Rural doctors wear 'a gazillion different hats' to fulfill community needs
NORTHWOOD, N.D. — Dr. Jonathan Berg crouches down close to Judith Hanson with a broad smile and a stethoscope in his hand.
"Take a deep breath," he tells her. "There we go."
The two haven't known each other long, but they joke like old friends. Hanson has been a patient of Northwood Deaconess Health Center's swing bed unit for only a week, but she laughs as she describes her stay as "too long."
"We're trying to get her out as soon as possible," Berg cracks. "She's driving us crazy."
Truth be told, Hanson says she asked if she could spend her recovery in Northwood after she was discharged from another hospital.
"I was very happy because they have a wonderful reputation," she said. "Dr. Berg is very thorough. He wants to get to the bottom of things. He's very inquisitive."
As a University of Minnesota Medical School graduate with a residency in family medicine and concentration in geriatrics, Berg has spent nearly 33 years getting to the bottom of things at Northwood's 12-bed hospital, clinic and nursing home.
"This is the only place I ever had a practice," Berg said. He got his start in 1985, and some might say he was destined for rural medicine.
He and wife Laurie, a physical therapist, lived in Saginaw, Mich., during his residency. Three years was the longest either had spent so far from family, and they knew they wanted to settle closer to home and their parents.
"I always had been saying I wanted to practice in a small town, and my wife agreed," Berg said. "It's just that her idea of a small town was Grand Forks."
Northwood became a compromise of sorts. It was only a short distance from her parents in Grand Forks, and though Berg grew up the son of a southern Minnesota minister, Northwood was his mother's hometown. Plus, the health center met his funding agreement to serve an area short on physicians.
Berg recalled Deaconess had four doctors at the time, and nearby Cooperstown Medical Center had two. Today, Berg is the lone doctor at both. He no longer does clinic care, but he does see patients at seven other long-term care facilities. He explains it's better for him to do the traveling and for the patients to stay put.
"Medicine is a challenge everywhere, but more so in rural areas where there are not as many people to diffuse things," Berg said. "You wear a gazillion different hats, and there can be a degree of professional isolation because you don't have multiple specialties just down the hallway."
A quick look at Berg's current professional posts shows he wears no fewer than 14 hats with either "medical director" or "chief of staff" stamped on the brim. He acknowledges being part of a shrinking demographic in American health care has its challenges, but he says the rewards of caring for a whole community far outweigh the demands.
"It's been a good life," Berg says.
Dr. Joel Johnson says the same. He earned his University of North Dakota medical degree in 1993, did his residency in Grand Forks and has served 22 years at First Care Health Center in Park River, just down the road from where he grew up in rural Adams.
Johnson said UND gives its students a lot of experience working rotations in rural North Dakota hospitals.
"Like in Rolla, I was working with these old-time doctors, and they did everything. They were the true old-fashioned family practice doctors," he said. "That's really one of the reasons I decided to go into rural medicine. Those rural doctors were really good to us. We got a lot of hands-on. They were really good teachers."
Johnson says he chose to practice in Park River right after his residency, where he now juggles dozens of patients up to 12 hours a day between clinic and hospital. And like Berg, he also travels to a number of regional nursing homes.
"I can't say we love medicine more than urban doctors. They love medicine, too," Johnson said. "But it's a different drive and a different lifestyle. We have to be accessible all the time. Where their day ends and they're done, our day keeps going — all night sometimes.
"You have a rollover, fires, bad accidents, you're taking care of it. It's not going to ER where there are ER doctors. You are the ER doctor."
But the long hours and hard work are all worth it when a young patient brings him a drawing or he knows he's made a big difference in someone's health outcome, Johnson says.
"There's not so many life or death situations rural doctors take care of, but when there is a major trauma like a heart attack or stroke, we can make a big difference with technology and clot-busting drugs."
Berg and Johnson believe rural doctors always will play an important role in health care.
"We need to be here for emergencies. Some things won't last (a long ambulance ride)," Johnson said. "Right now, the big push from insurance companies is to do as much outpatient treatment as you can. That doesn't hurt the physicians because the work is still there. The scenery is going to change a little bit as far as how care is provided, but I think rural medicine is going to go on for quite a while."