There are fewer physicians per capita in west-central Minnesota than the state average, they are older and closer to leaving their jobs, and more likely to provide care that otherwise would be handled by a specialist.
Those were among the findings presented by a Minnesota Department of Health researcher at a rural health listening session Tuesday at Alomere Health in Alexandria.
The session, the fifth and final to be held across the state, was intended to gather information on health care issues facing rural areas.
What state officials heard from a few dozen people from the region who work in health care were numerous challenges that exist in rural areas. Among those cited were mental health, workforce, transportation, affordability, integration of care, access, consumer education, preventative health and social isolation.
That mental health was part of the list came as little surprise.
"For the overall health of west-central Minnesota, mental health is a very big concern," said Mike Doyle, administrative director at Heartland Orthopedic Specialists. "There is an identified issue happening, but there are not the resources available to take care of the need."
Cheryl Strand, a social worker at Horizon Public Health, agreed.
"Access for mental health is much less than it is in metro areas," she said. "That's a huge barrier."
Access to inpatient mental health for crisis situations is a huge issue, said Jim Przybilla, CEO of PrimeWest Health, a partnership of 13 rural Minnesota counties including Douglas. That lack of access is causing patients to be sent out of state for care.
Carl Vaagenes, CEO for Alomere Health, stated that the creation of a mental health coalition and an opioid task force in Alexandria showed how great the demand was for addressing those topics.
"It was important to open up the lines of communication," he said.
Margaret Kalina, director of patient services and chief nursing officer with Alomere Health, has been part of the mental health coalition.
"Over the two-plus years that we've met, we've focused on how we can identify and support current mental health resources, and identify new resources that are needed," she said.
Kalina has also represented registered nurses on the state's Rural Health Advisory Committee for several years, and this next year will be co-chairing the committee's task force on behavioral health issues.
"Our No. 1 strategy this year is to address mental health issues," she said.
The other issues also resonated. For Strand, overall access to health care is a major challenge.
"That stuck out for me, and it's something we deal with every day. It's not that we don't have enough providers, but people can't always get to where the providers are," she said.
Finding time or a way to get from Brandon or Evansville to Alexandria can be a challenge for people with their busy schedules, Strand said.
Another problem, she said, is that there is only one dental clinic in Alexandria that will see patients who have state insurance. That's due to reimbursement rates that are lower than private insurance.
Doyle noted that drug shortages for common procedures is a problem that has flown under the radar.
"We have a great team at Alomere Health that works to make sure we can get the drugs that are needed for the clinic and the operating room when they are available. Unfortunately, instead of just placing orders and receiving what is ordered, some drugs are rationed and it takes a significant amount of administrative time to check with multiple vendors every day to keep us ahead of the game," he said.
Doyle raised another issue that has caused frustration for patients since it causes delays in scheduling a procedure.
"Increasing and constantly changing regulations are causing a noticeable disruption to our ability to deliver care," he said.
For example, he said they work with most insurance plans. So even if the plans make only one or two changes a year, it can force Heartland to make monthly changes.
"For us, we are trying to make sure we have a clear picture of what the covered services are so that a patient does not get the shock of a large bill because the service was not covered by their insurance plan," Doyle said.
Specific to this area
Angie Sechler, a researcher with the state Department of Health, offered data specific to west-central Minnesota, a group of nine counties that includes Douglas, and how the region compares to the rest of the state.
She said the 249 physicians in west-central Minnesota have a median age of 53, three years older than the state median, and 27.5 percent plan to leave their jobs within the next five years, compared to 17 percent statewide.
West-central counties have 2,626 people for every one family medicine doctor, while the state average is one per 2,000 people. There is a shortage of licensed mental health workers, with one provider for every 915 people in this region, vs. one per 300 people statewide. Job vacancies for alcohol and drug counselors have more than doubled in the state since 2015.
"We think it might have something to do with this opioid epidemic that we're seeing," Sechler said.
The labor market will continue getting tighter in the next decade, and that's entirely a function of an aging population.
"For health care organizations this isn't very good news. The number of people 65 and over is expected to double between 2010 and 2030. More than one of every five will be age 65 and over. This is a double whammy for our health care workforce," Sechler said, explaining that the retiring workforce is creating an increased demand for services.
Recruiting health care workers in rural areas can be difficult. Julie Benson of Lakewood Health System said many students don't see opportunities in rural areas and instead accept jobs and stay in metropolitan areas.
The lack of availability or accessibility to specialists is also a larger issue in west-central Minnesota, causing physicians to provide care that otherwise might have been provided by a specialist. That was particularly true with mental health (55 percent do that here, vs. 25 percent statewide), pediatrics (52 percent vs. 21 percent); and OB/GYN (27 percent vs. 12 percent).
The systems for handling mental health and substance abuse are overwhelmed, Przybilla said, increasingly causing primary care providers to tackle it.
"That doesn't mean that's bad care, but it overwhelms primary care providers, and sometimes it's outside of their scope," he said, adding that it places pressure on the medical system.
"Douglas County is blessed with a tremendous medical system for the population we have. You just don't find that in most rural communities," he said. "Yet, mental health is still sitting out there."
Specialists are not coming to rural areas as often, Strand said, at least partly because they have no shortage of patients in their own area and don't have to travel.
The two-hour session was well received by many of those who attended.
"It was a really great sample of stakeholders who can impact what can happen in the future," Strand said.
Zora Radosevich, director of the state's Office of Rural Health and Primary Care, was pleased with the turnout and the conversation the session generated.
"We heard more about coordination of care and workforce issues directly related to mental health," she said of the Alexandria meeting. The success stories that were shared will be taken back to advisory committees and the state department.
"I am hopeful that progress can be made," she said.