From the Dean

Susan and I visited the Northwest (Minot) campus yesterday for the last holiday party of the season, and it was a lot of fun. As I’ve mentioned before, the School hosts these get-togethers on all three of our regional campuses in Minot, Fargo, and Bismarck, along with one on the central campus in Grand Forks. The parties serve two major functions: to celebrate the holiday season, and to thank the staff and faculty–especially the “volunteer” or clinical faculty who do not receive a UND salary–for their wonderful efforts in support of our students.

On another note, I just finished looking through the December issue of Health Affairs, perhaps the most esteemed and respected journal for health management and policy matters. This most recent issue focused on rural health issues, and several of the articles were of particular interest to me (and I’ll bet to you) as we continue to work hard to address the health care delivery issues for rural North Dakota.

The first especially interesting article was contributed by Kenton Johnston and colleagues, and it looked at the factors responsible for excessive preventable hospitalizations and mortality among rural Medicare beneficiaries. What the authors found was that the frequency of preventable hospitalizations and mortality were significantly higher in rural compared with urban areas. The single most important observed factor that accounted for the poorer outcomes in rural areas was the absence of seeing a specialist in patients with chronic diseases. Access to specialty care was associated with roughly a halving of the rural-urban disparity in preventable hospitalizations and mortality. Thus, the implications of this study are that while primary care is especially important in rural areas, access to specialty care is too. It is not a “one or the other” proposition. And this is where what we are calling “virtual care” is going to be particularly important. Through the use of effective telemedicine, for example, we should be able to bring the specialist to the rural patient, rather than expecting the patient to travel long distances over sometimes icy roads to “see” a specialist.

The second interesting article came from the Association of American Medical Colleges (AAMC) and was written by Scott Shipman and associates. This article studied the composition of students matriculating at U.S. medical schools over the past 15 years in terms of rural or urban background. The authors found that there has been a continued decline in the number of medical students with a rural background over the time period of 2002 through 2017, decreasing from about 1,200 annually to a little over 800 nationwide. At present, medical students with a rural background comprise less than 5 percent of the current medical student class across the country.

So we are proud that UND has bucked this national trend. Our admission policy explicitly favors students from rural backgrounds, since having a rural background is one of the stronger predictors of eventually practicing in a rural area. Our RuralMed program also encourages eventual rural practice for UND medical school graduates by reducing or eliminating the potential barrier of substantial educational debt for graduates who agree to practice in a rural area of North Dakota for five years.

Finally, the last article of note is one with a cautionary tale. Hayley Drew Germack and colleagues looked at the physician workforce following the closure of a rural hospital. Although fortunately not a major issue at least so far in North Dakota, across the rest of the country there have been around 100 rural hospital closures over the past decade. It turns out that following the closure of a rural hospital, there is on average about an 8-percent-per-year decline in the supply of primary care physicians in the vicinity of the closed hospital for at least the six-year period after the closure. Thus, this is another stimulus for us to both work to keep rural hospitals in North Dakota open, but also to work hard on developing alternative health care delivery models (especially those based on virtual care).

Joshua Wynne, MD, MBA, MPH
Interim President and Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences