In 1948, the people of North Dakota voted to levy a one mill statewide property tax to help fund the UND Medical Center. They did it because they wanted doctors.
Even though the levy was no longer necessary, they voted against repealing it in the 1980 primary election. They wanted more doctors.
In November, 1982, they again voted against repealing the one mill property levy. They wanted more doctors.
The 2013 Legislative Assembly appropriated $125 million for a new Medical School building. Legislators all around the state voted for the building because they wanted more doctors.
Then the Assembly passed Resolution 4002 mandating a study of health providers, especially in rural areas. It wants more doctors.
So let it be clearly understood. The people of North Dakota are pouring millions of dollars into the Med School because they want more doctors.
As provided in state law, the purpose of the Medical School is to upgrade medical services in North Dakota. Not in the nation, not in the region, but in North Dakota.
And the greatest shortage is family practitioners interested in going to the underserved communities of the state.
Recruiting medical students for smaller communities poses some major problems: (1) choosing family practice over a more romantic and profitable specialty; (2) the after-hours obligations of family practice, and (3) accepting the lifestyle of smaller communities.
Comparatively speaking, family practitioners are often on duty more hours a day than specialists. Family practitioners deal with a wider range of medical emergencies; specialists confine their skills to a repetitive practice.
Family practitioners are rewarded with half the pay of the specialists. Family practitioners in rural communities have more limited social opportunities than specialists in larger cities.
It is obvious that to be a family practitioner requires a different set of personal values than that of specialists.
The recruitment process must recognize these differences. A “values” screening process is necessary to find students with a compassion for people that makes the sacrifices of family practice in smaller communities worthwhile.
The next challenge is recruiting students who want to practice in smaller communities because they grew up in rural North Dakota and don’t need to be persuaded about the merit of community values.
Medical students from Fargo, Bismarck, Sioux Falls and Minneapolis will not spend their careers in the Mohalls, Cooperstowns or Killdeers. We can bribe them with payment of their loans, grants for five years of service and other inducements, but they will bail out as soon as they have met their obligations.
We need to support students who have the heart to serve the rural areas of North Dakota. The family practitioner candidates with rural roots ought to be the beneficiaries of all of the subsidies, grants and aid available to medical students.
The next crucial step in building a cadre of community family practitioners is getting ND graduates to complete their 3-year residency training in North Dakota. North Dakota currently has state-supported primary care residency sites in the four major cities. Unfortunately, these residencies have not attracted enough North Dakota students.
Only about five UND Med School graduates per year choose to compete their training in a North Dakota primary care residency program. That isn’t enough.
Now folks in the Med School may think they are doing everything they can to get North Dakota more family practitioners. The truth is that none of us ever does all we can. And the message is that North Dakota wants more doctors.