Transcripts of Interviews

Transcript of Prairie Public’s Interview with
Jim Long, Administrator, West River Health Services, Hettinger, ND

Jim Long, the Administrator of West River Health Services in Hettinger, ND, provides background on the founding of the clinic and its history of innovative staffing and progressive outreach efforts that have resulted in numerous awards as well as the designation of "Little Mayo".

Prairie Public
Explain the important role of this clinic and how it was the first to have satellite clinics to serve more remote areas.

Jim Long
The history of this place is pretty typical for a small rural location prior to the mid 60s, Back in the 60’s Dr. Paul Retzer(?) was here he asked his UND classmate, Dr. Jerry Seiler to come out and take a look at the practice. There was some opportunity, so Dr. Seiler joined him, and they looked at what was being done. They said, “Well we have all this knowledge and training but it’s difficult to use it in the rural environment ‘cause we don’t have the technology to support it.” They worked to figure out how to increase the amount of volume so they could support a higher technology and be able to practice medicine both as they were taught to practice medicine, and also provide an urban level of care in a rural environment. They looked to having other clinics spread around their service area, and as Dr. Seiler explained that it was right at the time of the space race, and in addition, satellite was a term that was coined for the first clinic that was away from the mother house at New England. So when that clinic was opened that was its first satellite clinic of West River Health Services and is believed by the organization to be the first satellite clinic formed in the United States. Satellite clinics are very common today, but in the mid 60s most medical practices were “build it and they will come”. This group looked for more ways to provide a high quality of medicine in the rural environment.

Prairie Public
What kinds of medical services can people get here in Hettinger?

Jim Long
The physicians could talk more about specific procedures and some of the equipment, but I can just tell you the amount of technology that we have in radiology and lab and even just the services we support are really quite significant. We were early on with cardiac rehab, and put in a CAT scanner not as a mobile service but as a fixed unit back in 1984. We’ve got nuclear medicine. We have color flow ultrasound. We have a lab system where we actually could do some reference lab for Bismarck. We just have an incredible amount of technology but what is even more important, is high quality people to run it. Because part of the philosophy of Dr. Seiler and his partners was to recruit high quality people with the promise that they could practice medicine as it was intended and with technology to support them and to do something innovative and progressive. And they didn’t come to make more money. They can make more money elsewhere, and they still could. But they came with that promise of a unique and progressive system. When I first came here, I heard of Hettinger referred to as a littleMayo, and I think it’s a fair comparison. I understand physicians at Mayo aren’t the highest paid in the nation, but they’re considered the experts and very progressive, and I think that’s what this group was really trying to do back in those early years, and it’s continued since.

Prairie Public
Tell me about the services.

Jim Long
We have a radiologist on staff, we have a podiatrist, we have geriatricians. Eight family practitioners out of our total of 15 have a specialty. Each picks on something to take a little additional education in and to be able to provide that’s unique to themselves. They can do all kinds of different services that in a more urban environment your family practice doc have to refer you out. We can do lots of things here. Also part of the system that really makes it work with our satellite clinics is that we’ll send to another community five physician days worth of service, and each day is a different physician. So on one day you get an internist like Dr. Willaby has a high interest on diabetes. Maybe on another day you get Dr. Heroff who has a real high interest in asthma. Then you get Dr. Thorngren who does some general surgery as well as some obstetrics. You get Dr. Beatty who looks a little bit more at pediatrics, and so you get all these different interests and specialties with the equivalent of one FTE a position but with all these different capabilities from these five different people. So I think that’s another part of the system that really makes it work and really serves the public

Prairie Public
A lot of small clinics have cut out OB. They don’t have enough kids being born. Cab you deliver babies here?

Jim Long
Yes we can. We deliver around 80 babies a year here. In the typical small community, they have one or two physicians and the community has the skills of just that one or two physicians. Here you really end up with the skills of the entire group. I say it’s quite unique. It works, and I’m just astounded by it anytime I go anywhere else and compare. I’m just happy to be where I’m at.

Prairie Public
How important is it to get a doctor here and keep ‘em here to make that one-on-one connection with people throughout the years?

Jim Long
I think a major strength has been the number of people that have come out of the UND program. The people who come here have some connection generally to a rural area, and they understand that if you talk with somebody, you treat somebody, it’s going to affect and ripple throughout that entire family, and that entire family is going to be various people throughout the service area. Personal skills are very important, and I think when these physicians were recruited, I think that that was part of it. It’s certainly something that we look at with our nurses and respiratory therapists and lab techs and everybody else that’s here, is that caring for the patient, compassion and respect are all very important. And I think the physicians understand that and the group that was recruited here live that. A lot of other places recruit a person in just to be a license, and they’re desperate for a physician, and they said okay, here is somebody who says they have an M.D. or D.O. behind their name, and so they fill the bill. And this group has never done that. They search for high quality people, people that they think can relate to the general public and who deliver high quality medicine. We’re not adverse to foreign medical graduates, but we look at them from the standpoint meeting those same goals and being able to converse with the public and meet their needs.

Prairie Public
Touch on the problems with reimbursements and declining population. You said you went through some bumpy times in the 90s?

Jim Long
Rural health care today it is truly a challenge. Reimbursement does not favor rural care or operations in any way. We get paid substantially less, and then when it comes now to the staffing shortages, we worry even more. With population losses, we worry about that as well. All those items are working against us. But I’m also one of those who believe that in change there is opportunity, and so you have figure out what the opportunity is, and you also have to maintain commitment to your mission. And in this organization it’s to provide the comprehensive health and wellness services that the residents and visitors to this region need. And so it’s a struggle to figure out how to do it, but I am confident this organization, that has a strong and progressive history, will be able to continue that service into the future.

Prairie Public
Does your reputation help you when you have to go out and recruit staff?

Jim Long
I think it helps a lot. I think it’s the same as when we’re recruiting physicians. We talk about quality and being progressive and doing something innovative. When we talk to any of our professional staff the same motivations hit with them—be part of a system that is unique, that is doing all it can do to provide urban quality medicine in a rural environment. I looked in our area for some of the nurses that we have. We have nurses driving in from over 70 miles away to work here. It’s not pay because we aren’t the highest pay in the nation or even in the state or the region, but it’s to be connected with something that they believe in.

Prairie Public
Where do you see the future of this center – 10 to 15 years down the road.

Jim Long
I would still like us to be integrated more with some long-term care. I would like our operation to be connected with a nursing home and providing the full spectrum of services, and that’s really the only element in health care we don’t have. I also think we’re going to see our organization more involved in public health. We already are now, and we cross a lot with the county nurse, and I could see at some date this is where we blend those even more. In the future, I think that the acute in-patient will get to be less important, but the ambulatory, the out-patient, and clinic services will become even more important. Then we will become a large focus, and you know I’d sure like to see our service area grow in population. We’re actively involved in various economic development efforts. I would like to see it grow in population, but if it doesn’t, we’ll just have to continue to try to be innovative in figuring out how to further expand our borders and be able to have the number of people that it takes to provide the technology and provide the services that we currently enjoy.

Prairie Public
There are people working in this organization that were born and bred right here in Hettinger. If there are kids who are interested in medicine do you try to get to them and try to maybe bring them back?

Jim Long
Oh, absolutely. In fact we have an academic loan program that we put together back in the early 80s. Its focus is on training area youth to be able to return. And we’ve used that academic loan program for recruiting a variety of health professionals in physical therapy, respiratory therapy, and nurses, as well as physicians. It’s a major push making it available so the students know what job opportunities are available in the area. We provide some scholarship assistance in the first few years of their education and then loan assistance in the last two years of their education to help give them the opportunity to come here and also to help fill our needs. We have a pretty good percentage of people that are from the area, maybe not specifically from Hettinger, but from our service area that have taken advantage of the program. We’ve started working with DSU for an LPN nurse training program that will be hosted here on-site in Hettinger to help in training LPNs for the future as well.

Prairie Public
Approximately how many employees do you have at all your sites combined?

Jim Long
All employees together is a little less than 300, and that works out to be about 220 full-time equivalents but a total of 300 employees. West River Health Services is a total medical system. It’s a small rural hospital with a high amount of technology, but we also operate home health, and a whole medical equipment store. We have a senior housing with assisted living. We’ve got an optometry clinic. We got a foot and ankle center. We provide counseling services. We really run the full gamut of medical services in a rural environment which I think is great for our population and rather unique.

Funding for Life Support is provided by a grant from USDA Rural Development