Grand Rapids, Willmar residency programs aim to train more doctors in rural health care

NINA MOINI: The University of Minnesota Medical School is expanding rural physician training in the state, with a new residency program planned for Grand Itasca Clinic and Hospital in Grand Rapids. The new program joins a similar one in Willmar, where the first cohort will start their residencies next week.

With these two programs, the U says it aims to create more opportunities for students to specialize in rural health care. Joining me to share more about this is Dr. Shailey Prasad, the Associate Vice President-- or I apologize, Shailey Prasad, the Associate Vice President for Global and Rural Health at the University of Minnesota Medical School. Thank you so much for your time this afternoon.

SHAILEY PRASAD: Thanks. I appreciate it. I think I might be disappointing a lot of people because that music was wonderful, and we had to stop that to talk to me, right?

NINA MOINI: [LAUGHS] We go all over the place on Minnesota Now. So that's just fine. And this is very important. So thank you for being here. Could you share more about how this residency program works? What does it entail for the resident?

SHAILEY PRASAD: Yeah, thank you. That's a good question. So I'm going to start with the training of physicians usually follows a pattern where folks go through medical school, which is typically about four years. And following that, they get training in residencies. And then the residency training is where we differentiate themselves, them from others-- say, for example, folks going into surgery or neurology or family medicine. The training in residency is specific to those areas.

And for us, from a training perspective, what we have looked at is to look at rural-focused training. And one of the high-needs areas is family medicine. So setting up a program like what you just mentioned in the Grand Itasca Clinic and Hospital is an important part of that.

NINA MOINI: There are challenges, Doctor, right? People are aging. Doctors are aging. It's different, the needs perhaps in rural communities versus the cities. What do doctors have to think differently about when they are providing care in rural communities?

SHAILEY PRASAD: So one of the important things we talk about in health is the premise of access, access to services across disciplines. So if you are a rural provider, what you need to look at is how can you be very comprehensive in your approach while, at the same time, escalate care if needed.

NINA MOINI: Sure.

SHAILEY PRASAD: Training for rural doctors would include that. You are trained in a way where you look at a comprehensive picture of what's happening within an individual, within a family, within a community, but then also identify a needs-based approach of, when do I need to escalate care to a higher level? When do I need to send somebody to a major hospital in a big city, as opposed to taking care of people locally.

And a majority of things can be taken care of locally. And if there is a need for transfer, if there is a need for escalation of care, how can I keep a continued presence with that person, somebody I'm just transferring.

NINA MOINI: Sure.

SHAILEY PRASAD: What sort of care do I need to provide once they come back from this escalated care setup?

NINA MOINI: That's fascinating. Thank you. And I know that this has been a problem for years, this shortage of family physicians. What do you think works to keep physicians in those smaller communities? Why do you think they leave?

SHAILEY PRASAD: So I'm going to answer that question in two ways. One, there is a shortage of primary care and family physicians around the country, in all settings, in urban areas, in peripheral areas across frontier towns and small rural towns. But that need for family physicians, primary care physicians in rural areas, is much more acute than in urban areas.

And sometimes the challenge for us has been because the systems are not there to provide for the family physician, for the primary care physician, for the rural physician. Sometimes it is that the recruitment of people who come into medicine dictates where they go. We know now that some of the highest chance of people ending up in a rural area is when they come from a rural area. And then, obviously, being trained in a rural milieu increases the chance of retention in a rural area, too.

NINA MOINI: Yeah, that's--

SHAILEY PRASAD: There might be other factors, social factors of an individual or that particular physician's family that might dictate some of that rural retention, too.

NINA MOINI: Yeah. So what is the role of the University-- obviously, providing opportunities like this, but are there ways to study or to look at what it would take to get med school residents to choose rural family medicine?

SHAILEY PRASAD: I do think so. And part of it starts with the recruitment of who comes into our school, who comes into medical school. Don't get me wrong. It is very important to provide a broad breadth of training for folks and also have specialists. We need people across all disciplines for taking care of our communities. So that is an important part of what a medical school does.

What we need to do more is to increase our retention from rural areas, increase matriculation of rural students coming into, say, for example, our campuses-- and they're going to have three campuses soon-- and also create the setting of training where we emphasize the need and the vibrancy of a rural practice. I might be a little biased, but I do strongly believe there is a vibrancy in the practice in a rural area.

NINA MOINI: Yeah, because you were a practicing-- you practiced in Mississippi and India. What are you passionate about with providing health care to rural communities?

SHAILEY PRASAD: There is that part. Yes, I was a rural doc in Mississippi for nearly 10 years. And I do feel that, as a physician, you are an integral part of society. And obviously, you're an integral part of society wherever you practice. Physicians tend to be that.

But that's further enhanced in a rural area. You become part of the daily milieu of a rural setting. And there are folks-- there's a philosopher who once said, that no society can survive without a healer. And I'm approximating a physician to a healer here, so bear with me. I do feel that that nature of that practice in a rural area is further enhanced because you become an integral part of the social milieu of a community.

NINA MOINI: Yeah. Yeah, that's wonderful. It's good to hear from experiences of people who do love to practice, because there are so many people who love practicing in rural communities. When you're thinking about what's next for the program, are you hoping to expand anywhere? Did you mention something about three clinics?

SHAILEY PRASAD: Yeah, so as you mentioned, the one that you mentioned, the one that we're going to be matriculating residents in July of 2026, a year from now, is in Grand Rapids. And the one in Willmar is this year, like you mentioned, in two weeks time. And we are planning-- we are the building towards a third one in Staples with the Lakewood Health System in Staples, Minnesota.

And we hope there are more opportunities beyond that. This is-- it takes some time to build this. We've been on this journey for about six years now, talking about where to place, how to get funding for it, what are the structural things we need to consider, what are the regulatory things we need to consider. So it does take some time.

But as I was mentioning, we hope that we go beyond the three right now. And obviously, Staples we are still working on. And we hope that it goes to other spots within the state which need training sites.

NINA MOINI: Wonderful. Well, Doctor, I wish you a lot of luck with this. Thank you so much for stopping by Minnesota Now.

SHAILEY PRASAD: Thank you. I appreciate this time.

NINA MOINI: Thank you. That was Dr. Shailey Prasad, the Associate Vice President for Global and Rural Health at the University of Minnesota Medical School.