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Focus on Rural Health

The Doctors that ROME Built

By Stacy Kusler on

Providing training to health profession students in rural areas is a top rural recruitment recommendation, according to Dr. Dave Schmitz, chair of the University of North Dakota (UND) Department of Family and Community Medicine. "Training in the sticks ... sticks," as he likes to say. No place is this truer than in Devils Lake, North Dakota. Altru Clinic in Devils Lake has been a longtime training partner for UND School of Medicine & Health Sciences (SMHS) by hosting students for the Rural Opportunities in Medical Education (ROME) program, as well as other training options.

Altru Clinic in Devils Lake employs eight full-time physicians. Of those, six are UND SMHS graduates, five are former students who took part in ROME, and four completed ROME in Devils Lake, specifically.

The Roads that Lead to ROME

Devils Lake physicians (from left to right)
Dr. Candelaria Martin Arndt, Dr. Elise Dick,
Dr. Derek Wayman, and Dr. Stephanie

ROME is an extended rural training program that sends around eight medical students per year to rural healthcare facilities for 20-24 weeks during their 3rd year of school. To participate in ROME, students are selected from a pool of applicants and assigned to one of six locations. Students may prioritize which communities they would like to train in, but they are ultimately assigned based on availability. Devils Lake has been a ROME site since 1998. A total of 36 students have trained in Devils Lake through the ROME program since its inception, including current physicians Dr. Candelaria Martin Arndt ('04), Dr. Stephanie Foughty ('12), Dr. Elise Dick ('19), and Dr. Ashlyn Kamrath ('20). Dr. Derek Wayman ('03) completed ROME in Hettinger, ND and also practices in Devils Lake. Other ROME sites include Jamestown and Dickinson in North Dakota, and Benson and Ortonville in Minnesota.

ROME helped me determine that I wanted to serve in a rural area where medical care is most needed.

ROME has played a pivotal role for the physicians who now practice in Devils Lake. For some, it started with the decision of where to apply for medical school in the first place. Dr. Martin Arndt and Dr. Wayman are from Montana and New Mexico, respectively. Both sought out UND's medical school specifically for rural training programs like ROME. "I chose UND because they had a ROME program and it fit my interest in eventual practice in a rural area," Dr. Wayman said. "ROME helped me determine that I wanted to serve in a rural area where medical care is most needed," he said.

Dr. Martin Arndt was motivated to come to UND for similar reasons. "Having an Indian Health Service scholarship commitment to fulfill, I wanted to do [medical school and] ROME in a location that would give me the opportunity to work with a larger than average Native American population," Dr. Arndt said. Devils Lake is located just north of the Spirit Lake Reservation and many patients from the reservation receive care in Devils Lake. This fit what Dr. Arndt was looking for. During her ROME experience at UND, the physicians in Devils Lake helped her see the full spectrum of what family medicine physicians can do in a rural setting. "I had more hands-on experience [from ROME] than my main campus classmates. [I feel] I was better prepared for residency and had more confidence to perform procedures," she said.

Embracing Rural Medicine

Another program available through UND SMHS to encourage and entice a rural North Dakota practice location is the Rural Med program, a state-funded tuition forgiveness program in return for five years of practice in a rural North Dakota community. In addition to participating in ROME, Dr. Stephanie Foughty was the first-ever participant in the Rural Med program. She committed to the program in her 2nd year of medical school, even before her ROME experience, because she knew a rural medicine practice was in her future.

Rural medicine can be really challenging, and I had the opportunity to see how the group in Devils Lake handled these complex situations.

The decision to select Devils Lake as her rural practice location was an easy one. "Rural medicine can be really challenging, and I had the opportunity to see how the group in Devils Lake handled these complex situations [during ROME]," Foughty said. "The physician group works so well together and really has each other's backs. That has remained true during my time practicing in Devils Lake."

Like Dr. Foughty, Dr. Dick is also a Rural Med participant. "I had a brief identity crisis in my 1st year," Dr. Dick said. "I signed up for Rural Med but withdrew that same year because I thought it might limit my practice choices." Later, Dr. Dick re-applied for the program in her 4th year because she learned (through her ROME participation in Devils Lake) that by choosing family medicine, her practice choices wouldn't be limited at all. Before ROME and Rural Med, however, Dr. Dick's first encounter with Devils Lake was during her four-week externship through a now-discontinued program called the Don Breen program, which she completed after her 1st year of medical school. "I came to Devils Lake multiple times as a medical student and as a resident. The joke was that each time I stayed a little longer," Dr. Dick said.

Joining the team soon is Dr. Ashlyn Kamrath, who is currently finishing her surgical obstetrics fellowship in Grand Forks and will start practice in Devils Lake this summer. Kamrath is a 2020 SMHS graduate who completed ROME in Devils Lake during her 3rd year of medical school. Hailing from nearby Lakota, North Dakota, Dr. Kamrath was drawn to Devils Lake for proximity to family, as well as the impressive training she received. "Honestly, Devils Lake chose me as much as I chose them," she said. "I felt like I was accepted as a member of their medical team and was able to make a difference as a student." In addition to ROME, Kamrath made rural health a focus during her medical school career by leading the Rural Health Interest Group (RHIG) as a board member. RHIG is a student-constituency group of the National Rural Health Association. RHIG worked to bring rural-related content to health profession students on campus.

An Opportunity Like No Other

Going forward, these five providers are all doing their part to offer the same great training opportunities that they received, including teaching ROME students. And all five agreed that they would advise any medical student considering ROME to go for it. "The chance to experience being part of a care team in a small community is something you may never get to experience in any other aspect of your medical training," Dr. Foughty said. "After completion of [ROME], you realize your confidence in identifying diseases, treatment, and even how to do procedures has grown significantly," Dr. Dick added. Dr. Kamrath, who is looking forward to donning her white coat in the clinic room, looks back on ROME as one of the best things UND has to offer. "I feel that the ROME experience is one of the best opportunities for clinical medicine training available to students," Dr. Kamrath said.

Recruiting physicians anywhere, but especially in rural areas, will continue to be a challenge, which is why programs like ROME are so important.

While it may seem like Devils Lake is flush with physicians, they are continuing to keep their foot on the gas when it comes to accepting opportunities to showcase their location through training options. "Recruiting physicians anywhere, but especially in rural areas, will continue to be a challenge, which is why programs like ROME are so important," Dr. Foughty said.

Stacy Kusler Stacy Kusler is the connection between rural healthcare facilities in North Dakota and qualified health professional job seekers. As the workforce specialist, she assists rural facilities to attract medical providers and other health professionals to their communities by sharing job opportunities. Through her position, Stacy is working to reduce the healthcare workforce shortages throughout the state.