Health

WILLMAR, Minn. (AP) ― In Willmar, they need three family practice doctors, three internists, a neurologist and an oncologist. In Marshall, they need two internists, a family practice doctor, an OB-GYN and surgical subspecialists. In Litchfield, they need more doctors despite the recent addition of five physicians and two physician assistants.

And that's just the needs of one western Minnesota chain of clinics, the Affiliated Community Medical Centers. In Willmar, the Family Practice Medical Center is recruiting. Rice Memorial Hospital is looking for another emergency room doctor.

A growing shortage of rural physicians is taking its toll, and patients are feeling the crunch: Longer waits for non-emergency appointments. More care delegated to mid-level practicioners. Primary care physicians refusing to take on new patients.

"There are a lot of worries in primary care," said Dr. David Newcomer, medical director for Affiliated Community Medical Centers. "Our primary care doctors have said, 'We're working as hard as we can already."'

A number of factors have contributed to the shortage: Fewer medical students opting for primary care, challenges with reimbursement, the rising cost of medical school, and the lifestyle goals of a new generation of physicians.

Departures and retirements have contributed to the vacancy rate: When a longtime family physician at ACMC's Atwater clinic retired this spring, the clinic closed because a replacement couldn't be found.

Officials fear the situation is unlikely to change anytime soon.

"We are looking at a long-term shortage here," said Dr. Ronald Holmgren, president of ACMC. "I think it's going to continue to be the highest priority for our organization, other than quality health care. I think all our physicians share that."

Holmgren said hospitals and clinics used to have some choice of job applicants, but "now it's much more the residents driving things and deciding. There is a change in a lot of the candidates coming out and what they're looking for. The focus is much more on lifestyle."

It's difficult to sell young physicians on the idea of rural practice, particularly since most have opportunities in more populous areas. "We're already behind from the start," Newcomer said.

In response, ACMC has intensified its recruitment efforts -- now reaching out to new doctors in their first year of residency, and particularly targeting those with ties to the Upper Midwest. Last year, ACMC established a scholarship program to support local students in health care professions and encouraging them to consider returning to their hometown when they complete their training.

Health care officials said the drop in doctors doesn't just affect patients. Fewer doctors means less ability to perform procedures locally, with a resulting drop in revenue. Rice Memorial Hospital has had to decrease its number of orthopedic surgeries, because of a lack of surgeons to perform them. And, completing the vicious circle, that affects the ability to attract new doctors.

"Physicians are not interested in coming to a community where the hospital has limited services," said Dale Hustedt, interim chief executive at Rice Memorial Hospital.

Hustedt said rural health providers must be willing to invest more time and effort to recruiting than they have in the past.

"You have to be able to convince someone to get here and understand the community," Hustedt said. "We want there to be a full contingent of medical specialties here, but we don't want to rush into bringing someone on board. We want to be real thoughtful and wise about who comes to the community, and we want the fit to be one that lasts for a long time."

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A survey by Minneapolis-St. Paul Magazine cataloged 7,000 doctors and dentists in the Twin Cities area.

(© 2009 CBS Broadcasting Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)