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Dr. Michelle Placke, currently a resident at Altru Family Medicine Residency Center in Grand Forks, examines patient Brittany Bye. Placke, a of native of Beulah, received her medical training in Houston, but says Altru Family Medicine Residency Center was her first choice to complete her residency. (JOHN STENNES / GRAND FORKS HERALD)
Dr. Michelle Placke, currently a resident at Altru Family Medicine Residency Center in Grand Forks, examines patient Brittany Bye. Placke, a of native of Beulah, received her medical training in Houston, but says Altru Family Medicine Residency Center was her first choice to complete her residency. (JOHN STENNES / GRAND FORKS HERALD)

Getting more doctors for N.D.: A key retention tool, in-state residencies, is maxed out now but officials expect more

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Michelle Placke grew up in the small town of Beulah with a dentist for a father and a nurse for a mother, so she knew she wanted to be a doctor at an early age.

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After getting her medical training in Houston, Placke said her first choice to complete her residency was at the Altru Family Medicine Residency Center in Grand Forks, where she is now a resident.

But she doesn’t plan on staying there.

“A lot of people picture themselves long-term in a similar setting to what they were raised in,” she said. “I don’t have children right now, but eventually I think I would like to raise my kids in North Dakota.”

Specifically, a small town in North Dakota, which is exactly the sort of place that’s desperately in need of people like Placke.

“I’m definitely a small town girl,” she said.

In-state residencies like the one Placke is going through are a tool the state has been using to try to keep doctors in North Dakota. In fact, the state paid for more residencies, a kind of medical internship, to overcome a federal funding cap because statistics suggest doctors tend to stay in areas where they did their residencies.

These statistics were cited by officials at UND’s School of Medicine and Health Sciences a few years ago as they pushed for a new school building, which is now under construction. They said that, with more space, the school could train more doctors who could go into the in-state residencies. The hoped for result is more North Dakota-trained doctors staying in North Dakota.

But there aren’t necessarily enough in-state residencies for everyone that wants them. All 115 residency slots in the state are now full.

Last month, soon-to-be graduates of UND’s School of Medicine and Health Sciences were matched with residencies and, while 100 percent found placement, only 16 out of 62 found placement in North Dakota hospitals and clinics.

Boomerang grads

Dr. Joshua Wynne, dean of the UND medical school, said there are a lot of factors to consider before jumping to conclusions.

Students and residency programs are matched based on their mutual interests and qualifications, and some students are seeking residencies not available in North Dakota.

“If you look at the list, you’ll see people training in ob-gyn, radiology... a bunch that we don’t and won’t offer residencies in because they’re too specialized,” Wynne said. “For many of those positions, they have to go out of state because we don’t have them here, nor is it reasonable to have them here.”

Placke said in her experience, leaving the state for awhile was a good thing and that most people who do that tend to come back.

“I think it’s a good aspect of your education to get some exposure, especially in specialties where you might not see as much of it here as you would in a more populated area, so I think it’s not necessarily a bad thing to have to go somewhere else to learn it, but I think a lot of people are still drawn to where they grew up,” she said.

Marc Nielsen, director of Altru’s residency program, agreed and said the numbers are skewed because of the lack of specialty training in the state.

According to UND’s Center for Rural Health, 40 percent of physicians practicing in North Dakota and Minnesota had an out-of-state residency.

And of the eight residents completing the program this year at the Altru Family Medicine Center, four are staying in-state, two are going out of state, one is staying at the center to complete a specialty fellowship and one is undecided.

Wynne also said that when it came to students who are looking for residencies in the programs available in North Dakota, “roughly half the students stayed here and half went out of state” consistently for the last few years.

How it works

Medical residencies are essentially paid internships for medical professionals that last about four years. Residencies are also required for doctors to get a license to practice medicine and get board-certified.

Residents are paid about $50,000 per year for working an 80-hour work week, but extra funding is also required to cover the costs associated with medical professionals taking extra time to teach when they would normally be working.

“It’s time-consuming,” Wynne said. “Hospitals lose revenue because they can’t see patients.”

Nielsen said that, at the Altru Family Medicine Center, the 24 residents who are in different stages of training work just like regular doctors would and even worked through the night during the recent Blizzard Gigi.

“The residency is definitely a big team and the faculty are here as a foundation of the team,” he said.

As a result of being part of that team, those residents, like Placke, have a higher chance of being hired as full-time, licensed doctors at the center.

Funding limits

The number of available residency slots varies by state, limited by how much federal funding each state receives from Medicare and by the Accreditation Council for Graduate Medical Education, a private group that approves the number of residency slots.

“The strongest controlling factor has been funding,” Wynne said.

And for the last 17 years, there has been a cap on federal funding. Legislation has been introduced in Congress to change this but, for now, it’s up to states to fund more residencies.

In North Dakota, this year’s 115 residency slots are full, but there are plans to open more in the coming years. State funding has been allotted for 17 more open slots each year for the next three years, bringing the total up to 132.

Wynne said this will work in conjunction with UND’s $124 million new medical school building, which is slated to increase the graduating class size by about 20 students every year.

Other solutions

While a doctor’s residency may not always influence where they choose to settle down and practice medicine, North Dakota officials are trying to make the state look more inviting with RuralMed.

The program allows graduates going into family medicine to practice for five years in a rural part of the state and, in return, have all four years of tuition and fees absorbed by the schools.

“Those students have a real incentive to take a residency for family medicine in state and stay in state,” Wynne said.

Nineteen UND students have already been placed in the program, but won’t participate until they graduate in two or three years.

Rep. Gail Mooney, a Democrat who represents District 20 in the North Dakota House, is well-aware of the issues facing rural hospitals. She said that while it’s a multifaceted problem, she has family near Crosby, N.D., who deal with the shortage first-hand and it needs to be fixed.

“If there’s something we need to be doing on the state level, we need to be doing it,” she said.

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Anna Burleson is the higher education reporter for The Grand Forks Herald. She is a 2013 graduate of the University of South Dakota's Mass Communication program and is originally from Watertown, S.D. Contact Burleson with story ideas or tips by either phone, email or Twitter, all of which are listed below. More examples of her work can be found at grandforksherald.com.
(701) 780-1114
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