Spring 2010 Quarterly Newsletter
CONTENTS:
Director's Column
Partner Focus
Community Focus
Special Feature
Profile
SPRING
2010
Printable PDF
(PDF: 194KB/13pgs)
Email Mary Ann Radigan at
[email protected]
or call (651) 201-3855 with
comments.
The
Minnesota
Twins in
Target Field.
We invite you to forward this
newsletter to your colleagues.
Wayne
KrydubaMajor
League
Baseball
photographer
DIRECTOR'S COLUMN
THE LONG VIEW
At the end of each month young Lewis Thomas watched his mother head
into the yard in search of a four-leaf clover. Worried about paying the bills
and making ends meet, she would return with her good luck charm and
declare, "The Lord will provide." The year was 1918, and Thomas' father
was a physician. Doctors' incomes then were both modest and unreliable,
as was their success treating patients.
Mark Schoenbaum
Thomas was a noted physician, educator and author who lived from 1913 to
1993. In a series of essays published in 1983 as The Youngest Science, he
looks back at his life and career, and at the science and practice of
medicine to that point in the 20th century. I found his perspective instructive
to our own era of rapid change.
Early on Lewis shared his father's interest in medicine and often
accompanied him on house calls. Watching his father on those rounds, he
observed "there were so many people to help, and so little that he could do
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
for any of them." Morphine was the most important drug in the doctor's bag,
and the physician's principal duty was to literally stand by while an illness
ran its natural course. The elder Thomas, who had entered medical school
in 1901, emphasized to his son that he was not to have any ideas about
doing anything much to change the course of patients' illnesses if he chose
to enter the profession.
Lewis Thomas began medical school in 1933; and while he was an intern in
1937, the first commercially available antibiotic arrived. He felt as if his field
had changed just as he was ready to enter it. This was only the first major
change Thomas saw during his 50-year career. When he began practice,
hospital patients were treated in open wards; the few private rooms were
reserved for those about to die. He comments on the changing role of
nursing, and the development of both LPNs and nurse practitioners. As an
intern in the 1930s, he did all his own lab work, and he later saw the
creation of the lab technologist field.
Thomas was personally involved in many advances in health care and
medical education. He recounts his entry into the world of medical research
at a time when the major lab expenses were rabbits, mice and glassware;
and researchers cared for their own animals and washed their own test
tubes. All that changed after World War II with the advent of major federal
research funding. He went on to become the dean of two medical schools
and president of Memorial Sloan-Kettering Cancer Center, and he
chronicles the rise and the challenges of medical schools and medical
research institutions. Thomas served on the New York City Board of Health
in the 50s and 60s. It was the oldest such agency in the country, steeped in
a history of fighting epidemics of typhoid, scarlet fever and polio. Thomas'
term began as public health was refocusing on issues such as fluoridation
and poor housing conditions. He also saw changes in health care finance,
as Blue Cross and Blue Shield began covering people through their
employers in the 1940s and Medicare arrived in 1965.
The articles in this issue of the Quarterly echo some of Lewis Thomas'
themes from the last 90 years. Rural Health Advisory Committee member
Jeff Hardwig discusses his work as a psychiatrist in International Falls and
describes a personal engagement with his patients and colleagues I know
Thomas would have found familiar. And in the best traditions of medicine
and public health, both Southside Community Health Services and
Northfield Hospital are responding to health issues in their surrounding
communities. Pine Technical College writes about its innovative approach to
workforce shortages in its region. I think Thomas would have been surprised
by today's workforce crunch, but I'm sure he would have approached it as
another problem that would be solved as medicine continues its progress.
While at Sloan-Kettering, Lewis Thomas saw dramatic improvements in
curing cancer. And though he was pretty perceptive, he wasn't always right:
he believed science would achieve the end of cancer by the close of the
20th century. Nonetheless, I found it reassuring to join Thomas on his
review of an era with so much change, most of it for the better. He kept his
balance and sense of humor, and he always found ways to make a
contribution. His long view is encouraging to me in our own time of
recession, reform and nonstop readjustments. The recent federal health
reform law has been called "the biggest transformation of government since
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
World War II.” I wonder how we will look back on its passage at the end of
our careers.
The theme of our annual Rural Health Conference this year is "Leading
Change for Rural Health." Reading The Youngest Science has reminded
me how helpful it can be to look back at the same time we look forward, and
I hope to see you in Duluth June 28-29 and continue the conversation.
Mark Schoenbaum is director of the Office of Rural Health and Primary
Care and can be reached at [email protected] or (651) 2013859.
top of page
PARTNER FOCUS
VISION: TO BE THE PRE-EMINENT HEALTH CARE MODEL
By Tom Resnick, Southside Community Health Services Development Director
Southside Community Health Services, Inc. is a nonprofit organization and a
Federally Qualified Health Center (FQHC). Southside has two medical
clinics in Minneapolis, one medical clinic in Stillwater and one dental clinic in
Minneapolis. Southside has had an “Essential Community Provider”
designation from the state of Minnesota since 1997.
Community comes together
In 1971, three Volunteer in Service to America (VISTA) workers recognized
that residents of South Minneapolis had few resources for health care. They
relied on the emergency room at Abbott-Northwestern Hospital or waited
until they were quite ill to seek care. The VISTA workers set about
organizing community support for a volunteer clinic that would provide basic
services.
Local businesses, Southside Ministries and Abbott-Northwestern Hospital
supported the clinic, with the hospital also providing x-ray, lab work,
pharmacy services, supplies and backup services. Southside Medical Clinic
was incorporated as a nonprofit corporation. The governing body of the
clinic was structured to ensure community control and 11 residents of south
Minneapolis made up the first board. The original Articles of Incorporation
stated that at least 51 percent of the governing board should be community
residents or users of the clinic to maintain the community input to the clinic,
and this continues today.
Facilities grow with community need
In 1979, the first full-time physician was hired, which facilitated expanded
clinic hours and in-patient care at Abbott-Northwestern.
Also in 1979, with the hiring of a part-time dentist and hygienist, dental
operations could be offered. Dental services were expanded in 1993 to
begin the Southside Dental Outreach Program with mobile facilities serving
elderly and handicapped patients at nearby nursing homes. In 2004, the
dental clinic began serving as a clinical training site for dental assistant and
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
dental hygienist students from Herzing College.
Abbott-Northwestern funded a family practice nurse practitioner position in
1980, and in October of that year, a health educator was hired to develop
the educational and counseling goals of the original clinic visionaries. As
patient visits continued to increase, a sliding patient fee schedule was
factored into the budget more significantly.
Mental health services are provided on a contractual basis through the
Community University Health Care Center, La Familia Guidance Center and
African-American Family Services.
Clinic Demographics
SCHS is staffed with 65 full-time equivalent employees. Over half are
minorities and bilingual or multilingual. All of the clinics are staffed with
patient advocates who do social service referrals and help patients apply for
Medicare, Medicaid, MinnesotaCare and other publicly subsidized health
plans. All clinics offer an adjusted rate sliding fee scale for patients who are
uninsured and do not qualify for federal or state assistance. Only 10.5
percent of SCHS’ patients have private insurance. In 2009, 68 percent of
our patients were at or below 200 percent of the Federal Poverty Level.
Last year our clinics served mostly low income and underserved women,
children and families. These 12,783 patients generated 34,739 clinic visits,
including vision care. The rate of uninsured seen at SCHS grew to 38.2
percent in 2008 and to 46.2 percent in 2009 primarily caused by the
economic recession and unemployment with its attendant loss of health
insurance coverage. This caused a shortfall in operating revenues,
necessitating some layoffs in non-patient care areas. To the extent possible,
patients were placed on a sliding fee based schedule ranging from 0-100
percent of service charges. Publicly subsidized insurance such as
MinnesotaCare, Medicaid, State Children’s Health Insurance Program and
General Assistance Medical Care (GAMC) covered 41.6 percent of patients.
Our Clinics Today
Southside Medical Clinic (4730 Chicago Avenue South, Minneapolis)
provides comprehensive primary care to a largely African-American and
African immigrant patient base.
In 1994, we opened Green Central Medical Clinic (324 East 35th
Street, Minneapolis) with the assistance of the community and Abbott
Northwestern Hospital. It is located in a public elementary school and after
years of waiting for expansion, Green Central doubled its space in 2008,
when another program moved out. The majority of the staff is fluent in
Spanish, addressing a strong need for bilingual health care. Green Central
is seen throughout the Hispanic community as a source of medical and
social assistance.
Southside Dental Clinic and Administration (4243 Fourth Avenue
South, Minneapolis) houses dental operations including preventive,
restorative, rehabilitative and emergency care. In 2009, we began
expanding and renovating the dental clinic and administrative offices thanks
to capital grants from the Bureau of Primary Health Care-American
Recovery and Reinvestment Act and the Patterson Foundation. http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
Dental care is a growing need in the community Southside serves. During
Children’s Dental Health Month, one fourth of the local students admitted
they had never seen a dentist. A sampling of most of the student population
found that 27 percent were in the categories of “high-risk—visible caries” or
“high-risk—urgent care needed.” More than two students a week are sent
home with dental pain/problems. When looking at students in kindergarten to
third grade alone, 31 percent were found to be at high risk. An average of
four decayed teeth was shown in a retrospective chart review at Southside
Dental Clinic. Only 25 percent of patients had no decay. SCHS also found a
prevalence of baby bottle mouth among first time presenting Hispanic
children.
Southside’s mobile dental van stands as a positive story for the nursing
home facilities we serve. Several of the dentists, dental assistants and
dental hygienists take turns rotating through the mobile program. The
mobile dental van driver serves as the schedule coordinator, so it becomes
an efficient use of labor.
We have found, not surprisingly, that a critical factor is the mobile unit’s
state of repair. The older the mobile unit becomes, the more it is in the
repair shop, causing the missing of appointments and the need for rescheduling. We embarked on a capital campaign to replace our Dental
Outreach Mobile Van and received grants from the Minnesota Department of
Health-Office of Rural Health and Primary Care and the Healthier Minnesota
Community Clinic Fund. The new van will have two operatories instead of
one in the current van so the dentist and the dental hygienist can work side
by side instead of alternating visits. With a more reliable vehicle and two
operatories, we will increase the number of days of service, numbers of
nursing homes visited, and the number of patients seen.
In 2004, SCHS took over CommonHealth Clinic. The clinic, now known as
St. Croix Family Medical Clinic (5840 Memorial Ave. N., Suite B,
Stillwater), provides comprehensive medical services to residents of
Stillwater/Washington County and portions of Ramsey County and western
Wisconsin.
Southside Community Outreach, now known as Q Health
Connections (4243 Fourth Avenue South, Minneapolis and Lutheran
Social Services-Center for Changing Lives 2414 Park Avenue, Minneapolis),
provides health education to minority populations suffering dramatic health
outcome disparities.
Q Health participates in local health fairs and community events, reaching
over 10,000 residents, provides connections to a wide variety of community
social and health related initiatives and operates:
• The Father’s Program for 17- to-37-year-old men who are actively
involved in their children’s lives. After the fathers attend sessions with a
health educator and “graduate” from the program they qualify for a free
medical physical and dental exam. The men are also encouraged to meet
with Southside staff to apply for medical assistance or prescription
assistance programs. Class sizes range from one to eight participants and
cover a range of health, child care, nutrition and relationship issues.
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
• The Step To It Southside and Step To It Challenge programs persuade
and motivate people of all ages to get started on a physical activity.
• The Plain Talk/Hablando Claro strategy is simple: If you increase
adult/teen communication about sex, and increase sexually active teens’
access to contraceptives, the number of unwanted pregnancies, STDs and
HIV/AIDS will decrease. After five successful years of operation, the
program was discontinued due to a lack of funding.
Through all of these services, the vision that drove three VISTA workers in
1971 is alive in south Minneapolis today. We are still proudly serving people
of all ages, income levels and occupations, in a neighborhood setting that
fosters learning and respect. We accomplish this through collaboration and
communication, which patients accept as an opportunity to improve their
health.
top of page
COMMUNITY FOCUS
HEROIN: NORTHFIELD'S RAPID RESPONSE
By Ellen Tichich, clinical nurse educator, Northfield Hospital
The problem
When news of a significant pocket of heroin abuse in northern Rice County
made the headlines in the summer of 2007, Northfield residents and
community leaders responded with a mixture of shock, anger and denial.
The numbers were disturbing. According to local law enforcement and
treatment providers, an estimated 150-250 young people were abusing
heroin or other opiates such as OxyContin. Many of them started
using/abusing prescription pain medication and turned to heroin because it
was easier to obtain and less costly.
Heroin quickly became “Northfield’s number one public health problem,” and
a tragic one at that. In an 18-month period, five young adults in northern
Rice County died from heroin/OxyContin overdoses. The rate of overdose in
2007 in Rice County alone was approximately twice that of Hennepin and
Ramsey counties. An alarming 6.1 percent of Rice County residents seeking
treatment for addiction reported heroin as their drug of choice, nearly twice
the state average.
Heroin’s devastating impact cannot be overestimated. After cocaine, heroin
is the leading cause of overdose death in the United States. Not surprising,
considering the potency and addictive nature of the drug, both of which are
often unknown or underestimated by users. Without accurate and
aggressive community-wide education, the resurgence of heroin and the
illegal use of other opiates, such as OxyContin, pose a significant public
health threat for communities everywhere.
The response
Northfield Hospital, working closely with local and county agencies, began
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
addressing the problem of heroin and opiate abuse in northern Rice County
with the opening of its Opiate Agonist Therapy (OAT) clinic in August 2008.
Charles Reznikoff, M.D., the clinic’s director and an expert in addiction
medicine, is one of two physicians on staff trained to administer
Buprenorphine, a medication vital for those seeking sobriety.
While the opening of the OAT clinic offered local access to medical care for
individuals struggling with opiate addiction, there was still much work to be
done. In 2009, the hospital received a Minnesota Rural Hospital Flexibility
Grant from the Minnesota Department of Health - Office of Rural Health and
Primary Care and formed a coalition that included ARTech Charter School,
Northfield Healthy Community Initiative, Northfield Mayor’s Task Force on
Youth Alcohol & Drug Use, Northfield Police Department, Northfield Public
Schools, Rice County Chemical Health Coalition, Rice County Drug Task
Force and the Rice County Sheriff’s Office. The coalition began
implementing a comprehensive education/awareness project to: • Provide education to health care professionals regarding best-practice
care for patients abusing opiates and using heroin, as well as recovering
addicts receiving treatment with Buprenorphine
• Increase awareness and understanding among educators, service
providers, parents and youth about the impact of opiate addiction, researchbased response methods, available local resources and
• Raise awareness and reduce the amount of prescription drug abuse in
the community.
Members of the project workgroup were Kathleen Meier, division
administrator for Ancillary Services at Northfield Hospital and project leader;
Zach Pruitt, Northfield Healthy Community Initiative; Dr. Charles Reznikoff,
addiction specialist and lead physician for education and policy initiatives of
the project; Kathy Sandberg, Rice County Chemical Health Coalition; and
Andrew Yurek, Northfield Hospital’s Safety/EMS Director. They met monthly
to discuss and set timetables for proposed action items, evaluate the
effectiveness of project initiatives and provide follow-up as needed.
Education
One of the group’s initial goals was to develop and implement policies on
state-of-the-art care management for patients receiving Buprenorphine
treatment who present to the hospital. Buprenorphine acts as an opioid
agonist when administered in low doses, enabling opioid-dependent
individuals to discontinue opioids without experiencing withdrawal. At
moderate doses the agonist properties reach a plateau, and at higher doses
the opioid antagonist properties dominate and can actually precipitate
withdrawal symptoms in acutely opioid-intoxicated individuals.
Health care providers who are unfamiliar with the effects of Buprenorphine,
or who work without specific guidelines for treating individuals using
Buprenorphine, may inadvertently provide medical care that is inadequate,
inappropriate, and in some cases, detrimental. For doctors, nurses, EMS
technicians and paramedics to deliver best care to these patients, policy
development and comprehensive training/education regarding
Buprenorphine therapy is essential.
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
Working with Dr. Reznikoff, Northfield Hospital developed two protocols: “Acute Pain Control for Patients in Buprenorphine Treatment” and
“Maintenance Pain Control for Patients in Buprenorphine Treatment.” These
protocols, accompanied by in-depth staff education, ensure personnel in the
emergency department, operating room, same day surgery, and medical
surgical units are properly prepared to care for patients undergoing
Buprenorphine therapy for opiate addiction.
In collaboration with Rice County Chemical Health Coalition Provider’s
Team, Dr. Reznikoff conducted education sessions for medical personnel
throughout the region on identifying drug-seeking patients, the use of
Buprenorphine as treatment for heroin and opiate addiction, and the role of
providers in reducing prescription drug abuse.
Community awareness
Response to the project’s second objective of increasing awareness and
understanding among educators, service providers, parents and youth
regarding opiate addiction, response methods and available resources has
been very encouraging. More than 230 educators and 1,000 students have
attended information sessions to date, over three times the original project
expectations. In addition, over 550 community members have attended
public presentations. These numbers attest to the level of professional and
public interest in the problem of heroin and opiate abuse as well as the
community’s intention of actively working together to find realistic and
attainable solutions.
Abuse reduction
Another key objective for this project focused on decreasing prescription
drug abuse, a known precursor to heroin and opiate abuse. In 2009, project
partners, along with local stakeholders launched “Take It To The Box.” This
program focuses on the safe use, storage and disposal of prescription and
over-the-counter medications as well as extensive community education
about the dangers of prescription medications. Secure drug disposal boxes
—in the Northfield and Faribault police department lobbies—are available 24
hours a day, seven days a week. In the first few months of operation over
700 pounds of medication was collected, significantly reducing the amount
of medication available for potential abuse. Rice County’s drug disposal
program is the second of its kind implemented in Minnesota.
Impact of collaboration
Through the planning, development and implementation of an aggressive
and comprehensive community-wide education/awareness program,
protocols guiding the treatment of patients receiving Buprenorphine for
opiate addiction, and working to reduce prescription drug abuse, the
Northfield/Rice County coalition’s response—in collaboration with local
community leadership and overwhelming community support—serves as a
model for rural communities facing the issue of heroin and opiate abuse.
Relationships with partnering organizations and agencies in Northfield and
greater Rice County have been significantly strengthened. Awareness and
attention to a significant community health problem has increased. Patients
battling opiate addiction have continued access and support through the
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
Opiate Agonist Therapy Clinic.
These efforts are making Northfield and northern Rice County safer,
stronger and healthier.
top of page
SPECIAL FEATURE
PINE TECHNICAL COLLEGE WILL TRAIN ALMOST 1,200 IN HEALTH
CARE
By Stefanie Schroeder, director, Pine Technical College Strategic Initiatives
Before debating costs, benefits and delivery of health care was in vogue,
east central Minnesota and western Wisconsin were delivering highly trained
health care workers. Yet the situation remained grim:
Our health care community “is on a demographically-induced collision
course defined by an increase in retirees and fewer workers coupled with a
growing demand for healthcare services,” reads Healthcare Labor
Shortages: Get the Facts. Workers will not meet the demand in the near
future, and funds have not been available to address that shortfall. The
report goes on to quantify the coming crisis: Minnesota will likely experience
vacancies in registered nursing—the largest employment group in health
care—of over 4,400 by 2010 and 9,200 by 2015. Alarmingly similar
forecasts are anticipated in almost all health care programs including
laboratory, radiology, pharmacy, home health aide, respiratory therapy and
nursing assistants.
In 2007, Pine Technical College (PTC) gathered partners from area school
districts, higher education, health care providers and the workforce
development center system to address the pending worker shortage. Initially
the group—dubbed the Healthcare Alliance—included 12 partners. Nearly
three years later and more than two dozen partners strong, the assembly
has “built a vision for a strong, qualified workforce with opportunities for
professional growth,” says PTC President Robert Musgrove.
HOPE is on the way!
PTC is setting into motion a $4.2 million grant project (U.S. Department of
Labor American Recovery & Reinvestment Act funding). Over three years,
the project, called Health Occupations Providing Economic Stimulus
(HOPES), will touch almost 10,000 people in our region through outreach.
HOPES will recruit, train and employ almost 1,200 registered nurses,
licensed practical nurses, certified nursing assistants, home health aides
and medical laboratory technologists in east central Minnesota and western
Wisconsin. HOPES will provide:
• $270,000 in scholarships over three years • A web-enabled game using dynamic graphics and situational experiences
to build competencies and engage students in Certified Nursing Assistant
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
(CNA) courses
• Elementary school curriculum to encourage interest in the medical field
• Engaging, theatrical career awareness events for high school students
• Medical laboratory technician degrees through a partnership between
Pine Tech and Lake Superior College
• Opportunities for assistance with child care, transportation and other
barriers students may face
• Access to professional development and continuing education via
interactive and archived television
• Training for participating health care providers aimed at identifying waste
in health care processes, developing problem solving skills, reducing errors,
creating a safe working environment and improving care collaboratively
• New classroom technology for life-like training activities at school and
health care facilities: Two SimMan 3Gs computerized simulation manikins
(one at Pine Technical College and one at Alliance partner Anoka-Ramsey
Community College, Cambridge Campus), two regular SimMan manikins,
and one SimBaby manikin
• Capacity-building clinical coordination to address a classic bottleneck—
lack of clinical stations—through a regionalized system of possible clinical
site opportunities
• A standardized orientation for nursing students to increase hands-on
clinical time and reduce costs incurred by clinical sites
• Distance-eliminating learning equipment (videoconferencing technology)
at six partner sites
• Enhancements to the distance learning program run by the East Central
Minnesota Educational Cable Cooperative, affiliated with 13 school districts
in east central Minnesota. These components come together to create a flexible career pathway that
interests our youth and supports unemployed, dislocated and incumbent
workers. This pathway also translates into solid job opportunities and limits
the predicted health care worker shortage.
Spreading the word
Our east central Minnesota and western
Wisconsin regions include Chisago, Isanti,
Kanabec, Mille Lacs and Pine counties (all
in Region 7E) in Minnesota and Polk and
Burnett counties in Wisconsin. While a
river separates our dual-state region,
workers and students pass back and forth
without particular attention to a state line.
This region is about to hear a lot more about HOPES. From traditional flyers
at partner sites to postings on partner Web sites, e-newsletters, e-mail and
social networking sites, and informational presentations and forums. HOPES
aims to reach potential, future health care workers of all ages and
backgrounds to ensure the right people achieve the right training to fill
critical needs in their communities.
“Pine Technical College is no stranger to leading this type of collaborative
effort,” explains Musgrove. “Just one year ago, the U.S. Department of
Labor awarded Pine Technical College $1.9 million to provide advanced
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
manufacturing training to our students, industry partners and high school
students across the region. It has already made an impact invigorating the
manufacturing industry with a workforce of well trained individuals. This
HOPES grant will do the same for health care.”
Our partners came together with a tremendous amount of enthusiasm and
commitment for growing our region’s health care workforce. We’re proud to
lead this partnership in bringing valuable resources to our community.
top of page
RHAC MEMBER PROFILE
ORHPC TALKS WITH RURAL HEALTH ADVISORY COMMITTEE
(RHAC) MEMBER JEFFREY HARDWIG
Please explain your professional work to us . . .
I work as a general psychiatrist in International Falls, a town of 6,000 on the
Canadian border. The practice is entirely outpatient and divided between
the clinic side of Rainy Lake Medical Center—my employer and a primary
care clinic—and Northland Counseling Center—a community mental health
center. My colleague, Kathi Henrickson, a certified nurse practitioner, and I
see patients of all ages, from children to residents of two nursing homes.
Dr. Jeffrey Hardwig
A shortage of new patient openings is causing a bottle neck in psychiatric
care. It is no longer feasible to assume care of all referred patients because
established patients require ongoing follow-up. My work is evolving from
referred patients becoming part of my ongoing patient load to a
consultation-based practice. In the consultative model, psychiatry provides
support to primary care, where responsibility for ongoing management
remains for all but the most complicated situations. For someone who
derives professional satisfaction from treating patients within a therapeutic
alliance, the consultative model is not something I want to practice 100
percent of the time; however, it may be a necessity if we are to achieve
access to care for rural Minnesota.
For the past seven years, I have been involved in the Minnesota Psychiatric
Society and other public service activates such as the Rural Health Advisory
Committee. Active involvement enriches my professional life through contact
with idealistic, hardworking, unselfish people. I feel a sense of connection,
hope and movement toward solutions to our health care problems.
And your life away from work?
We aren’t living here for the shopping. My bond to this place is rooted in the
natural setting, the boreal forest and my early experiences on the lake.
While living away from Minnesota, I vacationed here. And during those
summers, I never dreamed of vacationing anywhere else. This is where I
wanted to be—and still do.
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
My desk job makes me acutely aware of an inner drive for movement. This
is soothed by a daily three-mile walk with my wife and insistent black Lab. In
the winter, we cross country ski and snowshoe. In the winter we also travel
to Arizona—not for the weather—but to visit our new granddaughter,
Leighton.
In the summer we spend time at our cabin in Canada where we fish, swim,
read and just hang out. Summers also include canoe trips to nearby Quetico
Provincial Park and farther north to Woodland Caribou Provincial Park.
What do you think are the most important issues facing rural
health?
As always, the main issue is access. Family doctors have it rough. As a
psychiatrist who works in a primary care setting, I worry for my colleagues
when demands threaten to overwhelm supportive resources.
One challenge is that 85 percent of patients with psychiatric illness are seen
in the primary care setting with little access to psychiatric care. There is also
a glaring lack of resources for those with chemical dependency problems.
And children’s mental health services are lacking.
The segregated and fragmented condition of our non-system of care leads
to poorer psychiatric outcomes and increased medical costs. Conversely,
there is a need for medical services within the behavioral health sector:
Seriously ill psychiatric patients die 15-25 years younger than the general
population. What do you think would make the most difference for rural
health?
Psychiatry can help and we want to help primary care meet the needs of
our shared patients. In my own practice in a primary care clinic, my
colleagues have been welcoming and supportive of integrated care and
want more psychiatric support, as well as child services, chronic pain and
chemical dependency expertise. Telehealth must be more fully developed to
fill the breach in these services for primary care.
Segregated care is a failed system economically, conceptually and morally.
It has not been equal or equally reimbursed. Why do we not have integrated
care after a decade of seeking it? Barriers exist in the form of carved out
behavioral managed care. These separate management systems must end
and behavioral health and chemical dependency services must be made
subspecialties within the field of medicine, which would be paid for out of the
same budget and use shared medical records to facilitate safe and effective
care.
In such an integrated system, teams of providers (psychologists, social
workers, psychiatric nurses, psychiatrists, physician assistants, etc.) will
produce better results for patients and healthier working conditions for
providers. Such a supportive system will attract and retain providers proud
to be a part of a real system of care.
The Rural Health Advisory Committee advises the commissioner of the Minnesota
Department of Health and other state agencies on rural issues; provides a systematic
and cohesive approach toward rural health issues; and encourages cooperation among
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]
Spring 2010 Quarterly Newsletter
rural communities and providers. Meeting information is online or contact Tamie Rogers
at [email protected] or (651) 201-3856.
top of page
VIEW ONLINE ALL PREVIOUS ISSUES OF THE OFFICE OF RURAL HEALTH AND PRIMARY CARE PUBLICATIONS.
Minnesota Office of Rural Health and Primary Care
P. O. Box 64882
St. Paul, Minnesota 55164-0882
Phone (651) 201-3838
Toll free in Minnesota (800) 366-5424
Fax: (651) 201-3830
TDD: (651) 201-5797
www.health.state.mn.us/divs/orhpc
MISSION: To promote access to quality health care for rural and underserved urban
Minnesotans. From our unique position within state government, we work as partners with
communities, providers, policymakers and other organizations. Together, we develop
innovative approaches and tailor our tools and resources to the diverse populations we
serve
http://www-dev.health.state.mn.us/divs/orhpc/pubs/quarterly/2010/spring.html[4/21/2010 1:52:30 PM]