Duluth med school leader remembered for rural health care legacy

a portrait of a man in his office
Dr. Jim Boulger worked for nearly a half-century at the University of Minnesota medical school’s Duluth campus, where he helped develop an innovative curriculum to help meet the state’s goal of training physicians to live and work in small towns that were losing their doctors.
Courtesy University of Minnesota Medical School, Duluth campus

A man credited with inspiring and training hundreds, if not thousands, of medical students to become doctors in underserved rural communities all around Minnesota died Saturday. He was 81.

Dr. Jim Boulger worked for nearly a half century at the University of Minnesota medical school’s Duluth campus, where he helped develop an innovative curriculum to help meet the state’s goal of training physicians to live and work in small towns that were losing their doctors. 

“I can't even imagine what the state of Minnesota would look like in terms of physician workforce, without the work of this campus, and Jim Boulger, in particular,” said Dr. Emily Onello, a professor in family medicine and biobehavioral health at the Duluth campus.

"Every chair that he saw in that lecture hall was a rural community to him. That’s the lens through which Jim did everything. Is this going to deliver a rural doc to a community that needs it?"

A med school for rural Minn.

Boulger began working at the University of Minnesota Medical School, Duluth campus, shortly after it was founded in 1972. 

The state legislature called for the school's creation to train more doctors to work as family practice physicians in rural Minnesota. It began as its own, separate two-year medical school, until it officially merged with the Twin Cities campus in 2004. 

Jim Boulger
Jim Boulger created and directed the University of Minnesota Duluth's family medicine preceptor program, which matches students with small town doctors.
Jennifer Vogel | MPR News 2011

Boulger quickly realized that in order to get students to be willing to work in rural communities, he had to show them how a physician works in those communities, said Janet Fitzakerley, an associate professor in the biomedical science department at the medical school Duluth campus. 

Minnesota’s ‘preceptors’

To do that, he recruited a network of rural “preceptors” – doctors in rural communities around the state who agreed to help teach medical students. 

Nearly 50 years later, the preceptorship program – now called the Rural Medical Scholars Program – is still a core part of the Duluth campus curriculum. 

Students in their first and second years spend a total of five weeks a year in the same rural community. They work under the same physician – and usually live in the same house — so the students can truly experience life as rural doctors. 

"He has a network of physicians who are willing to take strangers into their homes and show them how being a rural family doc works,” said Fitzakerley. 

“So our campus success is built on not only recruiting students who want to serve the underserved communities, but showing them that it's possible to do that, and putting them in contact with people who can guide them.”

The fact that many students actually live with the physicians who are mentoring them “is really unique–  an extraordinary gift from our voluntary physician teachers,” said Dr. Onello, who now directs the medical scholars program.

Over the years more than 400 family physicians all around the state have served as preceptors. About two-thirds of them attended medical school in Duluth. “They're part of that lifecycle ecosystem of learner and teacher and giving back,” Onello explained. 

She said Boulger once tried to calculate the value of the instruction the preceptors donated to the program’s medical students over the years. 

“If you were to pay these physicians by the hour, even just for their daytime work, the donated time that they've provided to the school is literally in the tens of millions of dollars,” Onello said.

One of the first doctors Boulger recruited to become a preceptor was Dr. Raymond Christensen. He was a young physician who had just opened a family health clinic with a partner in Moose Lake around the same time the Duluth campus had welcomed its first class of 24 students. 

"And my first memory of Jim was him walking down the hall, asking us to be preceptors for a couple of students from the med school,” Christensen said. “I was scared because I wasn't sure how much I could teach.”

Eventually, Christensen agreed. Now, for the past 20 years, he’s served as Associate Dean for Rural Health at the Duluth campus. 

Boulger constantly championed “the importance of rural, to train family physicians who could cover the needs of rural Minnesota," Christiansen said. 

‘Dad of the school’

Boulger’s friends, colleagues and former students say he was more than a mentor or a coworker – he was family. They say he fostered a supportive and tight-knit atmosphere at the medical school.

“He literally felt like the Dad of the school,” said Dr. Stephanie Carlson, a radiologist at Mayo Clinic in Rochester who attended the Duluth medical school campus from 1990 to 1992.

“He knew everybody’s name. He knew all about their families. He kept everybody under his wings. He was much more than a teacher and a Dean. He was very well-respected. But he was also a father figure to many. He just loved his students.”

Carlson was part of what she described as a “parade” of former students and colleagues and friends who visited Boulger in hospice care before he died early Saturday morning.

His loved ones say those visitors are an indication of the long-standing influence he’s had on the medical school in Duluth, and in turn, on the state as a whole.

After 50 years, the Duluth campus has graduated more than 2,000 doctors. In any given year, between 30 and 50 percent go on to become family practice physicians, compared to a national average of less than 10 percent. 

Moreover, nearly half of graduates end up working in towns with fewer than 25,000 residents. 

Now, when Dr. Onello drives around the state, she often visits communities where a sizable percentage of the physicians are graduates of the medical school in Duluth. 

Onello said people in greater Minnesota may want to ask their family doctor if they went to medical school in Duluth. If they did, “then Jim Boulger definitely has touched your life.”

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