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Having a doctor return home to set up a practice is rare says Mary Amundson, assistant professor in community medicine and rural health at the UND School of Medicine. Kristi (Midgarden) is one in 1 million, Amundson said. You don't get the locals going home very often. Kristi's comfortable treating people she grew up with. Having doctors practice in their hometowns is a win-win situation, Amundson said. A doctor builds a trust with the people because they know him or her, she said. The provider might know the personal history or the family history so care can get started immediately on that patient. Plus the retention factor shoots way up. These at home doctors have a commitment to their community and could be there long term unless something happens.

Small, rural hospitals have more trouble attracting doctors than health systems in bigger cities. Here are some potential roadblocks for rural hospitals and clinics in attracting doctors: A high volume of work. Fewer doctors in a small town mean longer office hours, more nights and weekends on call and more trips to the emergency room. Having just two doctors means being on call half the time, limiting activities. Variety. Is there enough variety in cases? Some students think rural health would be boring, but in fact, they have to know something about a lot of things. Spouse dissatisfaction. Spouses are more educated than in the past, and they often want to put their degrees to work. Lifestyle. With the shrinking enrollments, will the school have all the offerings they want? Does the town offer the church of the family's faith? Is there enough entertainment? Access. Is access to medical education, a referral center and technology available? But rural settings have their pluses, too, Amundson said.

The heavy workload in rural communities offers a chance to more quickly pay off the substantial debt accumulated from medical school. State and federal programs and incentives from hospitals/clinics also help pay off debt. Some doctors want autonomy, something that comes easier in a rural setting, and some physicians want a leadership role in the community, that is also  more available in a rural setting Amundson said. 

With an occupancy average of eight patients a day in its 20-bed hospital and less than $5 million a year in revenue, St. Ansgar's has fought almost a continual battle to survive. Its future has long been uncertain. The No. 1 key to success, of course, is the strength of the medical staff. In 1995, it had no full-time doctors, only temporary ones. So to go from that situation to having (two physicians) is a gravy boat, said Mike Mahrer, the St. Ansgar's Health Center president. This should be a good time for St. Ansgar's. Mahrer expects that these physicians will attract more patients, especially in obstetrics. A common denominator of its public surveys has been the desire to have a female doctor.

Some people prefer a woman provider for certain health issues, Mahrer said. And they know Kristi is an all-around quality person who understands the culture here (in Park River). She's as good as it gets in being able to relate to patients. People like as high of a level of communication as they can get with their doc. That leads to a quicker solution to a medical problem. This is especially a trying time for rural clinics because of cuts in Medicare reimbursements. Approximately 70 percent of St. Ansgar's business comes from Medicare.

Grand Forks Herald, July 25, 2000