Advice to rural Minnesota: Look beyond the physician

DULUTH -- There was talk all day here on Monday about new ways of looking at the delivery of rural health care in Minnesota.

Build community organizations to help residents lose weight and exercise more. Connect small town emergency rooms to operations centers that can lend expertise in real time. Train paramedics to do more and even make house calls. Think about team care with several patients from different parts of the state meeting at the same time.

These ideas and more were tossed out during the annual Minnesota Rural Health Conference in Duluth.

Then finally near the end of the day, Mark Schoenbaum, director of the office of rural health and primary care for the state Department of Health, summed it up this way: "We have no choice but to look beyond the physician."

He was part of an end-of-day panel discussion and was responding to moderator Julie Zenner of Almanac North, who asked about incentives to solve the rural doctor shortage.

Schools won't be able to produce enough doctors to serve the aging population in rural Minnesota, Schoenbaum said. He and others said that creates imperatives to change.

Laws and habits that seem mostly to protect turf need to change, said Marty Witrak, dean of the school of nursing at the College of St. Scholastica. That might mean nurses don't object to pharmacists giving flu shots; it might mean docotrs no longer have to sign off on hospice care.

She also told the 150 people attending the panel discussion that the one-on-one doctor-to-patient model probably needs to change. Doctors should be health care system puzzle solvers these days, she said, because what is needed are new approaches to patient care.

Not that widening the team of providers solves everything. Ira Moscovice, professor in the division of health policy and management at the University of Minnesota, pointed out that getting nurse practitioners to rural Minnesota could be just as difficult as getting doctors there.

"It's not a simple task to get any health provider into rural areas," Moscovice said.

But part of the equation that surfaced repeatedly was that patients need to take more responsibility for their own health and make better decisions. Figuring out how to get patients to do that and make other adaptations to what Brock Slabach of the National Rural Health Association called the "era of austerity" is a work in process.

I was surprised by how often during the day I heard references to a need for better communication and more talk between communities about what's working. Clearly lots of people are engaged in preserving valuable community assets across Minnesota. Just as clearly, it seemed to me, there's a need to share what's working.

For more on rural health care in Minnesota, see our Ground Level section on the topic.

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