Finding doctors in ND: Majority come from within
GRAND FORKS -- Before being hired by Altru Health System last year, Dr. Jason Go saw Grand Forks as just another town along the interstate between Nebraska and Winnipeg, Manitoba.
"I'll be honest with you, I had no plans to be in North Dakota," said Go, a doctor in interventional cardiology. "I said, 'I'll never go back to winter weather.'"
But when personal and professional interests aligned to bring him to the city, he turned to advice he had heard from other doctors about hospitality in the more empty parts of America.
"The people know most physicians here are not from here, and they're far away from home," he said. "They will treasure you because they know the sacrifice you're making to come here."
Originally from the Philippines, Go is a long way from home. But the Northern Plains offer him rewards in addition to whatever he has sacrificed by leaving home.
On a personal level, it includes his wife's family in Winnipeg, the destination of his drives north on Interstate 29 during post-medical school training in Omaha, Neb. On a professional level, it is the way places such as Grand Forks embrace foreign-born doctors with a respect more common in Asian countries.
"From the Philippines or any Asian country, to go to the U.S., there is a big barrier," Go said. "I believe these foreign-born physicians have less of a barrier to practice in rural areas."
Though North Dakota long has provided a home to doctors from afar, medical providers and educators in the state also want to increase the share of doctors working in their home state to ease recruitment and retention difficulties and head off an expected shortage created by a growing and aging population.
"North Dakota has had challenges in recruiting people from elsewhere," said Dr. Joshua Wynne, dean of the University of North Dakota's School of Medicine and Health Sciences. "The physician shortage is not a unique problem in North Dakota."
North Dakota providers recruit doctors from a national and international pool, and Go is not the only doctor in state who is far from home. Nor is he the only one of his countrymen in the state.
According to the North Dakota Board of Medical Examiners, there are 33 doctors licensed to practice in the state from Go's native Philippines, the second-biggest source of doctors outside the United States and Canada.
No. 1 is India, providing 126 doctors in the state. After that is Pakistan with 22 -- and 79 other countries, including places ranging from Albania to Zambia, each providing one doctor.
The majority of the state's foreign-born doctors are from Asia, with the largest continent providing 297 doctors in the state. Europe was the birthplace of 61 doctors licensed by the board of examiners, many from the former communist countries of Eastern Europe such as Romania, Russia and Poland. Africa provided 55 doctors, with Nigeria and Egypt accounting for the biggest shares.
Among the state's doctors, one hails from Australia.
Though North Dakota always has depended on doctors from other states or countries, it provides roughly a third of its own doctors. Those born in North Dakota account for 519 of the doctors licensed in the state. Neighbors Minnesota and South Dakota provide 150 and 50 doctors, respectively.
But with more than 1,700 doctors licensed in the state, it leaves roughly 1,000 recruited to a sparsely populated place with a reputation for nasty weather.
"We kind of like Upper Midwest (medical) programs, because people are at least familiar with the weather," said Joel Rotvold, executive physician recruiter with Altru. "You have to be competitive, not just in North Dakota, but you have to be competitive nationwide."
Rotvold said roughly a third of the system's recruits are from North Dakota. Of 56 physician positions added by Altru in the past two years, about 17 had ties to UND. "About 30 percent. Not bad," Rotvold said.
For providers such as Altru, recruitment means nurturing relationships with medical students in Grand Forks as well as potential recruits around the country.
"We use databases. We do career fairs," said Rotvold, listing Omaha, Chicago and New York as recruitment sites.
North Dakota's largest medical provider, Sanford Health, takes pains to recruit from UND and lure doctors with North Dakota roots.
"We always believe it's really important to grow our own," said Dr. Richard Marsden, president of Sanford Clinics. "They know what they're coming back to."
Among Sanford's 647 doctors in its North Dakota region, which includes facilities in northwest Minnesota, 179 were born in North Dakota and 112 were born in Minnesota, Marsden said.
"I'd just as soon recruit someone who grew up here," he said. "You just have a greater faith that someone who grew up here is going to come back here and be happy."
That doctors with North Dakota origins are a valuable commodity for health care systems is not because of prejudice or hometown boosterism. It is acknowledgement of the challenge anticipated by those providers in the recruitment process that is difficult and expected to get tougher.
"Compared to the national average, we have a harder time getting physicians to come here," said Colleen Swank, Altru medical director of primary care.
The medical school is waiting for final legislative approval of a $124 million expansion to recruit more North Dakota students into medical school and into residency programs in the state. According to Wynne, doctors who have both their medical training and residency in North Dakota will have a two in three chance of staying in the state, and 80 percent of recent medical residents in North Dakota stayed.
"The challenge is getting an adequate number of providers for all of North Dakota, that's urban as well as rural areas," Wynne said.
It will be years before any expansion is finished and larger classes complete the medical school, residencies and intern programs. In the meantime, North Dakota health care providers still will depend on attracting doctors from near and far.
For Dr. Go, who also considered a job in Tampa, Fla., Grand Forks was a good choice, despite his reservations, he said. He likes that it is a family-oriented, low-stress, small city but not too far from the urban areas of Winnipeg and the Twin Cities.
"Grand Forks, I think, is very strategically located," Go said.
"You know there will be no perfect place for a job," he said. "But I think the only downside about Altru and Grand Forks is the weather."