Workforce Wellness: How South Dakota is Healing its Rural Healthcare Gap

By Alex Strauss

Dr. Maurice Chessmore and colleagues (l to r) nurse Brenda Punt , Jennifer Bietz, PA, and nurses Samantha Menning and Jenna Leibel

Across South Dakota, from the biggest cities to the smallest towns, a healthcare workforce crisis continues to unfold. While medical facilities in Sioux Falls and Rapid City are struggling to fill positions, rural communities face an even more acute shortage of providers with nurses topping the list of most in-demand positions.

Paradoxically, South Dakota's distinction as the state with the lowest unemployment rate in the nation has only made matters worse. While that distinction is evidence of a robust economy, with so few job seekers to fill the open positions, it's even harder to fully-staff healthcare facilities statewide. 

But even in the midst of these challenges, there are success stories, thanks, in large part,  to a host of state programs designed to cultivate and support the rural healthcare workforce. Dr. Maurice Chessmore, a family physician at Douglas County Memorial Hospital in Armour, South Dakota is one such story.

Just two years out of residency, Dr. Chessmore serves as the sole primary care physician for the town of about 600. His journey from business major to rural doctor showcases the potential of targeted recruitment initiatives coupled with personal commitment and offers some valuable insights into how South Dakota is working to heal its healthcare gaps.

Small-Town Roots, Big Medical Dreams

Maurice Chessmore is no stranger to rural life. Raised in small towns with populations under 2,000, he initially charted a course for the financial sector and earned his undergraduate degree in business administration. But he quickly found that banking was not his calling.

"I just wasn't enjoying it," says Chessmore who, at the time, was already a father of three. "I came home one day and asked my wife if she thought it would be OK if I pivoted to healthcare." 

As Chessmore progressed through his medical education at the University of Nebraska Medical Center in Omaha, he was drawn to the breadth of family medicine, even though he was worried about paying off student loans on the salary of a rural primary care physician. 

"Once I decided on family medicine, I knew without a doubt that I wanted to be in a rural area," he says."But my biggest fear when I was looking at family medicine was my medical school debt." 

Dr. Chessmore would eventually find out that South Dakota was eager to help him. In the meantime, he made the leap into primary care on faith. After medical school, he had his first experience with one of the leading tools South Dakota relies on to develop its rural healthcare workforce - the Pierre Rural Family Medicine Residency Program. 

Supported by the South Dakota Health Department and run through the Center for Family Medicine in Sioux Falls, the program is specifically designed to prepare physicians for the diverse demands of rural practice. 

Residents spend their first year in Sioux Falls, gaining exposure to a wide range of medical specialties and procedures. They then transition to Pierre for their final two years, where they immerse themselves in the realities of rural healthcare delivery.

"There are not a lot of programs that train people to do a little bit of everything, which is what is needed when you are a rural provider," says Dr. Chessmore. "I felt like the Pierre program did a great job. When I came to Douglas County Memorial Hospital in Armour, I couldn't have been better prepared."

Kaitlin Sherer

"At the South Dakota Office of Rural Health, our whole mission is to ensure access to healthcare in rural South Dakota," says Kaitlin Sherer, Administrator of the South Dakota Health Department's Office of Rural Health, underscoring the program's strategic importance. "The residency program is the result of the governor's Primary Care Task Force in 2012 aimed at increasing primary care in rural communities."

The program is banking on statistics showing that physicians trained in rural settings are more likely to practice in similar environments post-residency.

Incentivizing Rural Practice

After residency, a second South Dakota initiative came into play for Chessmore, who was weighing two job prospects - one in his home state of Nebraska and one in Armour, South Dakota.  

"When it came down to it, the South Dakota recruitment program was significantly better," he says. Through the South Dakota Department of Health's Recruitment Assistance Program, physicians like Chessmore, as well as nurse practitioners, physician assistants, midwives, and dentists, can receive incentive payments for commiting to practice for three years in a community of fewer than 10,000 people. 

A second recruitment program - the Rural Health Facility Recruitment Assistance Program - covers an even broader array of professionals including nurses, dieticians, physical, occupational, and speech therapists, laboratory technologists, pharmacists, social workers, and more. 

This facility-based recruitment program also offers financial incentives for working three years in a small community, but the cost is shared by the facility and the Department of Health. The smaller the community, the larger the share the state will shoulder. 

"We also have a state loan repayment program that covers about 30 professions If they practice in a health profession shortfall area as designated by the Health Resources and Services Administration," says Sherer. "When they make a three- year commitment, we actually pay the financial institution, as long as the student has qualifying educational loans of $30,000 or less."

Cultivating Tomorrow's Rural Providers

The recruitment and loan repayment programs are not the only ways South Dakota is seeking to build its rural healthcare workforce. In fact, Sherer says the efforts start as early as junior high school in many communities, where state-sponsored 'Scrubs' camps introduce students to healthcare career options. 

High school students are eligible to attend longer 'Camp Med' events where they have more hands-on opportunities, like suturing pig's feet, making a cast, or injecting a hotdog. For college students, there is the Rural Experiences for Health Professions Students (REPS) program. 

"This is a program that pairs up health professions students to spend a four-week rotation in a rural community," says Sherer. "What is cool about this is that it pairs folks up interdisciplinarily, because that is how healthcare is being delivered when you are working in a facility."

Melissa Magstadt

“We are at a pivotal moment in our journey to advance public health in South Dakota,” says Department of Health Secretary Melissa Magstadt. “From the groundbreaking of our Workforce Development and Education Center in April to the workforce summit in August to the rural healthcare incentive programs we offer, and the work that we continue to navigate with our tribal partners, my team and I are committed to enhancing the health and well-being of our fellow South Dakotans.”

Thriving in Armour

As for Dr. Chessmore, he is happy with his choice and grateful for the programs and incentives that helped him get here. He starts each day with rounds at the critical access hospital (if there are inpatients) before opening his clinic. If an emergency comes through the ER, his patients know he must drop what he's doing and go. He takes call one day a week and one weekend a month and sees patients for a few hours on Saturday mornings. 

"Rural life is pretty good," says Chessmore. "I am the only physician here but we have one nurse practitioner and three full-time physician assistants. The group takes turns staffing the Armour clinic and two outreach facilities in Corsica and Stickney. "In Armour, there are five of us that rotate through the clinic depending on the day of the week. There are usually up to three of us there each day."

Overall, the arrangement has made rural practice more enjoyable for Chessmore than it might otherwise be. 

"I'm lucky to be in a place where people understand the challenges of rural medicine and they have created an environment where there is less stress," he says. "When a provider doesn't stay in a community, you have to look at the whole picture. Sometimes it's the environment, sometimes it's the administration, sometimes it's a fellow provider that pushes them out. There's not one easy fix." 

Melissa Magstadt agrees that good communication and flexibility are critical to attracting and maintaining a strong healthcare workforce, regardless of the size of the community.

"Managers, administrators, physicians, and other providers have to be willing to get creative in order to retain their employees," says Magstadt. "Stay open and relevant, offer shared shifts and remote work, if possible. Employees have high expectations and it is up to us, as leaders, to stay accountable and committed to those whenever possible."

Those kinds of creative approaches took center stage at the Department of Health's first Healthcare Revolution Workforce Summit in Pierre in August, where the goal was to build on the momentum the state has established and take the lessons from success stories like Chessmore's.

"We are always looking at problems, but do we ever look at what is working really well?" says Sherer. "The workforce summit was a chance to look at what's working now and ask 'What are they doing right?'"