News 8 Investigates: Finding physicians for rural areas

A shortage of doctors, especially in rural areas, is causing patients to go to great lengths to get care. They may have to drive for hours or wait months to see a primary care physician. The problem isn’t new and is expected to get worse as baby boomers retire.

After completing her residency training in Denver, Colorado, Dr. Kim Breidenbach wanted to come back home to the dairy state.

“It has been a joy to practice in a rural setting,” said Breidenbach, a family medicine provider at the Gundersen Health System Whitehall Clinic.

While she enjoys her work, days can be long.

“And that’s OK. That’s good. But it gets tiring,” Breidenbach said.

She’s one of only three physicians at Gundersen Health System’s Whitehall clinic.

“When one person takes time off, other people are picking up a lot of extra loads. And so everybody’s working hard all the time,” Breidenbach said.

There’s no one else to fill in and no one else to call on when doctors need help caring for their patients. It’s one of the many reasons why some doctors don’t want to work at rural clinics.

“So I think people maybe are fearful of that, managing a little more complex cases just because patients don’t want to travel as much to the larger cities,” said Dr. Jodi Breska, a family medicine physician at Mayo Clinic Health System’s Arcadia clinic.

They feel the need to not only be a physician but a specialist, even though that’s not their training.

“We really do have to work hard to keep apprised of the newest and greatest in medicine because our patients will go see the specialist and come back and want to be educated by us and know our opinion,” Breska said.

All of these issues combined create a hard sell for medical systems looking to recruit physicians to these shortage areas. But keeping them at the clinic is the next step.

“We can have very stable physician staffing in one area and then because they’re small groups, you lose one or two doctors to retirement or resignation and then all of a sudden it’s a real hardship for that community,” said David Rushlow, the chief medical officer for Mayo Clinic Health System.

In the coming years, the problem will reach a tipping point.

“We’re finding that as the baby boomers retire, it might take two younger clinicians to replace that person who’s retiring. So that makes the shortage even more accentuated,” said Dr. Marilu Bintz, senior vice president for population health and strategy at Gundersen Health System.

Which is why medical providers like Gundersen and Mayo have doubled down on their recruiting strategies. Both are looking for doctors who may have rural roots or have spent time studying in these areas during their training– doctors like Jodi Breska.

“Growing up on the farm and being so involved with a rural community and just feeling like I reaped the benefits of that, I wanted to get back to a similar type of community,” Breska said.

Her colleague, Dr. Bert Hodous, was an unlikely fit.

“I’m kind of a city guy,” said Hodous, a family medicine physician at Mayo Clinic Health System’s Arcadia clinic.

But he came to love the area, leaving a busy practice in St. Paul to move to Arcadia. He’s made it work.

“Maybe there aren’t as many restaurants, maybe there aren’t as many shopping places. But I’m not a big shopper and my wife’s a good cook,” Hodous said.

It’s this kind of eagerness to adapt that the two health systems are looking for in candidates.

“Because that’s the other thing that patients don’t want. They don’t want to get familiar with a primary care clinician only to have them leave in two or three years,” Bintz said.

But they know that recruitment can’t be the only solution to filling these shortages.

“We’ve seen more residency programs focusing on rural practice and that brings about more physicians that are interested,” Rushlow said.

One program hopes to show perspective doctors what the practices are like even earlier. After completing their bachelor’s, medical students may apply for the Wisconsin Academy of Rural Medicine. It’s one of the very few programs of its kind in the state.

“Our job is to work with medical students who feel that they might be interested in going into rural areas and we try to nurture that,” said Dr. Kimberly Lansing, the associate curriculum design director for WARM.

With sites in La Crosse, Green Bay and Marshfield, they have about 25 students per year statewide. Ninety-one percent of graduating students have come back to Wisconsin to practice.

“A little over half of the people that have gone through the program go into primary care. And interestingly, one-third of the people that trained in the WARM program go back to their hometown to practice medicine,” Lansing said.

She would like to see other medical providers and colleges create similar programs to show future doctors the benefits of practicing in rural areas.

For Breska, one of her favorite parts of practicing in a rural area is, “being able to be the doctor in the community but also go to church and to go to the grocery store and do everything else with the people who live here.”

Hodous said when we worked in St. Paul, it would be a very rare occurrence to see patients in the community. Having a close relationship with the people he sees in and out of the clinic is one of the best parts of the job.

“At the end of the day, I usually feel good about the interactions that I’ve had and hopeful for the next day,” Hodous said.

There are similar programs to expose perspective doctors to work in rural areas in other states. The University of Minnesota offers the Rural Physician Associate Program.

Similar to the WARM program, medical students train under family physicians in rural areas. So far, 40 percent of RPAP graduates go on to practice in rural settings.