Hospitals and medical clinics in rural South Dakota experience many challenges when recruiting physicians but officials are able to focus on the benefits the state has to offer as they try to bring new doctors on board.

Difficulties come about not only for Sanford and Avera but also other rural medical facilities when they try to recruit providers for different positions. Not the least of those problems is one of perception.

Despite those challenges Avera will be adding three female providers to their system in Pierre within the next six months.


Dr. Tad Jacobs, chief medical officer for Avera Medical Group, acknowledged that being in the rural area that Pierre is, there are bound to be challenges in recruiting.

“South Dakota as a state has unique challenges,” Jacobs said, but it does share some similar challenges with the other four states in the region.

He listed the rural nature of parts of Minnesota, Iowa, Nebraska, North Dakota and South Dakota as recruitment challenges. There is the possibility that the cold, snowy weather would contribute to those challenges, he said.

Karl Richards, administrator of Avera Medical Group Pierre clinic, said the area does have a unique challenge being in the Midwest in what may seem to be an isolated area.

“We do have some special challenges associated with that,” Richards said. “But it also appeals to certain physicians.Pierre as a community is quite appealing depending on their wants and needs and that’s really what it comes down to.”

Angie Bollweg, the director of the Sanford clinic in Pierre, said the clinic has an active recruitment plan that includes strategic steps for future expansion.

The clinic tries to focus on the opportunities the community has to offer rather than its location or size when recruiting.

A recent sign of that expansion came when Shekiba Shahab, M.D., filled a newly added position in April.

“We do try to emphasize the different opportunities available in Pierre, everything that Pierre/Ft. Pierre has to offer,” Bollweg said. “There are great schools, churches, great health care and an array of activities and groups to be involved in. The hunting, fishing, recreational activities and sunsets are a plus. It’s a wonderful place to raise a family and work and grow here, too.”

Two of the physicians at the clinic have been practicing there for more than 57 years combined and have well-established patients because of that. The clinic also recruits physicians with a guarantee that they will have help growing the newcomers’ clientele once they arrive. This acts as a strategized approach to expand the clinic in the coming years.

Despite the positives, recruiting is still difficult. Because of that the medical industry is turning to more creative measures to increase the pool of doctors from which to recruit, this is especially true for women.

Sparking kids’ interest

Dr. Daniel Blue, Sanford clinic president, said Sanford Health is working to attract kids to the world of medicine at a young age through several programs.

The Program for the Midwest Initiative in Science Exploration known as PROMISE was created to inspire middle school, high school and college students, along with anyone else interested to learn about science and research. In a classroom, educators and scientists are able to lay the groundwork for educating South Dakota physicians.

Dr. Susan Anderson, chair of the Department of Family Medicine at the Sanford School of Medicine at the University of South Dakota and a family physician herself, said women physicians should take the chance to be role models and mentors to inspire younger generations to pursue fields in math and science.

“By recognizing that females can be just as successful in careers in math and science, perhaps we’re going to see more females go into those type of careers,” Anderson said.

Going to school

According to the Association of American Medical Colleges, the Sanford School of Medicine at USD had 203 students enrolled in 2004 and that number has grown about 15 percent to 239 enrolled in 2013.

Anderson said as far as women in medicine, the numbers have been on a gradual rise for years.

But this year's incoming class at the med school has an odd ratio.

While most years, the ratio has wavered at about fifty-fifty with a slightly higher number of males than females, theentering class of 2018 has 22 males and 34 females. These numbers are almost completely opposite of the year before when the class of 2017 had 33 males and 23 females.

“I think this year is just kind of an unusual year,” Anderson said. “If you look at the ratio, it’s exactly the opposite of last year which was probably an odd year with ten more males versus females because usually it’s more fifty-fifty.”

Preference at the medical school is given to South Dakota applicants or those who have strong ties to the state, Anderson said. Their mission is to provide medical care to the residents of the state and so far, that has been successful as they are increasing class size.

“We’re going to work diligently to recruit the brightest and best from our state to come to medical school here and tohopefully come back and practice in South Dakota and take care of South Dakota patients and residents,” Anderson said.

Contracted early

Dr. Mikel Holland who continues to serve as a family practice physician in addition to his role as chief medical officer for Avera St. Mary’s, said although the road to becoming a provider can be long with four years of college, four years of medical school and a minimum of three years of a residency at a hospital or clinic, doctors are being contracted early.

He said finding someone to fill a position can be a long process but having an incoming provider sign a contract to a particular health care center saying they will work there when they are officially qualified would help. Contracting physicians into the Avera system, some even six or seven years early, before they fully complete their training can help shorten what could be a lengthy process.

Avera Medical Group Pierre is already signing future employees when they are enrolled in medical school or when they go into their residency after graduation and Holland said there would be more female providers than male providers entering the Pierre system in the future.

“If I look at the physicians we’ve signed at our clinic over the last year and the physicians that we have signed to start in the next few years, the majority are women,” Holland said. “I think it helps quite a bit to see a larger percentage of women in med school and that trickles down.”

Work/life balance

Both Avera and Sanford officials said their systems are working to create an ideal balance of work and life, something that would appeal to both men and women as a way to help their recruiting efforts.

“Pierre is fortunate, we have a multi-specialty group, we have a broad spectrum, we can offer a primary care physician, a family physician, a pretty good opportunity to practice and yet have some backup and kind of that balance of lifestyle which I think a lot of physicians are looking for, especially our younger generation physicians, that they’re trying to get that work/life balance and I think women have that special challenge there, too,” Holland said.

Doctors like Krista Hoyme, a family medicine physician at Sanford’s 41st and Sertoma Family Medicine clinic in Sioux Falls, are looking to have that balance.

Hoyme is originally from Brandon and attended the University of Nebraska, Lincoln for her undergraduate degree. She then went to medical school at Des Moines University and returned to Sioux Falls for her residency at the Center for Family Medicine and ended up with a full-time job in Sioux Falls.

“My family is from this area, and my husband and I just decided that for us, having family close and then being able to raise a family in a good community like Sioux Falls, we thought it was a good option,” Hoyme said.

As health care changes with advances in technology and with larger staffs, more opportunities to be in a flexible position arise, according to Blue. A number of options are then available for career paths as an educator, researcher or administrator.

Being employed with a large company like Avera and Sanford also has its perks of security and stability, while being able to live in a more rural community, Blue said.

Pleasantly surprised

With residents who, Anderson said, tend to be humble and honest and not used to tooting their own horn, more people are being drawn to South Dakota to practice medicine.

According to Jacobs, Pierre has been successful as far as health care goes, with a broad range of medical specialties covered in the system offering more opportunities for young people to be work there.

“As a medical group, you have an awful lot going for you and you have some folks that are seasoned that are mentors for the young people that are coming,” Jacobs said.

A stable work environment and other positives of the community often have people surprised when they arrive.

“When we get ‘em here, people are very surprised. It’s not only about the organization but it’s about our state and ourcommunity and our people here in general,” Blue said.“People here are friendly and open and warm and they see a great place to raise a family.”

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