Family medicine residency program addresses provider gap in rural communities

More than 400 physicians have graduated from the Duluth Family Medicine Residency Program since its inception in 1975. That means 400 talented clinicians prepared specifically to practice in small towns, which face a shortage of doctors and thus reduced access to quality health care.

“That’s always been the mission — to provide comprehensive training for rural physicians,” said Dr. Thomas Heinitz, a family medicine specialist at Essentia Health who also is heavily involved with the residency.

The Duluth Family Medicine Residency Program is a collaboration between the University of Minnesota medical school, Essentia and St. Luke’s. All faculty members, as well as the residents and other staff, are employed by Essentia, which manages the program and develops the curriculum.

Residents get practical experience with a vulnerable patient population at the Duluth Family Medicine Clinic, located in the city’s Central Hillside neighborhood. Hospital training sites — Essentia Health-St. Mary’s Medical Center and St. Luke’s — are within walking distance of the clinic. Rotations also occur at many of Essentia’s rural clinics.

The training is intentionally diverse and “rigorous,” according to program director Dr. Caryn Gerber. Residents are exposed to a broad spectrum of family medicine. They can choose electives to tailor their experience and supplement the family medicine focus, so it aligns with career aspirations; for example, advanced obstetrics with C-section training if that’s of particular interest.

The emphasis on rural and underserved communities informs the program’s design. Residents receive extra training in OB, behavioral health, substance use disorders and the emergency department — areas they are likely to encounter in remote regions, where specialists may not be immediately available. Rural rotations deliver valuable insight into the breadth of practice. Indeed, small-town providers wear many hats.

“In family practice, you provide comprehensive care to the communities,” said Dr. Gerber, a 2019 graduate of the residency. “Not only as the family physician, but working in a rural ED providing emergency care, orthopedic procedures and OB/GYN services. You can do all of it.”

Patient needs vary, as do their ages.

“That’s what family medicine is,” Dr. Heinitz says. “You’re taking care of a newborn and then you’re seeing a 95-year-old.”

Based on a recent performance report from the American Board of Family Medicine (ABFM), few programs nationwide do a better job of preparing residents for that challenge than the one in Duluth. There are 782 family medicine residencies in the country. Of those, 685 had five years of data to include in the ABFM report. From 2019 to 2023, Duluth’s average score for the residency program exam among first-time takers was 596; the national average for the same time period was 535. Only 11 programs in the country had a higher board score average, placing the Duluth Family Medicine Residency Program in the top 2% nationally.

Additionally, all 45 Duluth residents who completed their training during those five years passed the exam, for a 100% success rate.

“Hopefully, many of our residents come out feeling like, ‘OK, I can do this. I’m ready for this,’ ” Dr. Heinitz said.

Both Dr. Gerber and Dr. Heinitz credited the program’s dedicated faculty, who are passionate about sharing their knowledge and empowering residents. That’s one of the reasons for the three-year program’s strong national reputation that attracts excellent candidates.

As a leader in rural health care, Essentia understands the importance of equipping providers with the tools they need to be successful in isolated communities. Only 10% of physicians in the United States practice in rural areas, where populations typically are older, with more acute health needs and an increased likelihood of chronic disease. Thus, programs like the Duluth Family Medicine Residency are helping to fill a gap.

It’s one of many ways Essentia addresses the challenges of rural health care.

“Being able to train more physicians to go into rural communities and continue providing care for our patients there is not only necessary — it’s paramount,” said Dr. Gerber, who continues to serve as a hospitalist at Essentia.

Dr. Heinitz, who practices at the Essentia Health-Proctor Clinic, went through the residency from 1998 to 2001.

“I had initially planned on going to a rural community and serving in whatever capacity I could, and wanted the best training I could get,” he said.

Essentia has hired 15 physicians from the Duluth Family Medicine Residency Program in the past five years alone.