CentraCare on a journey to better provide rural health care in western and south central Minnesota


— When Kandiyohi County Commissioner Roger Imdieke heard that the pharmacy in the CentraCare — New London Clinic, the only pharmacy in town, was set to close, he sent an email to representatives of CentraCare to share his frustrations.

"It got me thinking about the state of rural health care in Minnesota," Imdieke said at the May 2

Kandiyohi County Board


That email, and subsequent discussions, prompted the County Board to invite Dr. Cindy Firkins Smith, a


vice president and longtime Willmar physician, to discuss the future of rural health care and what CentraCare plans to do to keep it vibrant.

"I will state right up front, I don't have all the answers," Smith said. "We are trying to do the best we can looking to the future. There are a lot of challenges."

Those challenges included finances as well as recruiting and retaining providers. The fixed costs for both staff and stuff continue to rise.

Rural facilities also usually have a higher concentration of government-paid, uninsured and underinsured patients. These patients also tend to be sicker, require more expensive treatment and tend to get this care in the emergency room, which is the most expensive place to receive it.

As all these costs rise, the government reimbursement rates are decreasing, Smith said.

Then there is the challenge of finding health care professionals to practice in rural areas. Throughout her career as a rural physician, Smith has been recruiting other physicians to come to the Willmar area. It has only gotten more difficult, and the coronavirus pandemic made it worse.

Health care providers of all kinds struggled with higher levels of burnout, moral injury, fear and differing views regarding masks and vaccines. Many providers, including nurses, also took advantage of higher pay and more control over work hours by becoming traveling staff. These people would work at various hospitals for a set period to help fill urgent vacancies, but are not considered permanent hires.

"We are only starting to see a little bit of recovery from that, but in no way near the recovery we need," Smith said.

According to data presented in Smith's presentation, approximately 20% of the United States population live in rural areas, but only 11% of doctors practice in the same areas. Not having enough doctors is a major problem if one is trying to improve rural health outcomes.

"There is a big mismatch," Smith said.

It gets even more challenging when the age of rural physicians is factored in. The average age of a rural doctor is 58.

"One in three of those rural physicians plan to retire within the next three to five years," according to Minnesota Department of Health data, Smith said. "That is real, it is remarkable and we are sitting at the edge of a cliff."

One way to help fill that gap would be to train more rural doctors. A medical student from a rural area is five times more likely to practice in a rural area than a student from a more urban area, Smith said.

However, rural students make up only about 5% of medical school enrollees, and it's an even worse picture for rural students of color, who make up fewer than 0.5% of medical students. The rate of graduating rural medical students would need to quadruple to meet the need for rural doctors.

"There are a lot less kids from rural areas applying to, being accepted to, matriculating into medical schools than there were when I started," Smith said. "We have to do something."

That something is a joint venture between CentraCare and the University of Minnesota Medical School to create a regional campus of the medical school in the area. The campus will cover both undergraduate and graduate medical education, with the students living in and around the St. Cloud region.

"We believe that putting a rural campus in western Minnesota, in our area, is the answer to this challenge," Smith said, who recently took over the leadership position of getting the campus started, serving as CentraCare's medical education vice president.

Smith was senior vice president of CentraCare Rural Health prior to that and has been a practicing dermatologist in Willmar for more than 30 years.

The University of Minnesota will act as the degree-granting institution. For undergraduate medical education, commonly referred to as medical school, it will be a four-year campus, allowing students to complete both their classroom and clinical rotation requirements in western Minnesota. There will be 24 students accepted each year to attend the regional campus. The first freshman class is set to arrive in fall 2025.

"We will have students starting their first-year anatomy classes on the ground in St. Cloud," Smith said, adding about 50% of the classroom instruction will be available online.

Starting even sooner will be surgical clinical rotations for University of Minnesota Medical School students in year three or four of their undergraduate medical studies. There will be clinical rotation opportunities in St. Cloud and across the CentraCare coverage area, including in Willmar.

Once students graduate from the four-year undergraduate program, they will have the chance to participate in a graduate residency program. A family practice program based in St. Cloud will accept six graduates a year, while a Willmar-based family practice program will be open to two graduates a year.

"It is a big step," creating the campus, Smith said.

Students will also be able to really connect with the communities of the region, Smith said, something CentraCare feels is very important if they hope for the students to stay and practice.

"We envision creating a flavor for our medical school that is very, very community-based," Smith said.

The regional campus will work like any medical school. Students will need to have earned a bachelor's degree and apply to be accepted by the University of Minnesota Medical School.

This means for CentraCare to help increase the number of rural doctors, they'll need to find ways to increase the number of rural students going into medical school. Smith said that is a challenge, as principals and superintendents have told her that students don't seem to believe they can achieve medical school.

To do this, Smith said CentraCare will need to find ways to engage and connect with students at all levels of school — from elementary through undergraduate college. Having medical students in these communities could help with showing local students what is possible.

"We just need to get in there and show them what they can become," Smith said.

With hospitals and clinics in 12 counties — and a coverage area spanning a total of 17 counties around south central and western Minnesota — CentraCare is considered the largest rural health care system in Minnesota. It is a hat the system is proud to wear, and a new system focus called "Make Rural Life Healthier" looks to find ways to invest in the health of the people, communities and future of the region.

"We have made it our goal, our mission, our vision over the 10 years to address these problems. We are not going to run from them," Smith said. "We are committed to our patients in rural Minnesota."

And while CentraCare would be more than happy to accept financial help and other means of support from both the federal government and the state, they aren't waiting around for it.

"We are not depending on anyone from St. Paul to solve these issues for us," Smith said. "We have to take charge. We rely on everyone in our communities to help us take charge of these issues."

It most likely won't be easy, but Smith feels CentraCare has to be the leader in Minnesota regarding rural health care.

"The question we ask is, if not us, who? If not now, when?" Smith said.