Essentia Health's hospital in Fosston is permanently ending the scheduling of baby deliveries, joining with more than 20 other small Minnesota hospitals that stopped offering this service. (Essentia Health)

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The discontinuation or relocation of hospital services has made headlines across the state. Those conversations are often accompanied by assertions that finances are the only factor driving these decisions (“Baby delivery in Fosston is latest victim of health care executives’ greed,” Opinion Exchange, Feb. 14).

That narrative is untrue and unfortunate, because it allows the systemic challenges plaguing health care — especially rural health care — to be obscured. As long as the blame is misplaced on health systems, the real work of identifying and solving root causes cannot begin.

Rural health care is at an inflection point. The current landscape — marred by inadequate reimbursement rates, workforce shortages, a lack of providers and increasing labor costs — is not sustainable. Without change, it will be difficult to preserve access to care in rural communities. That is particularly concerning when you consider that rural populations tend to be older, with more pronounced health needs and a higher likelihood of chronic disease.

Chartis, a health care advisory and analytics firm, reports that about one-fifth of the nation’s rural hospitals are in jeopardy of closing. That’s in addition to the 136 rural hospitals that closed between 2010 and 2021, according to the American Hospital Association (AHA).

The situation is similarly dire in labor and delivery. The Center for Healthcare Quality and Payment Reform states that fewer than half of all rural counties in the U.S. have hospitals that deliver babies.

At Essentia Health, multiple factors led us to relocate baby deliveries from our hospital in Fosston to St. Mary’s-Detroit Lakes, beginning with a shortage of trained staff. The American College of Obstetricians and Gynecologists stipulates that a safe and sustainable labor and delivery program entails a well-trained team of caregivers — physicians, including those with OB emergency intervention capabilities, along with additional advanced practice providers, nurses, anesthetists and other supporting roles. The care team must have emergency response training, and 24/7 coverage, along with a 20-minute response time for C-section emergencies, is required.

Recruiting that kind of team isn’t always possible, especially in small towns. For starters, there are fewer family physicians practicing obstetrics than there once were. According to the American Academy of Family Physicians, only 12% of all medical students were matched to family medicine in 2023. Of those, 7% practiced OB, and 1.6% had C-section competency. There also is an acute OB-GYN shortage.

Essentia Health is the only organization in Minnesota that offers obstetric fellowship training for family medicine physicians to better prepare them to provide services in rural areas. We are passionate about rural health care, but we are facing challenges that are bigger than us.

Only 10% of U.S. physicians practice in rural areas. Yet, the workforce issue isn’t limited to clinicians. The U.S. Bureau of Labor Statistics estimates that 275,000 additional nurses will be needed through 2030. There are tens of thousands of open health care jobs in Minnesota. While the demand for care is increasing, the labor supply is decreasing.

In Fosston, we worked with search firms to recruit numerous physician candidates. But we repeatedly heard from clinicians that they preferred to work at a hospital with larger teams, and thus a better work-life balance. They did not want to be on call 24/7 and wanted to practice at a facility with more births. From 2017 to 2021, Essentia Health-Fosston averaged 72 births per year, or about one every five days.

If the circumstances were different, our preference would be to deliver babies in Fosston. Studies continue to show increased risks to moms and newborns at low-volume birth centers. Complications have become more common in pregnancies, and rural hospitals often don’t have sufficient care teams to offer the proper level of support. The heightened potential for maternal morbidity and mortality at rural hospitals presents too great of a safety risk. We are unwilling to compromise the safety of our patients.

This is not an isolated incident. Systems will continue to discontinue or relocate baby deliveries from rural communities, even with significantly higher birth volumes. As we’ve seen elsewhere, this is true for other services as well. The challenges are too many, and too complex, to expect otherwise.

Inaccurate and inflammatory rhetoric will neither properly frame nor solve these challenges. It’s imperative that we collaborate with lawmakers, educational institutions, professional organizations and our communities to affect meaningful change and solve issues that cannot be solved by health systems alone. One of those changes should be aligning reimbursement rates with the cost of care. For rural systems, most patients have government insurance, which reimburses about 70% of care costs. Rural emergency medical services are reimbursed at about 25-30% the cost of care by government programs. Reimbursement for behavioral health faces a similar gap.

This model is not sustainable.

By working together, we are better equipped to find solutions to these problems and preserve care in rural communities.

Dr. Mark Thompson is Essentia Health West Market president. Dr. Stefanie Gefroh, OB-GYN, is Essentia Health West Market associate chief medical officer.

A Star Tribune editorial on this subject, “Worthy battle to keep hospital birth care,” was published Feb. 4.