health Resources & Services Administration of HHS, even though about 20% of the U.S. population lives there. Further compounding the issue is that only 4% to 5% of incoming medical students are from rural areas, a figure that has remained largely stagnant.
Historically, rural recruitment strategies have prioritized students from rural backgrounds, based on the idea that they are most likely to return. But limiting recruitment efforts to that narrow pool risks compounding existing workforce shortages.
“We’re looking past 80% of our potential clinician workforce in the future that could practice rurally just because they didn’t grow up in a rural area or work in a rural area before medical school,” said Daniel Hoody, MD, chief medical officer of Sanford Health’s Bemidji (Minn.) Medical Center.
With this in mind, Sanford Bemidji last year established an innovative partnership with Minneapolis-based Hennepin Healthcare, where emergency medicine residents at Hennepin County Medical Center spend one month working at Sanford Bemidji, gaining exposure to what it’s like to work in rural medicine.
The goals are twofold, leaders told Becker’s. Emergency medicine residents at Hennepin Healthcare get the chance to broaden their skillset and gain more confidence practicing in a smaller hospital. For Sanford Bemidji, it opens the door to more potential recruits.
“Residents were really looking for varied learning experiences,” said Meghan Walsh, MD, director of HCMC’s residency programs. “They were actually coming into interviews saying ‘Is there a rural experience? Is there a chance to learn in an emergency department that’s not downtown Minneapolis? What options do we have?'”
Last May, HCMC, a level 1 trauma center, sent its first emergency medicine resident up to Bemidji for a one-month rotation. “He was our canary and he came back singing loudly, so every resident after him was really excited,” Dr. Walsh said.
Since then, one resident has returned for a second month, and the rotation now includes psychiatry residents. Leaders are eyeing expansion to other specialties as interest grows.
The model means 12 emergency medicine residents will get the chance to rotate through Bemidji per year, a higher number than the hospital would train annually through a traditional rural residency training track. With a greater number of new physicians gaining real experience in rural medicine, leaders anticipate more will choose to pursue rural practice.
Many new medical school graduates have perceptions about what it means to practice rural medicine, often dismissing it without ever having stepped foot in a rural healthcare facility.
This program, “turns the decision not to practice in a rural area from a passive one to an active one,” Dr. Hoody said. “This truly has the opportunity to bend the curve for the clinician workforce gap,” in rural medicine.
Another unique aspect of the program is that residents rotate through Bemidji during their second year of residency training — a critical period when new physicians are deciding where they want to begin their career.
The program’s first participant was a physician from Boston, who had his sights set on practice in a major trauma center. After his month at Bemidi, he changed course and ended up pursuing a rural position in Utah, Dr. Walsh said.
One of the key challenges Dr. Hoody and his team had anticipated in starting the program was the acceptance of clinical staff at Bemidji, since residents had never been on site. That concern was quickly put to rest.
“Right out of the gate, a notable portion of our clinical staff were excited about the energy and enthusiasm that residents bring to the workforce – a lot of curiosity and energy that can help combat burnout,” he said.
Under the model, Hennepin Healthcare houses the institutional accreditation and infrastructure required by the Accreditation Council for Graduate Medical Education, enabling Sanford Bemidji to serve as a training site without having to independently meet those requirements.
There are two primary ways for teaching hospitals to receive funding for rural physician training: Either by becoming a sponsoring hospital in a small community, or by establishing a standalone residency program — both of which are complex and resource-intensive. Currently, CMS does not fund rotation-based experiences like the one Hennepin Healthcare and Bemidji have established, Dr. Walsh said.
“It would be amazing if CMS came in and said, ‘We see that a single month during a three-year residency is enough for a resident to choose to practice in rural America. We know there’s a workforce crisis, and we want to finance novel funding opportunities in order to introduce more and more trainees to rural practice.'”
