Dr. Fiona Axelsson is on her way to becoming a doctor, and she’s already one of three that will be working at Perham Health in the next two years. She’s always had her heart focused on rural medicine and found Perham like a “sister city” to her hometown of Gimli, Manitoba, Canada.

While a resident in the Sanford Family Medicine program at the University of North Dakota, Axelsson completed a one month rotation at Perham Health where she saw patients, learned about the community and gained experience with the electronic medical records system while shadowing a family medicine doctor. She is the first of what could be many that Perham hires from this residency program.

“Basically it was everything that I wanted. We would jump around from doing procedures in the clinic to seeing geriatric patients to going to hospital rounds,” Axelsson said. She also helped deliver babies.

Perham Health has partnered with Sanford and rural residency programs through long-built relationships, as director of clinic operations Beth Ulschmid said. They have about 20 students a year from Minnesota and North Dakota. The programs in Duluth, Grand Forks, Fargo and Des Moines, Iowa are their key partnerships. They hope to support medical students and residents, helping them create an open mind toward the possibility of rural as well as having the best providers for the community.

While recruiting new staff is a years long process, 2020 included the signing of eight providers and a certified nurse anesthetist. Five will work in family medicine, two as specialty providers and two in the surgery area. Three started in 2020: Dr. Max Disse, Dr. Matthew Haugen and Brittney Schmidt; and three others have or will start in 2021: Dr. Luis Martinez, Dr. Kathryn Obregon and Dr. Robert Steininger.

“2020 was one of our best years of recruitment in a long time,” said Chuck Hofius, Perham Health CEO. Hofius has been CEO since 1997.

But recruitment is not a success that happens all in one year. Hofius said the impact came from conversations, relationships and changes extending back to 2016-17. The conversations start earlier and earlier as medical students are signing two to three years in advance instead of six months to a year, according to Hofius. Perham Health also begins those relationships by tracking community members on a list and offering resources like shifts or practice interviews.

“We’ve not always had an easy time with recruitment but lately we’ve had some really good both luck as well as what we’ve been doing is paying off, as far as recruitment,” Ulschmid said.

They host high school, college, medical school and residency students, as well as partner with Sanford for a signing and referral bonus of up to $10,000, according to Ulschmid. The free student housing offered as well as students’ family members having lake cabins in the area are another benefit.

When working with students and hiring staff, the number one aspect they're looking for is fit. That’s fit for the person and their family, fit within the culture of the clinics and the community as well as people who plan to stay for awhile.

“I see so many places just recruit, recruit and sign, sign but they turn them over so fast and we rarely have anybody turn over and that’s because we look for fit,” Hofius said. “We are looking for people that want to make Perham their home, and have a good fit for our community.”

As a Pelican Rapids native, Haugen joined Perham Health as a resident and started in September 2020 as a family medicine doctor in the Perham clinic and hospital, which encompasses babies, adults and grandparents—the “womb to tomb” care. He chose Perham Health because of its location, the good colleagues and the ability to provide a wide scope of services for patients.

“I think the thing that drew me to medicine initially was just the blend it presents of science and people,” Haugen said. “Medicine seemed like a really good intersection that allowed me to stay involved in both of those things. I wasn’t tucked away in a lab but it let me keep doing that scientific and technical side of things as well.”

Over the next three to five years, provider retirements will also come with four of the five additional providers replacing retirees. Some employees, or 6.2%, have been at Perham Health for upwards of 26 years with 65.2% of employees remaining for zero to five years and 15.8% for six to 10 years, according to the Perham Health 2020 annual report.

“The good news is as our doctors reach retirement age, we’ve so far been able to find replacements for them,” Hofius said. “Still trying to get ahead by a couple.”

As more providers are added, patients will have increased access to their doctors. The goal is to have patients seeing the same doctor on a day when they’re sick as when they’re in for a routine medical visit, as Hofius said.

“The big impact of course is access for patients,” Hofius said. “As we get more doctors and more providers here, that (getting into your provider) loosens up and the patients get spread over a bigger group of people and hopefully you can get into your own provider then as we move forward.”

With a range of family medicine work available, Haugen said the relationships developed over time are beneficial for rural areas and for the patients. The range of care and skills needed with doctors being the specialists in everything is an aspect Axelsson is excited to be a part of.

“It’s a better way to provide medical care, honestly. When I know a patient and their priorities and goals it makes my job easier and their life better as well,” Haugen said.

The medical staff will see a benefit from additional providers with a decrease in the number of weekends that family medicine providers are on call. Hofius said one of the challenges of working in the rural medical industry is likely being on call every fourth or fifth weekend in comparison to every 10-20th day, or not at all, in larger cities.

“Once you get to that magic one in eight, it’s so much easier. … That’s manageable when you have little kids, when you have a family,” Hofius said. “It used to be when I first got here, it was one in three, one in four, that’s a huge commitment on your family. And so we’re finally to that tipping point.”

This aspect just adds to the attractive quality of life already present in Perham, as Hofius and Ulschmid said. The lakes, country living and family medicine doctors being able to deliver babies are some aspects they see as a draw to the area. After one visit to Perham, Axelsson canceled her remaining interviews to commit to Perham.

“Unlike a lot of people these days that want to live in cities, I’m like 'Find me a place on a lake' and just set me up there until I retire because I grew up on Lake Winnipeg so I am a lake person,” Axelsson said. “My heart feels so at home there (Perham).”

With only some hospitals allowing family medicine doctors to deliver babies, not just OBGYN doctors, Ulschmid said Perham Health has an advantage as one of those hospitals.

The providers and clinicians have respectful and caring relationships with each other and their patients. And the community wanting to get to know their providers is a help—even with the promotions and blogs that become a part of their job.

“We hire nice people,” Ulschmid said. “I just cannot say enough about how fun my co-workers are and it’s really a pleasure to help them build their practices.”

Perham Health 2020 New Providers
The hospital also added an integrated health therapist, where they’re already seeing the benefit of having someone available to support patients’ mental health rather than waiting for a follow-up appointment that might be months out. Families are also traveling to the Perham and Fergus Falls areas for a new pediatric dentist.

In these next few years, Perham Health is focused on adding a family medicine provider at their New York Mills clinic and having a full-time orthopedic surgeon.

“There’s always specialists that kind of come and go as the market demands, and we’re always curious what the community wants as well as developing telemedicine,” Ulschmid said. “We do more telemedicine visits with specialists than ever and that’s been fun to watch that grow with behavioral health as well as sleep medicine.”

The wishlist for additional providers and services is always ongoing, of course: from nephrology to cardiology, hand surgery and oncology. But the discussions and relationships are always being built, even if that means a provider chooses another hospital.

“We’re real honest about what the practice is like and what our community’s like, and so when we sign someone, it’s because they really looked and they’re a good fit for us,” Hofius said.

Read Perham Health’s full 2020 annual report on the Perham Focus website.

Editor's note: This article was updated on June 9, 2021 to remove incorrect information about Dr. Michael Kerr working in the Perham area.