By Deb Nicklay, Austin Daily Herald

ADAMS — There was no mention of closing the Mayo Clinic Health System clinic in Adams during a community meeting Tuesday — but it doesn’t mean the make-up of the clinic might not change in the future, officials said.

A physician and nursing shortage, combined with growing baby boomer numbers, have combined to put pressure on rural health care and its ability to deliver quality care, Mayo Clinic Health System officials told the standing room-only crowd.

As a result, said Dr. Annie Sadosty, the regional vice president of the southeast Minnesota clinic operations, officials are looking for ways to partner with small communities and identify priority services.

“Our goal here tonight is to initiate the conversation,” she said.

Adams residents flocked to City Hall wanting to hear about the future of the clinic. Rumors had been circulating Mayo had plans to close the clinic. The overflow crowd tried to squeeze into the room, but many ended up leaving due to lack of space to either sit or stand.

On hand was Adams Mayor Nancy Thalberg; Sadosty; Dr. Brian Bunkers, a family physician who is head of operations for Mayo Clinic Health System in Owatonna and Faribault; Tricia Dahl, Mayo Clinic operations administrator; and Joan Gorden, Mayo’s public affairs manager for the southeast Minnesota region.

Sadosty and Bunkers outlined the challenges facing not only Mayo, but health care nationally, which the Association of American Medical Colleges said will be short between 40,800 to 104,900 in primary care and specialty doctors by 2030.

The officials said a number of factors have combined to create the shortages. Sadosty said small town family practitioners, such as the late Richard Schindler who worked in the Adams clinic, “are exceedingly hard to find.” That shortage in small town clinics also affects care given in community nursing homes, they said.

But this era’s medical school graduates are different from earlier generations.

The new generation of medical students are saddled with higher debt than their generational predecessors, would like to live in more urban areas and would rather work in a style more collaborative with other providers, rather than working as a single provider. Each graduate, they said, normally receives between 50 to 100 job offers.

Those qualities make “finding small town physicians exceeding hard,” Sadosty said.

That fact, she added, made it impossible for her to guarantee after current staff retires, they would be replaced with another physician who wants to work exclusively in Adams.

“I can’t promise that; that would be disingenuous,” she said. There are already clinics without community-bound physicians who rotate in and out of other small town Mayo-served clinics.

Providing incentives to students going to medical school — such as payment for a portion of tuition in exchange of staying in the area for a certain length of time — are effective, “but not the only answer,” Bunkers said. Laws regulating non-profit institutions restrict those kinds of financial arrangements, he said.

The shortage is being felt in larger operations as well. The Austin center, Bunkers said, will be short four physicians by the end of the year.

The solution to some of the issues will come with a multi-pronged approach. In addition to the rotation of physicians, Mayo has doubled the size of its medical school to prepare more physicians for the future.

Technology is being utilized to help address the issue. For instance, some 14 conditions are addressed via the internet through its Express Care Online site, allowing patients to find treatment without having to travel to a clinic. Such conditions range from influenza and sore throats to urinary tract infections and sinusitis.

Other care is being delivered long-distance, Bunkers said. He outlined an example of a patient with congestive heart failure whose condition is monitored remotely.

Audience members seemed to understand the issues, and wanted to know what community members could do to bolster its ability to draw doctors. Members cited the community emphasis on wellness, the nearby Shooting Star bike trail, golf course, fitness center, swimming pool and good schools. Communities can also encourage local students to come back to the community after medical school.

Still, Bunkers said, competing influences make attracting physicians difficult. It is a situation that is happening all over the U.S.

“As a country, we will have to decide how we’re going to take care of people in our rural areas,” he said.

Thalberg said she was happy with the meeting and feedback from the community was positive.

“I think they were honest with us about what could be down the road, and the overall shortage of doctors,” she said. “People weren’t contentious. I think if they educate us about what is happening, people will listen.”