Teacher shortage, welder shortage, doctor shortage—for Pete’s sake! Doesn’t anyone else want to live and work in South Dakota?
Not when small-town South Dakota life can be, in South Dakota State Medical Association president Dr. Tom Ridgway’s word, “brutal“:
We’ve got increasing numbers of medical students, but we have not expanded the number of residency slots,” said Ridgway. “There were 400 medical students that couldn’t find residencies.”
Those students then have to travel out of state to finish becoming a doctor. Once they leave, only 42 to 45 percent come back to South Dakota to practice, said Ridgway. But if they do their residency in state, 70 percent stay.
“Most medical schools are in more populated areas. Then you go out to residency. You might meet a spouse. It’s hard to bring someone to rural South Dakota” if they aren’t familiar with it, said Ridgway.
Another issue keeping doctors out of rural practices is quality of life.
“Students want quality of life, and these small towns can be brutal,” said Ridgway.
With few doctors in the area, the support is low and the demand is high.
“Our rural doctors are wonders. They may be on call every other night, available night and day. And it wears on them,” said Ridgway [Kathy Jensen, “Doctor Shortage Fact of Life in Rural America,” Aberdeen American News, 2015.09.16].
Brutal may seem a harsh word (or at least ironic when spoken by a doctor at the Moccasin Creek Country Club), but don’t take it personally, small-town neighbors. Young doctors find lots of things and activities to spend their income on (once they’ve paid off their student debt) in the big city that they aren’t going to find in Winner, Hecla, Madison, or even Sioux Falls (don’t get all big for your britches, Queen City—in many ways, you, too, are still a small town). Local boosters can improve their communities with good parks and schools (need to solve the teacher shortage for that) and other public services, but they’re just not going to be able to compete with an international airport and opera. Even if we offer our doctors and other professionals amenities, they may not have as much time as their big-city counterparts to enjoy those amenities, since they’ll be busy working more hours in the absence of a larger cadre of professional colleagues.
Apparently quality of life in this case outweighs income. The annual mean wage for physicians in South Dakota as of May 2014 was $232,530. The national mean was $189,760. The only state offering a higher mean wage for doctors is Minnesota, at $235,150. Yet South Dakota has one of the lowest location quotients (the ratio of a profession’s share of employment in a state compared to the national average) in the nation.
Now that doesn’t mean we can say, “Oh, higher pay isn’t bringing more doctors, so we might as well quit paying them so darned much.” If we weren’t paying 22.5% more than the national average, we’d be even further in the hole. Higher pay is necessary but not sufficient for recruiting doctors to rural outposts. As Dr. Ridgway told his country-club crowd last night, South Dakota communities have to find creative ways not just to provide amenities for their physicians but also to give them time to enjoy those amenities.
I thought Obamacare was going to fix this.
You’re an idiot, Clark.
How does South Dakota determine how much a Doctor earns? ps MC … How did Obamacare attempt to fix Sodak’s brutal climate?
The SD State Bar Association also reports a shortage of lawyers in SD’s smaller towns and communities. The Bar has established a program where they offer to supplement the income of 16 lawyers if the lawyer will agree to live and practice law in a small town for 5 years. The program will be funded by donations from attorneys and the public along with a pledge of up to $80,000 matching funds from benefactors Fred and Luella Cozad.
Doesn’t Obamacare mandate healthcare for everyone? To me it would make sense to have medical facilities and staff within a reasonable traveling distance. This is one thing the Obamacare law doesn’t cover.
Actually, Obamacare does fix this. What kills it is your dear leader Daugaard, with his no Medicaid Expansion. Without that, there is no money to recruit the doctors needed to take care of your needs. http://www.dailykos.com/story/2015/09/16/1421668/-Kansas-Republicans-Panic-Consider-Medicaid-Expansion-as-Rural-Hospital-Fails#
http://www.jhnewsandguide.com/news/health/mead-will-boost-medicaid/article_86922711-f67b-5cf7-958d-b020dfa153cb.html
I am one of the biggest supporters of rural Dakota life you’ll find, but there is a challenge to moving to a small town that needs to be met head on: It is really hard to find the “on ramps” to community life in rural places. Much of our socializing takes place around families. If you don’t have family in a community, it is tough to know how to make connections.
I think this happens differently in cities: People more often form connections around similar interests–the people you see regularly at the dog park, or at work. Or they connect with people in their proximity–but they have chosen to live in a place where people are more like them. In rural places–well, pickings are slimmer, just because the population is less, and there aren’t as many open invitations to community life. (Except, maybe, church, and an increasing number of people are finding that formal church is no longer for them.)
And this is VITAL to address for recruiting professionals to our rural communities, because as much as the professional him- or herself might have found a place in the community, if the spouse doesn’t make a connection, they are going to be gone as soon as they are able to do so.
If I were a community in need of professionals, I’d start documenting and boosting those social on-ramps so I’d have some robust options to present before those new folks arrive.
@Ms. Marttila-Losure So true. I’ve often maintained that’s the reason for so many Republicans when so few voters believe the way they think, act and talk is proper. There are so few people, one doesn’t want to disagree with anyone for fear of being ostracized … or stuck in a blizzard with no friends to rescue you.
The higher-than-national-average not-so-mean salary of SD physicians no doubt is mostly a function of fewer young docs; since fewer and fewer new docs want to settle here, SD docs likely tend to be older, hence, higher salaries.
Rather than concluding that SD docs make more that docs nationwide, all things – including age – considered.
And of course, the correlation between in-state residencies and higher-percentages of those docs staying in state is not necessarily causation; those who do in-state residencies no doubt already are more prone to stay in the state than those who don’t….increasing in-state residencies might not really affect it all that much.
I do believe Ms. Marttila-Losure is on to something here. I would add school has a way of bring people together.
There are maybe three South Dakota towns worth living in: all the rest are brutal, frozen, retrogressive cultural wastelands where old white Republicans hate the feds while paying property taxes with Social Security checks.
You poor bastards.
Air service sucks, highways are crap, teachers are fleeing in droves, poverty is endemic, and idiots run state government. Physicians have better choices than to be trapped in a blizzard at the gates of Zell.
Put cattle guards on everything west of Oacoma to Yellowstone and rewild the West.
MC, if schools are key to the socializing professionals are looking for in rural communities, then we can’t go consolidating all those small schools.
Heidi, very important observation. As I’ve bounced from town to town, I haven’t focused much on the problem of socialization. I’m somewhat of a happy loner. When I come to a new place, the first thing I go looking for isn’t new people to go hang out with; it’s the nearest good 20-mile bike route where I can go enjoy my quiet cranking time. I thus haven’t noticed how tough it can be to ease into the new local social circles.
Opening those social circles sounds like a deeper cultural change than anything we’re going to achieve with public policy. How do we make that change happen? How do we open more spaces in those local social circles?
Tim, I’m glad you made that point about the in-state/out-of-state residencies. Indeed, students choosing to do residency elsewhere are likely to be farther down the path of choosing to work out of state.
And income—ah, age! I wonder how tightly mean income is a proxy for mean age of doctors?
Hey, check this out: the number of licensed physicians per 100K population nationwide is 287. In South Dakota, that number is 423. How does that fit with the doctor shortage Dr. Ridgway talks about? Are we overloaded with docs in Sioux Falls, Rapid City, and Aberdeen but short everywhere else? Do we have a higher proportion of doctors who maintain an active license in our state but have moved away to practice elsewhere?
Are osteopaths and chiropractors counted as Doctors to get to 423?
@Kurtz … as usual you’re over the top. I can personally compare South Dakota to Vermont as far as climate, approx. population, rural land and size. Vermont is a wonderful liberal place to live. They have an odd type of government … town meetings once a year. Vermont has a few big business (Ben & Jerry’s – ski areas) but they’re liberal oriented business’ that attract people. The outlook and attitude of the majority however are polar opposites. (pun intended) South Dakota has big time potential but not so much with older angry white males bullying there way around in Pierre and making the state experience very unattractive to businesses moving their people in.
The most common largest employer across the 50 states, after Wal-Mart, was the state’s university system. Educational services dominated statewide employment in 13 of the states. The largest employer in 11 states was health care and social assistance institutions.Mar 19, 2015
Anti-gay, one-party conservative government, anti-teachers, anti-living wage, blatant racism. Do you honestly blame people for not wanting to move to SD? On top of it all, it is just boring, boring, boring, except for the Black Hills, which I don’t think I could stand living in b/c of the even more staunchly conservative views of the white folks living there. Whenever I go back to SD, it reminds me of a third world country with the glaring poverty in small towns. There is little to be positive about in SD unless you’re a part of the so-called elite Good Ol’ Boys Club out yonder in Pierre.
I am so grateful that here in MN we have a governor that works for ALL the people and not just the wealthy.
This story is a couple years old, but has some stats about the physician shortage in SD: http://dakotafire.net/newspapers/addressing-a-growing-physician-shortage-may-not-be-as-simple-as-adding-more-doctors/5504/
Cory, I might suggest that you have an automatic community with this blog that travels with you.
As far as how to open social circles, I’ll quote Will McEvoy (from “The Newsroom–have you watched it yet?): “The first step in solving a problem is admitting that there is one.” I’ve read several news stories about towns that are acutely aware of their lack of hospitality after they lost families who didn’t feel welcome. Towns need to assess their atmosphere earlier than that.
Porter, the 423 comes from a report talking about licensed physicians. I’m betting that does not count osteopaths and chiropractors.
Osteopaths (DOs) are generally counted in the number of physicians. Chiropractors and Naturopaths are generally considered separately.
It has been well proven that medical school students from rural areas are much more likely to practice in rural areas. The problem is, when you have a medical education system biased towards individuals from a higher SES and more urban settings and combine that with a secondary education system that inadequately prepares individuals for post-secondary education, you’re going to have a hard time recruiting physicians to rural areas. (Sure, there are tons of other factors in play, but it is a good start)
I always wonder why we cannot get to the real reasons we have no doctors here. Instead of wondering why, maybe we should ask the culprits who insist on killing us slowly with the nonsense about the ACA Obamacare.
Now to combat that negative bull puckey. Take over the student loans of the potential doctors. Then and pay them a wage that is comparative to the big city. Have high speed internet services and offer them part time jobs so you can have more than one doctor on staff at all times.
The ACA has provisions to educate new doctors for these kinds of services. It is a lot of fascinating reading, but worth it. http://www.hhs.gov/healthcare/facts/factsheets/2013/06/jobs06212012.html
It does make you wonder why NOem is on record (over 50 many times) to stop those doctors from coming to South Dakota. It does make you wonder why Tehran John is on record to stop those doctors from coming to South Dakota. Maybe someone should ask them.
The ACA is helping rural residents get health insurance, especially if their red rural governors quit politicking and expand Medicaid. But neither the ACA nor any other legislation can make rural communities more socially inviting.
You are correct about socially inviting, but are you? Here is a doctor from South Africa that is in Philip, South Dakota. This place is not exactly a huge city, but it has the resources to find ways to finance its operations. http://www.philiphealthservices.com/
Socially, doctors and healthcare providers need to develop needed social skills that will have them fit in to a society that is mostly friendly and could be receptive to that profession. The church deal is not exactly where you want your friendships to rely on as for the most part, it can be too petty. Communities need to have high speed communications so the residents, both old and new, can communicate with the outside world via skype, as an example. Doctors should be taught communications skills while in school so they can not only speak to their patients, but convey the feeling that they give a care. As far as politics go, be a well centered Democrat or Republican and you will go far.
When Dr. Ridgeway said “Small town South Dakota life can be brutal.” I’d bet he was speaking mostly about the weather. Unless you’ve lived a few years in a mild climate (CO for example – no wind, no bugs, no humidity) you won’t realize how hard it is to attract “high value citizens” to the frozen tundra.
While money and social interactions are important, Dr. Ridgway hit on the one thing that is hard to get around. While their office hours might be 9 to 5, a small town doctor is really never off the clock. It can honestly be so mentally demanding I’m sure many experience at least some depression at different times.
When doctors look at a town they look at everything. If they are churchers they look for the right church. If they like the outdoors then they check that out. They want to know how far between doctors in any direction and how far it is to the nearest hospital. They look at what percentage of their work might be Medicare or Medicaid, and what the average income is. And believe it or not, none of these things mean as much as the next two.
Is there at least one more doctor in town?
And something nobody talks about. Is there a pharmacy within ten miles of the clinic? When it became a violation for doctors to own their pharmacy s, it made a small town doctors life about twice as hard. Lets face it, if you have to travel 40 or 50 miles to fill your script, ya might as well just go there to the doctor.
You people are talking about recruiting young doctors when that isnt going to happen. Most of these young people have just spent twenty years in school, and the last eight working the same kind of hours they know they can expect if they are the only doctors in town.
Who wants to be a GP Dr. In a small town when a specialist, except for surgeons, goes in at 9 and is locking the doors at five with appointments scheduled throughout the day.
I have never been in a small town doctors office when they kicked someone out after closing hours, thats just the way it is.
I have a good friend that is a second generation doctor that grew up in Kadoka. For years he has worked as an ER physician rotating between several ERs in North and South Dakota. The hospitals he worked at were paying $500 a day to insure him in the ER. When hes busy, hes busy, and it is very stressful. But not as stressful as what he did for a few years.
He was a clinic babysitter. When a doctor needed to get away they would hire him to man their office. Well hes working the ER now, whats that tell you?
I think a lot of problems could be solved if there was a program that matched up Drs with compatible PAs. If you can get the right combination the relationship would last both people and the community a lifetime.
The Blindman
The Commission Corp for public health. These doctors and providers work the IHS and public health. http://www.usphs.gov/
Bill, you make a good point about what Dr. Ridgway would likely agree is the most brutal part of the job: rural doctors just don’t get a break. They can’t shut the office at five or take every weekend off. I wouldn’t go to school for all those years just to take a job that left me with no leisure time. What good is the peace and quiet of country life if you don’t have time to enjoy it? Regular hours, higher pay, and the opera—that’s a hard combo for rural towns to beat.
Speaking as someone who was born and raised out of state, who came here for college, and has since been trapped in the brutalness that is South Dakota, I can understand why young local doctors don’t want to stay, and young doctors from out of state don’t want to come here. It is a practical Hell on Earth. Now, I’m not a doctor (in fact, I’m a musician), but I agree with the statement the article makes that the quality of life is pretty abysmal. There is little for entertainment in most towns (outside of High School sports, and the movie theater – if you’re lucky). How can you compete with other nearby states’/provinces’ big cities like Chicago, Winnipeg, Denver, or Minneapolis-St. Paul? These places have those entertainment and cultural options that many people seek (sorry small towners, but we don’t all have our life revolving around the local High School football team).
When you pair the lack of culture, and lack of entertainment options that make up the good quality of life in a city with the fact that every small town in South Dakota and the two places you can remotely call “cities” (Rapid City and Sioux Falls) has such a cliquish attitude and distrust to “outsiders”, why would anyone care to be here? In fact, I’m trying to find my way out and back to a state with an actual city, and actual opportunities for somebody like me (the only options I’ll ever have here are hope I can get a teaching job, even without a teaching certificate, or work retail, all because I don’t have the right last name, or a degree in something like medicine), and I understand why young doctors are not likely wanting to be here either.
You want people to come here, South Dakota? Drop the cliquish attitude and “trust issues” towards out of towners, support some artistic and cultural endeavors (while the Washington Pavilion is beautiful, it could always be improved dramatically, and we need more things like it elsewhere in the state), and bring in other forms of non-High School sports entertainment options. Give people a reason to want to be here instead of sticking your thumbs up your butts and whining that there are deficits of people working in specific industries like education or the medical arts & sciences. These people aren’t going to give up the creature comforts that other states and cities have to live life in the brutally boring way you do.
And about the cliquish attitudes I mentioned earlier, I know some of you will live in denial that they exist (because you’ve lived where you are your whole life and never experienced it as the outsider). I can attest from personal experience that even though you all whine about the lack of teachers, and pride yourselves that the state has alternative certification programs, you all still turn away an outsider who would be willing to give a shot at being an educator, despite the locals crying that they need the position filled, I’ve interviewed at schools, been given the full offer of how much they’ll pay, and a tour of the whole facility, only to get a call the next day saying they won’t offer me the position. The way you people do things makes zero sense.
At the rate you’re going South Dakota, in two generations there may no longer be anyone in this state outside of the people in Sioux Falls and Rapid City. You leave too much to be desired, and you do nothing to remedy that problem.