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University of Minnesota Medical School-Duluth
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At the University of Minnesota Medical School-Duluth campus, 59 first-year students received their official working garb in “the White Coat Ceremony” in Weber Music Hall in October 2008. Courtesy UM Medical School-Duluth2 of 3
Northern Ontario School of Medicine
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The Northern Ontario School of Medicine opened in 2005 and has campuses in both Thunder Bay and Sudbury. The medical school graduated its first class of doctors in May 2009. 24 of its 55 graduates studied in Thunder Bay.3 of 3
Lake Superior State University
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Students in Lake Superior State University's paramedic skills and simulations lab set up shop in an entryway as other students take in the activity between classes at the Sault Ste. Marie, Michigan, campus. The training is part of the program that helps emergency medical technicians, as well as LSSU criminal justice and fire science students, receive paramedic certification. Geoff Girolamo / Lake Superior State UniversityIf you want doctors, nurses and other health care practitioners for rural communities like those that surround Lake Superior and its nearby regions, then it’s best to find them in your back yard, medical education experts say.
Luckily for this region, health care education, including two medical schools, thrives on just about every shore. Those interested in health care careers - still among the most needed workers in the United States and Canada - can find programs in a wide range of areas from computer data entry to medical technicians to nurses to family practice or specialty physicians; from certificates to associate degrees to full medical degrees; and in coursework lasting months to years.
The lake region has access two full medical schools, one in Duluth and one with a campus in Thunder Bay, which is quite an achievement with a lakewide population of slightly more than 600,000. The Northern Ontario School of Medicine - opened in 2005 and with campuses in both Thunder Bay and Sudbury - will graduate its first class of doctors in May 2009. The class of 55 includes 24 students who studied in Thunder Bay. The medical school is tied to two universities - Lakehead University in Thunder Bay and Laurentian University in Sudbury.
The medical school “was established really as a result of a strong community movement,” says Dr. Roger Strasser, founding dean and CEO of the school. The community, including a major push by Aboriginal leaders, encouraged the government to establish a northern school. Because of that, Roger says, “there’s hardly a person in northern Ontario who isn’t aware of the school.”
The new graduating class will be closely watched to see if the students choose northern, rural family practices or the more lucrative opportunities in specialty medicines in big cities.
The outlook is good for family practices, with about 50 percent of students considering that option, says Roger. That is more than double the national average in Canada.
In the United States, family practice medicine is an even less popular choice for most medical students with about 8 percent nationwide choosing the first option.
At the University of Minnesota Medical School-Duluth Campus, however, graduates also gravitate to family practice medicine at a rate of 50 percent. Its charter class graduated in 1976.
“It’s geographically related,” Dr. Gary Davis, dean of the school, says of the success in encouraging the rural practice options. “We heavily weigh rural backgrounds (in accepting students); 83 percent of our entering students come from small towns.”
According to school statistics, 53 of 58 students enrolled in 2007 (out of 1,330 applicants) were from Minnesota. Of those 58 students, 27 are women. At the Ontario medical school, 51 of 56 students enrolled in 2007 (of 2,274 applicants) were from northern Ontario and 40 of the students are women. “Around 90 percent of each (incoming class) are students who have grown up in northern Ontario,” Roger says.
Both schools have programs to recruit First Nations students because health care in those communities also has a critical lack of workers.
There are many reasons it is difficult to recruit and keep doctors and other medical professionals in small towns. Rural family practice physicians tend to earn less than specialists in large cities, for one.
Some might think a rural lifestyle would be more laid back than in the big city, but, says Roger, “it’s not necessarily low stress if you’re a physician.”
In towns that often have only one or two physicians, doctors face long hours and must handle complex medical conditions without the same range nearby of specialists and technology.
“You tend to have a wider range of medicine that you practice,” Gary says. “You’re on call perhaps more frequently. Your patients are known to you (out) in the community … some people like that and others feel like they’re never away from work.”
Students from rural backgrounds are more acclimated to small-town life, but might have a harder time considering medical school because of their educational backgrounds or costs. Most medical students in the United States graduate with more than $100,000 in debt; Duluth medical school graudates average $170,000 debt, which, staff there says, make scholarships critical to keeping them in family medicine.
“Our students have an average family income lower than families of medical students in other medical schools,” says Roger of the northern Ontario medical school.
If Thunder Bay’s graduates follow the pattern of those from Duluth, many will end up working in the region. Some 75 percent of the Duluth medical school graduates practice in Minnesota or western Wisconsin. While nationally about 4 percent of doctors work in rural areas, of those trained in Duluth, 47 percent practice in communities with fewer than 20,000 people and 62 percent in communities with fewer than 50,000 residents.
Becoming a physician is not the only option for those interested in health care, and medical school is only one of the education opportunities. In fact, the majority of those entering the health care field probably come from other college programs or with degrees from community or technical colleges or through programs offered by hospitals.
Within the Lake Superior and nearby region, there are more than 30 hospitals or clinics needing workers in the full range of skills.
To get a sense of how many options are available, it helps to examine some of the newest programs starting and review a sampler of established courses.
• Wisconsin Indianhead Technical College, which has five major locations, has a variety of health care options. Its newest success is that it can offer an occupational therapy assistant associate degree program at its Ashland, Superior, Rice Lake and New Richmond campuses thanks to an expanded interactive television system. This video option, which allows a teacher at one campus to give instruction to all campuses, increased enrollment in the program by 24 students the first year, says Mari Jo Ulrich, who heads the program. It had been in danger of elimination because there was not enough enrollment on any one campus.
“It’s one of the top 10 projected professions (needed),” she says, “especially with the baby boomers.”
One shift in the profession is from rehabilitation toward avoiding problems and using new tools to do that. “We change with technology,” she says, giving as an example a kind of “Wii-abilitation” that uses the Wii gaming system as a therapy tool.
Student expectations also have changed. “They need to learn when they want to learn,” Mari Jo says. That means 24/7 access to Internet coursework for some.
“Our students that we typically get want to stay in this community,” Mari Jo says. “They’re lake people; they really want to stay here and they want to find a career.”
• The private College of St. Scholastica in Duluth has a national reputation as a health care educator. The 97-year-old institution established by Benedictine Sisters began its education of professional nurses in the 1930s. What was once a five-year baccalaureate program now is designed for completion in four academic years.
“I’ve seen a huge change in nursing that runs parallel to advances in health care,” says Marty Witrak, dean of the college’s School of Nursing. “The knowledge explosion is so great.”
She says that hospitals need a mix of baccalaureate and advanced degree-level nurses as well as those in shorter programs.
The doctoral degree program has become increasingly needed. Nurse practitioners, those with advanced education who can deliver high-quality, lower-cost health care than physicians, are in high demand, especially in rural or underserved areas.
One of the many new options at the college’s nursing school is an 18-month nursing-degree program for those who already have at least a bachelor’s degree in any other field. This program allows those interested in career changes access to another option and helps to fill the need for professional nurses.
A second new program, called the ATHENS project, is receiving both national recognition and financial grants. Although the college has offered a degree in Medical Records Science since 1934 - now called the Healthcare Informatics and Information Management Department - this new project integrates education about computer health records into all of the health care programs. The fledgling project, officially Advancing Technology and Healthcare Education or ATHENS, already has earned awards for innovations in professional nursing and world-health innovations. “Up here in the little eternal land of winter,” jests Marty, “we have national recognition for the kind of work that we are doing.”
Rondell Berkeland, dean of the college’s School of Health Sciences, says that a new degree program that the college will offer this summer is a master’s degree in Athletic Training. The college just recently introduced a football team, which gives additional access to athletes for students in the program.
“We had many of the elements in place to prepare students to enter this professional program,” Rondell says. “We really have the ability to do a fine job teaching students (about athletic training) in depth.”
• Lake Superior College in Duluth has health care education both in the classroom and online. It also offers some community clinics, sometimes partnering with the College of St. Scholastica, that offer great education opportunities for students while providing certain care for community members.
The newest health care program launched by Lake Superior College is a hemodialysis patient care technician certificate that can be done totally online.
Pamela Elstad, dean of Allied Health and Nursing at the college, says that there are approximately 4,500 kidney dialysis facilities in the United States and in the five-state Midwest region that covers the Lake Superior area, there are approximately 400 such facilities. “Patient care technicians are employed in almost all states,” she says. The Lake Superior College online certificate program can be accessed by anyone wanting this specialized training.
“We developed this program completely online so that we could deliver it throughout the United States and help to take care of rural areas. The students can come from anywhere. … It’s a new way of thinking for us.”
After completing the online theory certificate, a student has the option to do a hands-on clinical experience in a dialysis site unit in one of many locations around the country.
A practical addition to Lake Superior College’s physical therapist assistant program and dental hygiene program are clinics offered to community members that give students actual experience. All work by students is supervised by faculty health care professionals.
The clinic connected to the dental hygiene program is open to the public in general, but it fills quickly with each 16-week semester, says Kathy Leonard, director of the program. Clients to the clinic in which the students do need to allow extra time so that the dental hygienist students can have their work reviewed. The college also allows its dental facilities to be used by licensed professionals who volunteer in the evenings, but it’s dependent on the interest of local professionals and the clients must meet certain needs criteria.
First and foremost, the clinics are teaching tools, says Jane Worley, director of the Physical Therapist Assistant Program. “It’s a really nice experience for the students.”
Community members with no health insurance or insurance that no longer covers their needs or staff and students at the college can attend the clinics for little or no cost. The physical therapy clinic offers students a range of experiences from treating patients with back and ankle pains to those recovering from strokes, brain injuries or ongoing multiple sclerosis and chronic arthritis. The physical therapist assistant students are joined by the physical therapist students from the College of St. Scholastica, offering the additional benefit of interacting with colleagues. “They work together as a team as students,” Jane says, and see “how it works in the real world.”
• Regional health care education includes training professions for first responses to medical emergencies. Lake Superior State University in Sault Ste. Marie, Michigan, for example, has a nursing and recreation studies and exercise science programs within its College of Health Professions, but it also has education opportunities for its students studying to become firefighters or law enforcement officers to broaden their knowledge. In the Paramedic Technology program, students can be certified as an Emergency Medical Technician by the end of the first year and as a paramedic, the highest licensed provider for pre-hospital care, by the end of the second year of coursework.
• Not all education is done at institutions outside of medical facilities. Many hospitals, especially larger ones, run their own training programs. Some smaller regional hospitals partner with colleges and schools to groom the workers they need in the future.
At Portage Health in Houghton, Michigan, the hospital staff invests time and gives opportunities to those interested in health care careers, working with students from high schools, universities or medical schools, including medical residents and nursing, radiology and labratory technicians, along with nurse practitioners and physician assistants.
One interesting program involves HOSA - Health Occupations Students of America - and local high school students through the Copper Country Intermediate School District. Catherine Manderfield, clinical education coordinator for Portage Health, enjoys helping the students. They create health care projects - such as medical photography, working at the nursing home, observing in surgery - that are presented to HOSA. “This program is just fantastic,” Catherine says. “They’ve (local students) come back with many gold ribbons.”
The small hospital that serves a large region developed partnerships that save it from one of the prominent national shortages in medical care.
“We have never suffered a nursing shortage; that’s a great strength for us,” says Dr. Kirk Lufkin, chief medical officer for Portage Health. “Gogebic College and Finlandia University … rotate their student nurses through our hospital.”
Northern Michigan University in Marquette works with Portage Health to place students from its radiology technician and laboratory technician programs.
Kirk points out that Marquette General Hospital has a family practice residency program for graduating physicians, perhaps the only one in the U.P. That program is one of more than half a dozen education programs managed through Upper Peninsula Health Education Corporation in Marquette. The non-profit UPHEC has a strong record of training physicians who then return to the U.P.
For hospitals around the Lake Superior region, getting and keeping the right mix of medical professionals can be difficult. As Kirk explains, the personnel needs at Portage Health, which serves the entire Keweenaw Peninsula and nearby areas, “are as broad and deep as any health care provider’s needs.”
The rural location, coupled with an impressive annual load of lake-effect snows (averaging around 200 inches), can make some professional medical workers nervous about locating in Houghton or Hancock.
But recruitment is not the only effort Kirk and the Portage Health staff put into finding the right person. Just because a person agrees to come to the hospital doesn’t mean they’re a match for the community long term.
“The irony of it is, you need to be more selective in your recruitment; we also talk about retention. Signing bonuses only last a year or two. … Any local tie, let alone coming up here (to vacation) or Grandpa still has a cabin anywhere in the U.P. is a huge marker” for long-term retention, he says.
The hospital also often must try to find a way to place not only the professional being recruited but also often the spouse. This is once again where ties to regional education institutions help. Those colleges and schools might have a place for a professional person or else the hospital looks elsewhere. “We’re collaborating more and more and we’re also finding the spouse a job in the community.”
Portage Health also has made contacts with education institutions outside of the U.P., which aids recruiting for positions and gives students a chance to sample the Lake Superior life. Thanks to a former U.P. resident now on the emergency medicine faculty at the University of Michigan, the university places senior emergency medicine residents on a rotation at Portage Health. Many are surprised at how technologically advanced the hospital is, Kirk says. “They say, ‘We didn’t realize a little rural hospital would have all this. They go back and tell others, ‘If you like snow, if you like snowshoeing, go to Portage Health.’”