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Home is Where the Opportunity Is

Jun 21, 2018 06:00AM ● By Alyssa McGinnis

By Alex Strauss

Like many young adults, Catherine “Cassie” Hajek swore she would never move back home to  South Dakota when she left for the big city after high school.

Hajek, an O’Gorman high school graduate and daughter of two Sioux Falls lawyers, studied engineering at the University of Michigan and became a consultant in Chicago after graduation.

“I loved making things run better and faster and more efficiently, but I just wasn’t satisfied,” she recalls. “I didn’t feel like I was having a personal impact on people.”

When she became a volunteer at the Rehab Institute of Chicago, offering smiles and hand massages in her spare time, Hajek found her true calling: healthcare. Despite considering herself a “big city girl” by this time, she applied to the University of South Dakota School of Medicine, a leader in training primary care physicians, and found that she was drawn to the complexity, variety, and patient continuity of internal medicine.

But she still didn’t plan to stick around.

After earning her MD, Hajek left the state again for a residency in New York City, where she also practiced internal medicine for a year. Eventually, though, she was drawn back to what she calls “the way medicine is practiced in the Midwest.”

“A lot of times in larger markets, people tend not to use a primary care provider as their primary provider,” says Dr. Hajek. “From an internal medicine perspective, practicing in the Midwest affords you the ability to manage patients more closely and really develop relationships.”

Fortunately for Hajek, primary care physicians are in demand in South Dakota and Sanford was hiring. But a few years into her career in Sioux Falls, she developed an interest in genomic medicine for its potential to improve primary care and moved to the West Coast to pursue a fellowship in medical genetics at UCLA.

When Hajek came back home for the third time, with new knowledge and interests in cardiogenetics, cancer predisposition, connective tissue disease, and neurogenetics, she was once again afforded the opportunity to do high-level work in the specialty of her choosing, right where she wanted to be.

“Sanford Imagenetics was just beginning to integrate genomics into primary care in the region,” says Hajek.  “If you had asked me when I was in resident if I would someday do a genetics fellowship, I would have said you were crazy. But what we are doing here at Sanford is very rare across the country. I knew it was a huge opportunity that I would be unlikely to find elsewhere.”

  Hajek says she is glad to be raising her young             son close to family in Sioux Falls.

Land of Opportunity

Today, there are a growing number of opportunities for new and experienced doctors in the South Dakota region in a range of subspecialty areas rarely seen in other small cities. In addition to medical genetics, less common specialties like nuclear medicine, wound care, hand surgery, hyperbaric medicine, physical medicine and rehabilitation, sleep medicine, as well as many pediatric subspecialties are all represented in our region now.

“I don’t think it is a bad idea to leave the area and try something different and know what’s out there. I have practiced in huge academic centers and community hospitals and I’m glad I did,” says Hajek.

“But the opportunities in healthcare in this area are tremendous. There are a ton of resources and people here are innovative and willing to take chances on new ideas. It makes for a great work environment. I have never felt like I was sacrificing anything, professionally, by deciding to practice here.”

And an increasing number of doctors are coming to the same conclusion. As the opportunities expand, it is becoming easier for health systems like Sanford to entice these clinicians to the area, even if they didn’t grow up here.

“We have had the opportunity to recruit people to Sioux Falls from places like the NIH and Johns Hopkins,” says Hajek. “These physicians see the potential and the resources and the opportunities here. Then they see the town and recognize that it is also a great place to live and raise a family.”  

Hajek herself has a three-year-old son and regularly takes advantage of family-friendly activities like riding the Sioux Falls bike trails.

Making an Impact

Not only is Dr. Hajek able to pursue her interests here, but she says she is able to feel as though she is making a significant impact in the up-and-coming field of medical genetics. “It is a really exciting time and it is fascinating to see how much has changed even from the time I did my fellowship in 2014,” says Hajek. “This is a field in which there is something new to learn and some new challenge almost every day.”

Right now, one of the biggest challenges for doctors like her is helping patients navigate their way through increasingly popular direct-to-consumer genetic tests. Hajek’s feelings about these tests are mixed.

“It is a positive thing that people are embracing the technology, and when they bring these tests to us, it can be a good way to engage. But the thing people have to understand is that these tests only tell part of the story,” says Dr. Hajek. “The technology itself is usually fine. But if someone comes to us with a test that says they have a certain percent risk for whatever disease, we don’t have a good way of translating that clinically.”

Because so many other factors also play a role in disease risk, including family history, lifestyle, exposures, and gene-gene interactions, Hajek says it is critical for people who undergo direct-to-consumer genetics tests to have the results verified and interpreted by a genetic medicine specialist.

“There are so many areas where genetics can have a relevant clinical application. Pharmacogenetics, for example, and even disease risk,” says Dr. Hajek. Among her duties is to help develop genetic resources for primary care doctors and to keep Sanford’s EMR system up-to-date with current genetic information. “One of the biggest things we can do with this information in primary care is in prevention. But we are just on the cusp of having an impact in the clinical setting.”

“This is the thing I am wrestling with on a daily basis: How do we make genetic information relevant to our patients so that we can provide better care for disease? How can we use it to do a better job with patient care?”

Although she does not rule out the possibility of pursuing additional training some day, as the field of medical genetics, and her own career, continue to evolve, Hajek says she is gratified to be able to explore these important questions right now without having to travel any further afield.

“I love helping to make this information accessible and usable so that others don’t have to be a geneticist to apply it,” she says.

Demand rising for medical specialists

According to this year’s annual report from national physician placement service Merritt Hawkins, while primary care physicians are still in short supply nationally, hospitals and health systems are shifting their recruiting efforts to medical specialists.

The report indicates that 74 percent of the company’s recruiting assignments in the last year have been for specialists - an increase of 7 percent in the last three years.

In contrast, the number of searches the firm conducted for primary care doctors dropped by 32 percent in the same period. The company says this is likely due, in part, to advanced practice providers taking on more of the primary care responsibilities.