Essentia’s obstetrics fellowship marks 16 years of preparing doctors to practice in rural areas

After completing her medical school and residency, Khloe Frank could have started practicing as a family medicine physician with obstetrics. But she recognized the value of additional training.

Dr. Frank expected to care for people in a small town, where there are fewer providers and even fewer specialists. She wanted to be prepared.

“My thought was that if I’m going to be practicing somewhere rural, I want to be experienced for whatever I might see,” Dr. Frank said. “I want to be exposed to a variety of scenarios so that I’m offering people the highest standard of care.”

One of her residency supervisors mentioned Essentia Health’s highly regarded OB fellowship. Dr. Frank thought it sounded like a perfect fit. She started the one-year program in July 2021. During the ensuing 12 months, she performed more than 100 C-sections, on top of the 53 she had performed as a resident.

Dr. Frank has cared for patients at the Essentia Health-Ashland Clinic since July 2022. She delivers babies at Tamarack Health Ashland Medical Center, which partners with Essentia.

Essentia’s fellowship — the only one of its kind in Minnesota — was created to strengthen the training pipeline and recruitment of family medicine physicians offering obstetrics care in rural communities. Only 12% of all medical students were matched to family medicine in 2023, according to the American Academy of Family Practice. From that group, just 7% practiced OB and only 1.6% had C-section competency. Thus, the pool of prospective candidates is shrinking.

Currently, less than half of all rural counties nationwide have hospital services for delivering babies.

Essentia’s OB fellowship offers practical experience and skills for providing high-risk OB services, including C-sections and operative deliveries. The fellow gains competency at managing numerous conditions while rotating among the OB floor at Essentia Health-St. Mary’s Medical Center, one of Essentia’s rural clinics and the Duluth Family Medicine Clinic. They deliver babies at rural hospitals and also spend four weeks apiece shadowing and providing assistance to the following teams at St. Mary’s — emergency department; hospitalists or critical care; and the NICU.

While an OB fellowship isn’t required for family medicine physicians to deliver babies or perform C-sections, there are many benefits for these doctors and their patients.

“This is truly additional training these physicians are seeking to make them better qualified for the communities they’re going to be serving,” said Christina Marshall, who is the program manager of health science and medical education for the Essentia Institute of Rural Health.

Added Dr. Nicole Seacotte, an OB/GYN at Essentia and also the fellowship director: “The goal is to allow them to get additional training to be very confident, to be able to go into rural communities and do obstetrics.”

Twenty-five fellows have completed, or are in the process of completing, the program since it began in 2008. Of those, 10 signed to practice at Essentia. They are providing care in small towns across the region — Ashland, Virginia and Moose Lake, among others.

Dr. Seacotte says the fellowship’s priority is to ensure candidates who get this specialized training will practice in rural regions. The demands on small-town physicians can be intense — and a potential deterrent for those considering this career path. That helps to explain why only 10% of all physicians in the U.S. practice in rural areas.

“It can be challenging to have a work-life balance, to find enough providers to help you cover everything,” Dr. Seacotte says.

The fellowship is one of several initiatives Essentia has developed to address rural recruitment challenges. It complements the general surgery rural residency program that we collaborate on with the University of Minnesota, as well as our leadership of the Duluth Family Medicine Residency Program.

Dr. Frank appreciated the flexibility of the fellowship, which is something Dr. Seacotte strives for. She wants fellows to get the experiences they desire, so she will tailor the curriculum accordingly. Dr. Frank also noted the benefits of getting diverse training at St. Mary’s in Duluth, which is a main referral center for the region. As a result, “you see a lot of high-risk patients,” Dr. Frank said.

Ashland is a lot like Dr. Frank’s hometown — Port Townsend, Washington, a small city on the Pacific coast.

“I originally came out here because the fellowship was exactly what I was looking for, and then I just fell in love with the region once I was living out here,” she said. “I feel comfortable in a smaller community, so I knew I would want to practice in a place like that.”