A Doctor in the House

Minnesota banker responds to need for physicians in rural Midwest.The United States is facing a crisis in rural health care. In the next decade, demand for physicians is projected to grow by up to 133,200 while supply is projected to grow by only three-fourths of that, according to the Association of American Medical Colleges. That leaves a substantial shortfall of doctors..One Minnesota banker is stepping up to respond, not only to his local community, but to rural towns across the state and the Upper Midwest. Philip Keithahn is chief financial officer of the Minnesota College of Osteopathic Medicine (MNCOM), a proposed graduate medical school in Gaylord which would educate doctors focused on providing primary care in rural areas.."What I've realized is when you do the math, it's a pretty scary outlook for rural Minnesota," said Keithahn, who is also chairman and CEO of the $184 million ProGrowth Bank, headquartered in Gaylord. "Minnesota is projected to have a shortfall of 2,000 physicians by 2025, and rural areas are even worse off," he said..Minnesota has 46 counties that fall under the federal definition of rural. Some 18 counties contain micropolitan areas – towns with populations between 10,000 and 50,000. "Kids leave to go to school and they don't come back. The people left behind are older, some are vets, others are those in special need of healthcare," Keithahn said. "We can't do everything expecting people [to get an education] remotely or by driving into the Twin Cities.".Keithahn became involved with MNCOM in 2013 through his work on the RS Fiber Cooperative, which is building a gigabit fiber optic broadband network to connect 10 cities, 17 townships and four counties in south central Minnesota. That project attracted the attention of the Danza Group, which is helping develop MNCOM and has also developed osteopathic schools in several other states, including New York and Nevada. Having the fiber optic network in place was a crucial first step before the school could come to town. The city's proximity to Minneapolis-St. Paul — about 50 miles away — and the availability of a campus building also were deciding factors..The school will start out with its first class of 150 students in summer 2018 if all goes smoothly in the accreditation process. The school will add classes of 150 students each year to reach capacity of 600 students and have first graduates in residencies with a Doctor of Osteopathy degree by 2022..Doctors who DO more.Osteopathists, known as DOs, are fully licensed physicians who practice all areas of medicine. Emphasizing a whole-person approach to treatment and care, DOs are trained to listen and partner with their patients to help them get healthy and stay well. They are trained to do more than alleviate pain or treat disease; they approach treatment by gaining a deeper understanding of patients' lifestyle and environment. A DO would treat foot pain caused by kicking a wall, for example, Keithahn said. "They would also ask why you kicked the wall in the first place," he said..DOs go through the same testing requirements and three-year residency programs as other doctors, and they can prescribe medications. From a regulatory standpoint, MD and DO programs are on a merger course over the next five years, Keithahn said..There is a complementary relationship between MNCOM's osteopathic graduates and more mainstream practitioners, Keithahn added. In rural areas where qualified physicians are few and far between, stopping first at an osteopathic general practitioner would be the first step to cover more common ailments and general care before moving on to a specialist if they desire. .Establishing a need .Right now, MNCOM is finalizing its application packet for accreditation from the Commission on Osteopathic College Accreditation. COCA requires a school to have proper facilities, financial stability and committed rotation and residency openings for students in their third and fourth years as well as for graduates. The facilities and financing are already secured, and Keithahn is working hard to lock in rural hospitals in Minnesota and surrounding states who are willing to take on students for residencies and rotations. In some cases, that will mean working with hospitals that don't currently have programs to begin offering slots..Securing residencies at primarily rural hospitals and clinics is particularly important because they create even more stickiness in retaining doctors. Three-quarters of students who originally come from a rural area and go to an osteopathic school stay in a rural area after graduating, Keithahn said. "Because they studied in a rural town and did their residency or rotation in a rural town, they lose the fear factor of what it's like to practice medicine in a small town," he said.."Part of accreditation requires us to show the need. There's definitely a need," Keithahn said..There were 105 primary care physicians for every 100,000 Minnesota residents in 2014, according to American Association of Medical Colleges. Illinois and Michigan had similar numbers, with 98 primary care physicians per 100,000 residents, while other Midwest states are in more dire straits. Wisconsin and Colorado clocked in at 95 and 94 respectively while the Dakotas both had 90 primary care physicians per 100,000. Montana had 88 and Missouri 87 while Iowa and Nebraska both had 85 primary care physicians per 100,000 residents. Kansas had 84 and Indiana had 80. Wyoming has the lowest ratio with 76 primary care physicians per 100,000 residents..Keithahn is collecting letters from community members and other interested parties from rural towns across the Upper Midwest, where these doctors would find work following graduation, to show the viability of the school..Once the application packet is submitted – by the end of the summer – COCA will send a commission to review the facilities, school leadership and community support. At the end of the review, which typically takes from 12 to 24 months, COCA will decide if MNCOM receives provisional accreditation. With that under its belt, MNCOM can recruit faculty and begin accepting student applications..Supporting the community.The city of Gaylord is fully committed to the project and is helping to facilitate acquisition of the school's new campus. "I'm 100 percent behind it," said Gaylord Mayor Don Boeder. "Not only the city leaders are behind it, but most of the citizens are behind it as well.".Gaylord is building a new elementary school. As a result, the city's 125,000-square-foot Sibley East elementary school will be vacated after the 2016-2017 school year. MNCOM will begin renovations as soon as school gets out. "It was a godsend to have this [land swap] come together like that," Boeder said..Boeder said he expects MNCOM to be an economic boon for Gaylord. "We're a relatively small town of 2,300 people, if you have students plus faculty and visitors and family, it will make a big difference to us," he said..The founders of MNCOM hope to bring positive change to towns across the Midwest by creating a supply of doctors for local healthcare. Such a change would be a feather in the cap for rural communities as they work to prove their viability to residents and potential residents. "There are a lot of people who want to live in rural America, but we need to make some changes to bring them back and keep them there," Keithahn said. "You need the community to decide to invest in itself.".Keithahn, a third-generation owner at Progrowth Bank, has worked there since 1990 after getting his start in agribusiness lending at Norwest Bank in the 1980s. While still very involved in running ProGrowth, Keithahn said he has relied increasingly on his bank team as commitments to MNCOM ramped up and he became CFO for the school.."Originally I saw the school as an economic development project," he said. "Then my role expanded and I realized I needed to step back from the bank a bit and focus on something that doesn't just benefit my bank or my community, but the entire state. I'm fortunate that I'm in the phase of life and have the people around me who can step up.".Keithahn said he'd like to focus entirely on the school, but right now he's working seven days a week between ProGrowth and MNCOM. "Luckily, [my wife] and others have been very supportive of this because they see the crisis we've been facing," he said. "Until I really started looking at the numbers on this, I had no idea of the economic burden [the physician shortage] was going to place on our rural communities.".Building MNCOM is just the first step for Keithahn. He also wants to push for a better network of clinics and wellness centers to cater to all health needs in rural communities, especially for the aging population. If Keithahn's plans come to fruition, MNCOM's students − who will be from rural Minnesota and who will have had their schooling and residency in rural Minnesota − will have attractive employment options at clinics and wellness centers in rural Minnesota..Building community viability through health care.The hospital of Hazen, N.D., faces challenges similar to many rural towns of 2,400 residents. It struggles to fill beds, control expenses and retain talent, said Christie Obenauer, CEO of Union State Bank of Hazen..As chair of the board of the Sakakawea Medical Center, Obenauer is spearheading the necessary improvements on Sakakawea's aging healthcare infrastructure. What began as a remodeling project for Hazen's 50-year-old hospital has become a project to construct a new hospital. "Like remodeling a home, you don't know what you're going to find until you rip into the wall," Obenauer said. New construction also was less disruptive than remodeling which would have been a seven phase process, she said..Construction began in September 2015. The hospital is expected to open in November. For Hazen, a new hospital means long-term viability, Obenauer said. "It means that this is a place that has a future ahead of it," she said. "It shows we are sustaining ourselves and that we're progressive. We're thinking about how we're going to take care of the next generation.".The new facility will have increased efficiency gained by moving the laundry and kitchens next to the basic care facilities. It also incorporates the clinic, which currently sits across the street, into the main building. "It allows for taking care of people over the course of their lives as they move from pediatric to ob-gyn, say, to geriatric care," she said..While Union State Bank has been an integral part of the financing package, the board also involved the other lender in town, Obenauer said. "It really was a project by the village for the village," she said. "I told my board at the hospital, let's never forget the amount of zeroes involved in the project − $30 million is a big project for our community.".Community leaders in small towns must address needs like Hazen's new hospital. "Projects like building this hospital signal to families that we're going to be here. It signals longevity," Obenauer said.