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The clinics Keith Harvey oversees cover 8,500 square miles in northern Minnesota – and serve about 14,000 patients.
“Our clinics are very remote,” explained Harvey, CEO of Scenic Rivers Health Services, whose six locations serve the area’s rural patients, many of them miners, loggers, and agricultural workers. “If somebody gets strep throat, they go to the local clinic. If that local clinic isn’t available to them…the ultimate result is that people receive less care.”
Rural community health centers like Scenic Rivers fill essential gaps in communities across the country. Providers treat comparatively fewer patients – but the care they provide is often exceptionally complex and multifaceted, demanding high levels of commitment. Some of Scenic Rivers’s physicians, for example, staff two local hospital emergency rooms that are open 24/7, work shifts in the hospitals’ inpatient department, and care for patients at two Medicaid-funded nursing homes, in addition to their clinic practices.
People who live in the sparsely northernmost areas of Minnesota often travel to a Scenic Rivers facility when they need healthcare. “A lot of people live on the lakes. They’re not in our community but we take care of them,” Harvey said. “We are the primary caregiver to that whole region up there.”
“It’s very high touch: Our volumes are low, but our needs are high,” said Kate Surbaugh, CEO of Sawtooth Mountain Clinic, a health center in northeastern Minnesota. New staff members often develop a “deer-in-the-headlights look” when they realize how complicated patient care in the area is.
A view of Grand Marais, Minnesota, where one of Sawtooth Mountain Clinic’s facilities is located. (Courtesy photo)
About 35% of Sawtooth’s patients are over 65 and many have complex health needs. An older adult in a rural or tribal community (Sawtooth provides health services to members of the Grand Portage Band of Lake Superior Chippewa Tribe, Surbaugh explained) may need extensive assistance to coordinate specialty care – and transportation to the nearest city where it’s available.
For example, an older patient may need to consult a cardiologist, endocrinologist, and podiatrist for interrelated health issues. Duluth, the most convenient nearby city, may be hours away – and the patient may not have a car, and be dependent on the weekly bus.
“This happens every day for us,” Surbaugh said.
Publicly funded community health centers are uniquely important in rural Minnesota because jobs are vulnerable and chronic health conditions common, said Jonathan Watson, CEO of the Minnesota Association of Community Health Workers. Taconite miners, for example, are peculiarly vulnerable to shifts in the global steel market.
“Folks need access to care when they lose their jobs and lose their insurance,” Watson said.
While populations are small, the need for healthcare providers is high – and Watson said keeping and recruiting providers is often one of the hardest challenges local health centers face.
“We have young folks growing up in these communities and they see the bright lights in the big city,” Watson explained. “That really has an impact on health centers and our ability to grow our own workforce.”
Keith Harvey, Scenic Rivers’s CEO, said many providers are from the communities they serve, and are committed to rural healthcare. (Courtesy photo)
Sawtooth has developed in-house programs to train pharmacy technicians and medical assistants – nurses, who Surbaugh said are hard to attract to the area, require more extensive training.
“It’s really important for the providers to just be present,” Surbaugh said. “They have to be honored and interested” in working in areas like Grand Portage, where being familiar, reliable, and dedicated are key to earning patient trust.
Sawtooth has developed specialized arrangements for patients with mobility issues, works closely with tribal providers, and even opened up a nonprofit pharmacy in 2021 when the Covid-19 pandemic forced the area’s commercial pharmacies to close down.
“There’s no shortcut to building trust in the community,” Surbaugh explained.
Many rural health providers are homegrown, Watson said. He recalled one clinic director who “recruited a waitress in a bar” to train as a dental assistant.
“Now she’s one of the best dental assistants,” he chuckled.
Several of Scenic Rivers’s physicians have deep ties in the community – one, Harvey explained, is the son of the health center’s first CEO. “I hope and I pray they stay here forever, because they make it a great place to get health care,” he said.
However, finding enough providers to meet community needs is an ongoing challenge.
“We currently employ three different dentists, but we could employ five more and they would be busy tomorrow,” Harvey said. “There are thousands of people who can’t get dental care.”
Scenic Rivers Health Services cares for 14,000 individual patients over 8,500 square miles in northern Minnesota. (Courtesy photo)
Watson and Harvey are both deeply concerned about Medicaid cuts, which would potentially cause up to 80,000 Minnesotans – and nearly half of the state’s community health center patients – to lose health insurance coverage.
“That’s my greatest anxiety: how we’re going to provide the services we need to provide,” Harvey said. Scenic Rivers’s revenue will be significantly affected by the cuts, and he’s concerned that patients will be less likely to seek care they can’t pay for. “They’re going to get sicker, and they’re going to need a lot more care.”
Health conditions that aren’t cared for promptly can spiral out of control, Harvey noted, whether that’s a chronic condition like diabetes or even an injury – common in an area with high levels of manual labor, recreation, and seasonal tourism. “Let’s say you cut your hand and you need stitches,” he said. If a patient can’t afford care – or the nearest health facility is hours away – they might forego medical attention and end up with an infection.
“Now you have something much more serious, and you’re going to end up in an emergency room,” he said.
Direct Relief equips rural health centers throughout the U.S. with medications and medical supplies, resilient power projects, mobile medical units, grant funding, and other support to bolster their work in smaller communities.
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