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The Shift: Rural Health Care
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We explored the nuances of healthcare delivery as people relocate and communities grow or shrink in size. SDPB's Kealey Bultena joined us live from Centerville where she spoke with Kailyn Nielsen, a Certified Nurse Practitioner who works at Pioneer Memorial Hospital and Health Service.

Of what rural health care delivery looks like in Viborg and Centerville today:

My day consists of clinic in Viborg, but also in Viborg we have an emergency room, we have a hospital, so I help take care of all of that. I see my patients through the day in the clinic taking care of pediatrics, I do well-child visits, I see people back to manage their diabetes, I see ear infections, all the respiratory stuff, and the influenza we've had going on. It's a big variety over there of what I do. We have a physician over there and another nurse practitioner, but then we also have another nurse practitioner here in Centerville at the clinic and a PA up in Parker, but mostly we're just taking care of the patients, whatever needs they have, all doing pretty similar things.

On how rural health care has maintained relationships from having a single small-town doctor to system-supported clinics:

 We do have a fairly large elderly population that we serve, but all ages too, and the convenience of having everything you need close, either in the community of Viborg, or in the surrounding communities that we're there for them. Yes, we used to have.. Dr. Nelson, Dr. Mark...those were some big shoes to fill, because unfortunately Dr. Mark passed away just shortly before I started over there, but I took on a lot of his patients and so I kind of feel like I got to take over being that small town provider for them. People really appreciate that. My plan is to stay there until they kick me out and I think that's important for the patients that feel they can establish, and that they have everything that they need, and that there's going to be that continued care, that they're not going to have to switch every few years when someone comes and someone leaves. I think that's just very important to our patients around here.

On what attracted her to stay in the area she grew up in to practice medicine:

I've always had a passion for rural medicine, that's where I wanted to be. I wanted to be in a small town. My inspiration was Dr. Quinn, Medicine Woman. If I could jump on a horse and have my black doctor's bag and go make house calls, that would be ideal, but the patients come to me and it's not too far away coming to Viborg, so always been a passion of mine. I'm happy to be serving the community like this.

Actually, my senior year my research paper that I wrote was on the shortage of physician assistants in rural South Dakota. I mean, even back then we were recognizing the shortage that we have of providers in these small towns and I'm happy to be able to fulfill and lessen some of that shortage, at least around in this area.

On how practicing medicine in a small town creates connections:

Right. I know most of my patients personally too. I mean, I see them down at the grocery store, and I go to church with them, and I'm on boards and committees in town with them. It's that nice connection where yes, you come in to see me and we take care of your health needs, but we sometimes spend a lot of time chit-chatting about what else is going on in just their lives too. I think that's an important part of it as well.

On how being a part of a health care system, like Sanford, offers advantages for patients:

Yes, maybe they don't utilize all of the services that we have, but they utilize quite a bit of it. We try to offer things like clinic hours. I'm there every Monday night in Viborg until 8:00 so that these parents don't have to rush their kid up to Sioux Falls to acute care and sit there for hours to get their ear infection diagnosed and taken care of.

Centerville's open late on Tuesdays, Parker's open late on Wednesdays, and trying to make it convenient for those working families. Then we also have things in Viborg too as far as like outreach physicians that will come down there, so we have an orthopedic doctor, we have a cardiologist, we have a podiatrist, we have a surgeon. We try to offer those things to our patients and there's so many of them that say, "That's just so convenient that I don't have to go to Sioux Falls for everything that I need." Occasionally, you do, because we can't offer it all, but we try to at least accommodate most of it for them.

How telemedicine and collaboration has changed care:

For instance, in Viborg we have this telemedicine that all I have to do is hit the button, connect up, and I'm talking with one of the Sanford ER docs up there saying, "Here's my patient," we've got a video on them, they can ... We have a stethoscope, we can have them listen to their lungs, their heart. It just makes things easier for us when maybe there's something more challenging that came into our emergency room that they probably see all the time, but we just need some help and they're always willing to be there to help us. That's what we're doing in medicine, though, is helping each other. We just want the patient to be taken care of no matter whether that's for me as nurse practitioner, or a PA, or a doctor, or a specialist, whatever they need.

On why access to medical care makes a community more attractive to new residents:

A lot of people that are moving there with kids and some of these smaller towns unfortunately are struggling to keep their populations, but they think having the clinics, the hospitals, having those things in those communities helps draw people there too. Where they can say, "Moving to Centerville, versus, another place that doesn't have a clinic, here I have a provider right there, a clinic that's open five days a week that I can get my healthcare needs." Just the same way where there's advantages to towns that have grocery stores, or these other businesses too. If we can provide healthcare in a small community, I think it's going to help keep those small communities alive and thriving.

Why it is important to keep medicine as close to the people it serves as possible:

Well, how convenient is it if you can drive down the street to the clinic and maybe if you had to go over to the hospital in Viborg from Centerville, that you can go get your blood drawn over there, you can go see the cardiologist over there when he comes, you can go see what we have in Viborg, versus, any time you need that you're leaving the town? Well, really for the benefit of the community, when those people are leaving and heading to Sioux Falls, to Yankton, to Vermilion, somewhere larger, where are they going to go get their groceries? They're not going to stop at Jones' in Viborg, they're going to be gone.


I think for the convenience of people ... I had a lady this morning that even made the comment, a patient I was discharging from the hospital and we were talking about what Viborg has to offer and she goes, "It's sure better than having to drive to Sioux Falls for everything." It's nice, we're appreciated for what we're offering these patients.

Listen to the full audio of the conversation here.