Dr. Bartelson, who has been working as an ER doctor at North Shore Health for the last seventeen years, lives full-time in New York. Each month he flies into Duluth and drives up the shore to work a three day shift as a temporary doctor or locum tenens. Photo courtesy of John Stember
Enticing staff to small town hospitals, like North Shore Health in Grand Marais, is an ongoing struggle for rural communities. One way hospitals get around this issue is through staffing agencies, which recruit, transport, and schedule physicians to temporarily fill positions. This kind of doctor is called locum tenens and essentially means “to hold the place of, to substitute for” another.
In Grand Marais for example, locum tenens providers are recruited to work at North Shore Health and come from across the country and globe—California, New York and New Jersey, Kenya and Israel—to work in the hospital.
For many years, Grand Marais depended on local physicians to cover both the Sawtooth Mountain Clinic and the hospital’s emergency room at the same time. If a patient required care in the ER at 3 a.m., the on-call clinic physician—who may have a full schedule of patients the next day—could end up working the night and entire next day.
Looking back, this put a lot of pressure and stress on local doctors and led to impacts on patient care. Although local providers still support the ER during difficult circumstances, the hospital realized it needed a better system for staffing.
Hospitals from big to small employ a variety of strategies to staff their facilities. Some rely on staffing agencies for support, some depend on local doctors, and other hospitals utilize a mix of both. For the last 10 years, Wapiti Medical Staffing has provided doctors for the North Shore Health emergency room.
Wapiti recruits physicians from across the country and overseas to fill shifts in urgent care, clinics, and emergency departments, particularly in small towns that struggle with employment. By taking over the responsibilities of searching for staff to work in the hospital, scheduling, and orchestrating shifts, Wapiti relieves the logistical pressure off hospital administration and allows local providers to focus on local patients.
So, why fly all the way from Israel to Grand Marais to work as a doctor in North Shore Health’s emergency room?
“Some doctors like the variety. By doing this they can work when they want to work, and they don’t have to when they don’t want to. They can choose where they want to go, what they want to do. Some of them do this in addition to their regular job. They call it moonlighting,” said North Shore Health Administrator Kimber Wraalstad.
For example, Dr. Bartelson spends a large portion of his life as a full-time provider in the foothills of the Adirondack Mountains of New York; Dr. Emery commutes from California; Dr. Brown from New Jersey; Dr. Kaplan travels from Israel; Dr. Dahlman splits time between East Africa and Grand Marais.
Overall, there are 22 different physicians who temporarily cover shifts in Grand Marais’ emergency room, many of whom have been coming here for years.
However, getting to Grand Marais isn’t always easy. Physicians typically fly into Duluth and then rent a car for the two-hour drive up Highway 61. Sometimes a flight doesn’t get in, or Wapiti can’t fill a shift, and local physicians pick up the slack.
Years ago, on the way up from Duluth, a Wapiti doctor struck a deer with a rental car. Unfortunately, the doctor was told there were no more rental vehicles available. In the versatile spirit of Wapiti, the physician made it to the hospital by renting a U-Haul truck.
Once a doctor makes it to Grand Marais, they sleep in what is called an on-call room, which looks like a run-of-the-mill hotel room at the end of a hospital hallway. Besides a television, bed, and desk, weights are tucked into a corner against a yoga mat. An elliptical machine and balancing ball slide up against a wall.
The shifts typically run from 12 hours to four days. Dr. Bartelson, who lives in New York, has been coming to Grand Marais for 17 years. He’s worked in over 50 small hospitals since the 1980s and usually travels to North Shore Health for three days a month.
“When I was working in Syracuse… you go to work and there are fourteen beds,” said Dr. Bartelson. “They are all full. It’s a different experience… Here, usually it’s two to four [patients] or maybe none, and a lot slower pace. When you have somebody who is very sick, I just spend my time taking care of that one person.”
Doctors like Bartelson and Brown enjoy the variety, small patient load, which means lower stress levels, reliable referral system to Duluth, and the team of quality nurses and excellent local doctors.
“The big corporate model is to have you working as hard as you can every minute that you are there, pay you a lot of money, but the risk is very high to the patients,” explained Dr. Bartelson. “Dr. Emery and I were talking and it’s not a matter of if something’s going to go wrong, it’s when something is going to go wrong. Too much to do.”
Many of the temporary physicians return year after year—from great distances— to work in the emergency room at North Shore Health’s hospital. For them, emergency medicine is the same all over and the attractive lifestyle of locum tenens means freedom, versatility, and an alternative way to practice medicine in contrast to a standard 9-5 office job.
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