Description

Attracting and retaining primary care physicians is an issue faced by many rural communities. Some of these communities are in states finding that the best way to increase their healthcare workforce is to develop the next generation of providers themselves, a philosophy referred to as "grow-your-own."

One state using that approach is North Dakota. In 2014, a new state family medicine residency with a rural practice focus was created, the Minot-Williston Rural Training Track (RTT).

Sponsored by the University of North Dakota School of Medicine and Health Sciences, the RTT program is actually an expansion of the UND Center for Family Medicine Program in Minot, the first residency program in the state. Since the Minot core program's start in 1975, it has graduated 201 family medicine physicians. As of 2017, the Rural Training Track has 8 graduates.

For many communities, family medicine is the foundation of the healthcare system, enabling all medical specialists to practice at the top of their expertise. This drives training programs for family medicine in rural areas to reflect America's larger healthcare transition to value-based care. Residents in the RTT will have firsthand experiences with efficient utilization of limited resources, preparing them to work in any environment.

Physician training in the new rural track program emphasizes traditional family medicine. Yet the program allows customization. Residents will split their three-year residency between the two rural areas of Minot and Williston where the residency's clinical partners are Minot's Trinity Health and in Williston, CHI St. Alexius Health.

This program was chosen by the American Hospital Association to serve as an example highlighting innovative models of care delivery.

Services offered

During the three-year curriculum, the first year of RTT residency is spent on the Minot campus with the core program residents. During this year, didactics, patient care at the family medicine clinic, and 13 months of block rotations are completed.

For the final two years of training, residents move to the Williston campus and practice in an even more rural environment. Training in Williston includes inpatient and outpatient care and skilled nursing care. During the Minot training time, residents also do home visits.

During their first year, residents also have a mandatory month of inpatient pediatric training at the Colorado Children's Hospital in Denver.

UND School of Medicine and Health Sciences offers a time frame breakdown of the curriculum.

Results

Rural-trained physicians are best suited to fulfill the needs of rural communities, and survey data suggests rural-trained residents are very likely to remain practicing in rural areas. These trends will be monitored as the program continues.

Other results from the program include:

• Capacity for two residents per year, with the first RTT class graduation June 2017
• Currently, there are around 800 applications per year the two slots
• Scholarly, educational impact on community medical practice standards

Challenges

Many rural regions have limited housing selections, and North Dakota's oil boom further impacted housing availability during the program's initial start.

Recruiting for professional support staff is also a common challenge for programs in rural areas. After a vacancy during the RTT's initial six months, the program now has a permanent coordinator.

In addition to support staff, finding supervisory physicians can be another challenge. In rural areas, practicing physicians are often busy and spread thin.

Replication

Initial identification of the program director and program coordinator is key.

For any organizations creating a new training track, expect a substantial interval between the start decision and final approval of the program's structure. When the program structuring in place and the accreditation process completed, recruiting of the first residents can take up to 2 to 3 years.

Retention is impacted by tailoring transitions to fit the needs of residents and their families.

Contact Information

Peter Sandroni, MD, Program Director
UND Center for Family Medicine Minot
701.858.6700