Rural Family Physicians in North Dakota Reach Out to Educate Students About Family Medicine

August 31, 2012 05:15 pm James Arvantes

At a time when many largely rural states are desperate to train and then retain family physicians, North Dakota has emerged as a major source of newly minted FPs, earning a reputation for both training and retaining a high percentage of family physicians.

[Stock photo of doctor in white coat talking with two students]

As a rural state, much of North Dakota's medical school training takes place in rural settings and practices, giving students an opportunity to experience the full range of family medicine practice early in their medical school careers, according to Robert Beattie, M.D., chair of the Department of Community and Family Medicine at the University of North Dakota School of Medicine and Health Science in Grand Forks. He notes that North Dakota physicians in family medicine practices provide much of the training the students receive. They play a key role in educating students about family medicine and encouraging their interest in the specialty.

Their efforts are one of the biggest reasons why the state has been able to produce a steady supply of family physicians, according to Beattie. North Dakota's lone medical school typically graduates 62 students each year, and about 24 percent of those students end up going into family medicine, a percentage that places North Dakota within the top tier of states producing family physicians, according to the North Dakota AFP(

Story Highlights

  • North Dakota family physicians use real-life experiences to educate medical school students in their state about a career in family medicine.
  • Students are able to train with family physicians throughout the state via a variety of programs.
  • Family physicians serve as educators and mentors, providing an example for medical students to emulate and encouragement for them to choose family medicine.
Family Physician Program Concentrates on Junior and Senior High-school Students

It's never too early in North Dakota for students to start thinking about a career in family medicine. In fact, the state's family physicians and the Altru Family Medicine Residency program in Grand Forks, N.D., have joined forces to create a program called Mission Physician( that provides junior and senior high-school students from rural areas with a real-world look at the practice of family medicine.

"I want to practice rural family medicine in North Dakota with an emphasis on obstetrics," says Natalie Crawford, a senior at the University of North Dakota who participated in the Mission Physician program as a high-school junior four years ago. "Mission Physician made it seem like this could be a reality for me."

Family physician William Mann, M.D., developed the idea for Mission Physician and provided the driving force for the program, which is funded by the Altru Health System, a grant from the Dakota Medical Foundation and individual contributions. Mission Physician takes place at the Altru Family Medicine Residency program and Altru Health System.

It highlights a variety of practice venues inside and outside of the residency program, relying on family physicians and family medicine residents to provide much of the program instruction. Six graduates of the 2008 Mission Physician class are applying for entry to medical school this year, according to Mann.

Mission Physician targets junior and senior high-school students from rural areas because they are more likely to pursue a career in family medicine than their counterparts from urban areas, according to program officials. The program itself is made up of five intensive five-day training and instruction seminars that cover a range of practice areas. Program directors assign about 10 students to each seminar.

Participating students have an opportunity to perform basic procedures, such as X-ray interpretations, vision and hearing assessments, lung-function testing, casting, and suturing. Students also have a chance to visit the different departments in the hospital departments, and they can shadow various specialists to get an idea of how they practice medicine.

"Mission Physician has grown into an opportunity for students to see the reality of family medicine," says Heidi Bittner, M.D., medical director for Altru Clinic-Lake Region in Devils Lake, N.D., and an associate clinical professor at the University of North Dakota School of Medicine and Health Science in Grand Forks. "The experience is invaluable to these students, who otherwise may not realize that their goal is truly attainable."

"There are so many opportunities with family medicine," says Brandy Jo Frei, executive director of the North Dakota AFP. "You can make your own path as far as what you want to do and what kind of patients you want to see. If you want to be in a rural practice, you have even more opportunities because there are not that many emergency room physicians and obstetricians in rural areas -- leaving that for family physicians."

Students at the North Dakota medical school are required to participate in an eight-week family medicine rotation before graduating. In addition, the North Dakota AFP operates the Don Breen Rural Externship in Family Medicine(, which places medical students in family physician practices for a one-month summer rotation between the first and second years of medical school.

"The students have a tremendous opportunity to do a lot," says family physician Heidi Bittner, M.D., medical director for the Altru Clinic-Lake Region in Devils Lake, N.D., and an associate clinical professor at the school of medicine. "They have to be self-starters because we really don't have time to spoonfeed them," she adds.

Reaching Students Early

The Don Breen Externship is named for a family physician leader and role model who died unexpectedly in 1989. The North Dakota AFP Foundation funds the program, providing a stipend of $1,000 for students who spend the month with a rural practice and $500 for students who work with a practice in an urban setting.

One of the goals of the externship is to reach medical students early in their medical school careers before they commit to a particular specialty. The program strives to get the students as involved as possible in patient care.

Mathew Malek, a second-year medical student from Minot, N.D., spent a month at an Altru Health System clinic this summer as a Don Breen extern. He notes that he was able to get a lot of hands-on experience in delivering babies, taking patient histories, irrigating ear canals and taking out stitches. "The whole point of the externship is to put students in the shoes of the physicians so that we can see what it is like to be a family physician on a day-to-day basis," says Malek.

He describes the hands-on knowledge he gained as invaluable, adding that his experience strengthened his resolve to pursue a career in family medicine.

"I try to push the envelope so that the students can no longer sit by the wall and watch someone else do the work," says Garman, a rural family physician whose community health center trains Don Breen students as well as third- and fourth-year medical students and family medicine residents who want more of a rural experience. "They have to do the work and have to take ownership in the patient's care."

In some instances, the externship plays a determining role in convincing students to choose family medicine instead of another specialty. For example, Chelsea Heppner Traverse, a fourth-year medical student was waffling between a career in pediatrics or family medicine before taking part in the Don Breen Externship two years ago.

Traverse was able to work with a variety of patients and perform numerous tasks during her month-long stay with a family physician practice. She soon discovered that she enjoyed working with patients from all age groups and backgrounds, and she decided to become a family physician as a result.

"It is very interesting to see students when they have a preconceived idea of what they want to do with the rest of their life and watching them change as they go through a family medicine preceptorship," says Garman.

Facts About the North Dakota AFP

Chapter executive director: Brandy Jo Frei
Number of chapter members: 289 members
Date chapter was chartered: 1950
Location of chapter headquarters: Hazen, N.D.
2012 annual meeting/scientific conference date/location: Oct. 26-27/Grand Forks, N.D.

The ROME Program

The University of North Dakota School of Medicine also runs a more intensive initiative known as the Rural Opportunities in Medical Education( (ROME) program. The program, which lasts six to eight months, is limited to third-year medical students.

Like the Don Breen program, students are matched with family physician practices. But they also are required to work with physicians from other disciplines, such as internists and surgeons. There are five family physician sites in the state that host the ROME program, including the Altru Clinic-Lake Region.

"If a patient comes into the emergency room and needs an appendectomy, the student will go with the surgeon to examine the patient," says Bittner. "They also will go to the surgery itself and will see the patient in postoperative care."